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Burial Record Form

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  To be completed once a funeral date has been confirmed.
  
  Note: this form should be completed by the funeral director/funeral home, if one is being used. If no funeral director/funeral home is being used, the next of kin or designee should complete this form.
  
  First and last name of deceased REQUIRED Please fill out this field. Please enter valid data.
  
  If married, maiden name of deceased Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Address of deceased REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Date of death REQUIRED Please fill out this field. Please enter a date.
  
  Place of death REQUIRED Please fill out this field. Please enter valid data.
  
  Cause of death REQUIRED Please fill out this field. Please enter valid data.
  
  Was the individual anointed prior to death? REQUIRED Please fill out this field.
  
  If yes, which priest did the anointing? Please enter valid data.
  
  First and last name of next of kin REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to deceased REQUIRED Please fill out this field. Please enter valid data.
  
  Address of next of kin REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone number of next of kin REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Is a funeral director/funeral home being used? REQUIRED Please fill out this field.
  
  If a funeral director/funeral home is being used, please provide name Please enter valid data.
  
  Address of funeral director/funeral home Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone number of funeral director/funeral home Maximum 20 characters Please enter a phone number.
  
  Full body or cremation? REQUIRED Please fill out this field.
  
  Calling hours Please enter valid data.
  
  Date of funeral REQUIRED Please fill out this field. Please enter a date.
  
  Time of funeral REQUIRED Please fill out this field. Please enter valid data.
  
  Location of funeral REQUIRED Please fill out this field. Please enter valid data.
  
  Celebrant for funeral Please enter valid data.
  
  Place of burial REQUIRED Please fill out this field. Please enter valid data.
  
  Section and plot Please enter valid data.
  
  If a funeral home is used and the deceased will be buried at Calvary Cemetery, have you notified the Cemetery Coordinator (Rich Clayton)? REQUIRED Please fill out this field.
  
  Additional information?
  
  Submit
  
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St. Benedict Parish

St. Bridget's Church St. Mary's Church St. Mary's School

Burial Record Form