Cemetery Interment Form

Name of Deceased*
First Last
Date of Death*
Date Format: MM slash DD slash YYYY
Birthdate*
Date Format: MM slash DD slash YYYY
Date of Interment*
Date Format: MM slash DD slash YYYY
Service Time and Place*
Funeral Home/Mortuary*
Contact Person*
Relationship to Deceased*
Contact Number(s)*
Email Address*
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Was deceased a Riceville Church member?*
If yes, How long?
List all relatives who are current Members of Riceville
Relationship
Was deceased a member of Christian Union?

@riceville