General InformationDECEASED:*DOB:* MM slash DD slash YYYY DOD:* MM slash DD slash YYYY AGE:*Service InformationSERVICE DATE:* Month Day Year SERVICE TIME:* : Hours Minutes AM PM AM/PM LOCATION:*MORTUARY:*TELEPHONE:*CELEBRANT:*OTHER INFORMATION:Next of Kin InformationNEXT OF KIN:*RELATIONSHIP:*ADDRESS:* Street Address City State / Province / Region ZIP / Postal Code TELEPHONE:*EMAIL ADDRESS:* SURVIVING FAMILY MEMBERS: INFORMATION ABOUT THE DECEASED (CLUBS, ORGANIZATIONS, ETC.)*Check #:Interment only - $50 - Please submit to the parish office when returning deceased's information. Thank you.Our Lady Queen of Martyrs 833 Magellan Drive Sarasota, FL 34243 941-755-1826
