General InformationDECEASED:*DOB:* MM slash DD slash YYYY DOD:* MM slash DD slash YYYY AGE:*Service InformationSERVICE DATE: TBD SERVICE TIME: TBDLOCATION:*CREMAINS: YES NO 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: PRE-PAID/CHECK #: INFORMATION ABOUT THE DECEASED (CLUBS, ORGANIZATIONS, ETC.)*Suggested donation for the upkeep & maintenance of Memorial Gardens at OLQM - $50.00
