Death Notice

Date Submitted :

Time Submitted :

Information Given By :

Callers Phone :

Please complete this section in its entirety. If information is unknown, verify with Membership Services before distribution.

Deceased Information

Date of Death :

Name :

Address :

City :

State :

Zip :

Phone :

Member of New Faith Baptist :

YesNo

Deacon :

YesNo

Ministries Active In (Separate by Coma) :

Send Acknowledgement To

Name :

What is your relationship to the deceased : HusbandWifeMotherFatherSisterBrotherSonDaughterGrandsonGranddaughterOther

Address :

City :

State :

Zip :

Phone :

Member of New Faith Baptist :

YesNo

Deacon :

YesNo

Additional information of other New Faith Baptist members related to the deceased :