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.

Date of Death :

Name :

Address :

City :

State :

Zip :

Phone :

Member of New Faith Baptist : YesNo

Deacon : YesNo

Ministries Active In (Separate by Coma) :

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 :