St. Mark the Evangelist Catholic Church

Plano, TX

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Committal Only Form

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  Decedent Information
  
  First Name of Decedent REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name of Decedent Please enter valid data.
  
  Last Name of Decedent REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Name of Decedent Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Date of Death REQUIRED Please fill out this field. Please enter a date.
  
  Age at the Time of Death REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Family Contact Information
  
  First Name of Contact REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name of Contact Please enter valid data.
  
  Last Name of Contact REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Relationship with Decedent REQUIRED Please fill out this field. Please enter valid data.
  
  List Immediate Surviving Family Members and their Relationship to Decedent REQUIRED Please fill out this field.
  
  Committal Service
  
  What type of Committal will be held? REQUIRED Internment of the Body at a Cemetery Inurnment of Cremated Remains in a Columbarium Please fill out this field.
  
  Internment Information
  
  (Omit if inurnment will take place)
  
  Name of Cemetery Please enter valid data.
  
  Address Please enter valid data.
  
  Contact Name Please enter valid data.
  
  Contact Phone Number Please enter valid data.
  
  Inurnment Information
  
  (Omit if internment will take place)
  
  Name of Columbarium, if not at St. Mark Please enter valid data.
  
  Address Please enter valid data.
  
  Contact Name Please enter valid data.
  
  Contact Phone Number Please enter valid data.
  
  Submit
  
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