Full Name of Deceased - including nickname*

Day/Date of departure*

Is he/she a member of Mt. Vernon Baptist Church?*

Who is the family representative who will be in charge of making the final arrangements? Please include name, phone, relationship to deceased. This is the person that the church official will contact. (Please list the best way to contact you.)*

Will the family have a repast meal at the church after the service? (If so, church leadership will follow-up with the family to work on the details)*