Notification of Death Form

“God is your refuge and an ever present help in times of trouble.” Psalms 46:1

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Of all life’s experiences, the death of a loved one is often the most painful and challenging that anyone can go through. Ebenezer Baptist Church understands the pain endured by our families. The pastor, ministers, deacons are here to provide comfort and support during this difficult time. Please notify us of a loved one’s passing either by submitting the form below or contacting the church office.

Notification of Death Form

Ebenzer Baptist Church Member

Yes
No
Full Name of Deceased
Full Name of Individual Submitting Form
Address for Family of the Deceased

Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number of Individual Submitting Form
Relationship to Deceased
Viewing Location
Date & Time of Viewing
Funeral Location
Date & Time of Funeral
Additional Information

Verification

Please enter any two digits with no spaces (Example: 12) *
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