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Bereavement Form

This form is intended for those who have recently lost a loved one and are looking for any services from the church.

Personal Information

First name*

Last name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Other Information

How is the deceased related to the Partner?*

Mother

Father

Child

Sibling

Grandmother

Grandfather

Aunt

Uncle

Mother-in-law

Father-in-law

Other

If other please list

Deceased Name*

Date and time of the wake?*

Month

Day

Year

Time

:HoursMinutes

Location of Wake Service*

Date and time of funeral/burial?*

Month

Day

Year

Time

:HoursMinutes

Location of funeral/burial?*

Funeral Home Information

Please provide the following information:

Funeral Home Name

Address

City, State, and Zip

Phone Number

Type Answer*

Today's Date*

Month

Day

Year

Signature*

Sign in the box or use the keyboard to type.

Signature field is empty.

If you need assistance with completing this form please let us know and we will be happy to assist you.

Email: att.cogfi@gmail.com

Phone: 716-215-6410

Visit Us

Niagara Falls location: 1329 Pine Ave, Niagara Falls, NY 14303

Cheektowaga location: 4600 Union Rd, Cheektowaga, NY 14225

cogfi.ministries@gmail.com | Tel: 716-348-7666

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