St. Therese of Lisieux

102 W. Randolph St., Lansing, MI

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Funeral Preparation Form

- Funeral Planning Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Deceased's First Name and Middle Initial REQUIRED Please fill out this field. Please enter valid data.
  
  Deceased's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Deceased's Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Deceased's Date of Death REQUIRED Please fill out this field. Please enter a date.
  
  Primary Contact Person, First & Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Contact's Relation to Deceased, e.g. wife, daughter, son, REQUIRED Please fill out this field. Please enter valid data.
  
  Contact Person's 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.
  
  Contact's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Primary Contact's Email
  After reading the summary of your submitted responses and you detect corrections need to be made, please reply to the St. Therese Parish Secretary. Thank you.
  Please enter an email address.
  
  Funeral Home Please enter valid data.
  
  Name of Funeral Home Representative Assisting the Family Please enter valid data.
  
  Additional Contact Person, First & Last Name Please enter valid data.
  
  Additional Contact's Relation to Deceased, e.g. wife, daughter, son, REQUIRED Please fill out this field. Please enter valid data.
  
  Additional Contact's Phone Number Maximum 20 characters Please enter a phone number.
  
  Additional Contact's Email Please enter an email address.
  
  After submitting this information, please contact the St. Therese Parish office, (517) 487-3749, so that additional details, dates and times for:
  
  A meeting with Fr. John
  
  A vigil service
  
  Funeral Mass
  
  Cemetery
  
  Luncheon
  
  can be made.
  Thank you.
  
  Submit
  
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