Cemetery Internment Request – Riceville Mount Olive Church

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Cemetery Internment Request

Name of Deceased*
First Last
Date of Death*
MM slash DD slash YYYY
Birthdate*
MM slash DD slash YYYY
Date of Interment*
MM slash DD slash YYYY
Service Time and Place*
Funeral Home/Mortuary*
Contact Person*
Relationship to Deceased*
Contact Number(s)*
Email Address*
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Was deceased a Riceville Church member?*
If yes, How long?
List all relatives who are current Members of Riceville
Relationship
Was deceased a member of Christian Union?
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