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Bereavement Intake Form
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Email
*
Your email
Family Contact Person
Your answer
Phone Number
Your answer
Name of the Departed
Your answer
Date of Birth
MM
/
DD
/
YYYY
Date of Passing to Eternal Life
MM
/
DD
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YYYY
Funeral Home
Your answer
Surviving Family Members
Your answer
Would you like a Wake Service
Yes
No
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If yes, please select location
Our Lady of Africa
Funeral Home
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Would you like a priest or deacon to officiate the Wake?
Yes
No
Other:
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Funeral Date - please confirm with Parish Office if available
MM
/
DD
/
YYYY
Mass of Christian Burial Time
10:00 AM - Viewing, 11:00 AM Mass
11:00 AM - Viewing, 12:00 PM Mass
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Priest that will celebrate the Mass
Father Carl Gales, SVD
Other:
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Priest or Deacon that will give Homily (Sermon)
Father Carl Gales, SVD
Deacon Michael Foggie
Other:
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First Reading - Old Testament
Choose
2 Maccabees 12:43-46 He acted in an excellent and noble way as he had the resurrection of the dead in view.
Job 19:1,23-27a I know that my Redeemer lives.
Wisdom 3:1-6, 9 The souls of the just are in the hand of God and no torment shall touch them.
Isaiah 25:6a, 7-9 On this mountain he will destroy the veil that veils all peoples.. He will destroy death forever.
Who will Read the First Reading at the Mass?
Family Member
Church Member/Lector
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Name of Person - First Reading
Your answer
Responsorial Psalm
Choose
Psalm 23: The Lord is my shepherd; there is nothing I shall want.
Psalm 27: The Lord is my light and my salvation.
Psalm 63: My soul is thirsting for you, O Lord my God.
Psalm 105: The Lord is kind and merciful.
Second Reading - New Testament
Choose
Romans 5:5-11 Hope does not disappoint.
Romans 6:3-4, 8-9 If we have died with Christ, we believe that we shall also live with him.
Romans 8:31b-35, 37-39 What will separate us from the love of Christ? No, in all these things, we conquer overwhelmingly through him who loved us.
Romans 14:7-9, 10c-12 Whether we live or die, we are the Lord's.
I Corinthians 15:20-28 So too in Christ shall all be brought to life.
I Corinthians 15:51-57 Behold, I tell you a mystery. We shall not all fall asleep, but we will all be changed...
2 Corinthians 5:1, 6-10 We know that if our earthly dwelling, a tent, should be destroyed, we have a building from God, a dwelling not made with hands, eternal in heaven.
1 John 3:1-2 We do know that when it is revealed we shall be like him, for we shall see him as he is.
Who will read the Second Reading at Mass?
Family Member
Church Member/Lector
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Name of the Person reading?
Your answer
Gospel Reading (Proclaimed by Deacon/Priest)
Choose
Matthew 11:25-30 Come to me and I will give you rest.
John 6:37-40 Everyone who sees the Son and believes in him may have eternal life and I shall raise him on the last day.
John 6:51-59 Whoever eats this bread will live forever, and I will raise them up on the last day.
John 12:23-26 Unless a grain of wheat falls to the ground and dies, it remains just a grain of wheat; but if it dies, it produces much fruit.
John 14:1-6 In my Father's house there are many dwellings
Who will give a Reflection or Special Tributes?
Your answer
Who will read the Obituary?
Family Member
Bereavement Minister
Other:
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