DEATH NOTICE INFORMATION
Name of GMBC Member:
Members Address:
Members Phone Number:
Cell #:
Date Submitted:
Name of Deceased: Relationship:
Date Passed Over:
Contact Person: Phone:
Relationship to deceased:
Funeral Home:
Address:
City & State:
Funeral Home #: Phone Fax:
Visitations:
Funeral Info:
11/1/2011, C:\Docstoc\Working\pdf\d4fef3ee-edf4-4109-9f51-61a0de562372.doc