MINISTRY TO YOU
PASTORAL CARE
C.A.R.E. MINISTRIES (Comfort, Aid, Relief, and Emergency)

REPORT THE LOSS OF A LOVED ONE
Faith Fellowship Ministries (FFM)

NOTE:
Online forms are checked during regular office hours. If you are completing this form on Friday after 3:00 pm and need immediate assistance, we suggest you call our Hotline.

Deceased Person Information: 

Name of Deceased:
Age:	Date of death:  mm JanFebMarApr MayJunJulAug SepOctNovDec / dd 1234 5678 9101112 13141516 17181920 21222324 25262728 293031 / yyyy 2007200820092010
Address for sending condolences:
City:
State:	SELECT Other Outside United States Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Washington DC   Zip:

Contact Person Information: 

Contact person name:
Contact phone number:
Contact person member of FFM:	Yes    No    Unknown
Relationship to the deceased:	Select one... Other Mother Father Grand-mother Grand-father Wife Husband Daughter Son Sister Brother Girlfriend Boyfriend Nephew Niece Aunt Uncle Cousin Grand-daughter Grand-son Mother-in-law Father-in-law Sister-in-law Brother-in-law
(Contact) Involved in any area of the ministry:	Yes    No    Unknown
If yes, please explain:

Additional Deceased Information: 

Was deceased a member of FFM:	Yes    No    Unknown
If yes, how long:
Was deceased Born Again:	Yes    No    Unknown
Was deceased Spirit Filled:	Yes    No    Unknown
(Deceased) Involved in any area of the ministry:	Yes    No    Unknown
If yes, please explain:

IF ARRANGEMENTS HAVE BEEN MADE, PLEASE FILL OUT THE INFORMATION BELOW:
Viewing Arrangements:  Date:  mm JanFebMarApr MayJunJulAug SepOctNovDec / dd 1234 5678 9101112 13141516 17181920 21222324 25262728 293031 / yyyy 2007200820092010 Time:  Place:  Address:  City:  State:  Select one Other Outside United States Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Washington DC Zip:  Viewing Comments & Directions:	Funeral Arrangements:  Date:  mm JanFebMarApr MayJunJulAug SepOctNovDec / dd 1234 5678 9101112 13141516 17181920 21222324 25262728 293031 / yyyy 2007200820092010 Time:  Place:  Address:  City:  State:  SELECT Other Outside United States Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Washington DC Zip:   Burial Arrangements & Directions:

Additional Information: 

Would you like FFM to help you make the arrangements?	Yes  No  Not Sure
Would you like FFM to help conduct any of the services?	Yes  No  Not Sure