Funeral Request DECEASED INFORMATIONFULL NAME OF DECEASED ADDRESS CITY/PROVINCE DATE OF BIRTH REQUESTOR INFORMATIONFULL NAME ADDRESS CITY/PROVINCE PHONE Primary (902) 555-5555 Work (902) 555-5555 Cell/Other (902) 555-5555 EMAIL ADDRESS MEMBERSHIP AT EPUBCWas the deceased a member of EPUBC? ---YESNOAre you a member of EPUBC? ---YESNOIf not, what church are you a member of FUNERAL & WAKE DETAILSDATE AND TIME OF FUNERAL REQUESTEDDATE (YYYY-MM-DD) TIME (2:00pm) DATE AND TIME OF WAKE REQUESTEDDATE: (YYYY-MM-DD) TIME (2:00pm) RESPONSIBLE FUNERAL HOME REPASS FOLLOWING FUNERAL? ---YESNOBURIAL AT EAST PRESTON UNITED BAPTIST CHURCH CEMETERY? ---YESNOCOST: THERE IS A COST FOR THE USE OF THE CHURCH AND FOR THOSE FROM THE CHURCH WHO PARTICIPATE IN THE FUNERAL. A FULL LIST OF COSTS WILL BE PROVIDED TO YOU. THESE COSTS COULD INCLUDE THE COST OF USING THE CHURCH, UTILITIES USED, PASTOR OFFICIATING THE SERVICE, MUSICIAN AND/OR CHOIR, OTHER COSTS, ETC. *COSTS MUST BE PAID IN FULL BEFORE FUNERAL.*OTHER SERVICE REQUEST /DETAILS Is everything correct?