San Jose Chinese Catholic Mission聖荷西華人天主堂

725 Washington Street, Santa Clara, CA. 95050	408-758-8961

Funeral Arrangement Request Form葬禮安排申請表

Name of Deceased Legal Name亡者法定姓名*: Last姓: First名: Middle別名:	Chinese Name中文姓名:
Date of Death死亡日期*:	Age年齡*:	Catholic*: _____Yes _____N/A	Baptism Name領洗聖名:
Address地址*:	[ ]Male(男) [ ]Female(女)
Name of Next Kin摯親者姓名*:	Relationship關係*: _Wife _Husband _Son _Daughter _Brother _Sister _Other
Funeral Arranged By治喪者姓名*:	Relationship關係*: _Wife _Husband _Son _Daughter _Brother _Sister _Other
Address地址:
Phone電話*:	Email電郵*:
Cemetery Name安葬墓園名稱*:	Date& Time安葬日期及時間*:
Cemetery Address安葬墓園地址*:	Priest 主禮神父*:
＊Please print clearly and complete all information above. 以上資料請務必全部填寫清楚。
___ Vigil Service 守靈禮 ( ___ at Mortuary+ or ___ at church ++)	___ Funeral Mass 殯葬彌撒 (at church++, with Eucharist, with casket or urn)	___ Memorial Mass 追思彌撒 (at church++, with Eucharist, no casket nor urn)	__Memorial Service 追思禮 (at Mortuary+, no Eucharist, with casket or urn)
Date:	Date:	Date:	Date:
Time:	Time:	Time:	Time:
Musician+++:	Musician+++:	Musician+++:	Musician+++:
Funeral Coordinator:	Funeral Coordinator:	Funeral Coordinator:	Funeral Coordinator:
Lay Minister/Priest*:	Priest*:	Priest*:	Priest*:
Fee & Suggested Donation: ++ $250.00 includes facility use and priest stipend. +++ Musician fee is varied and set by each musician.
Mortuary Name殯儀館名稱+:	Mortuary Address地址+:
Church Name 教堂名稱++:	Church Address地址++:
OFFICE USE ONLY: Registration in file : Vol.＃_____, Page ______________________ by______________ date:______________