Funeral Intake Form - The Basilica of Saint Mary

Parish ID Number*

If you don't remember your parish ID number or are not registered at St. Mary's, please contact the parish office at 703-836-4100 before filling out this form.

Point of Contact*

First Middle Last

Please indicate who is handling funeral arrangements.

Point of Contact Relationship to Deceased*

Point of Contact Phone*

Point of Contact Email*

Point of Contact Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of the Deceased*

First Middle Last

Was the deceased baptized?*

Was the deceased a parishioner of the Basilica of St. Mary?*

If the deceased was not a parishioner, please briefly explain why you are requesting a funeral at St. Mary's.

0 of 250 max characters

Was the deceased a member of the military?*

Deceased Date of Death*

Deceased Age at Death*

Marital Status of the Deceased at Death*

Did the deceased receive the sacrament of Anointing?*

Deceased Date of Birth*

Residence of the Deceased at Time of Death*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Desired Date for Funeral*

Please indicate 2-3 options for dates and times for the funeral Mass. Due to our regularly scheduled Masses, funerals at St. Mary's typically take place on weekday mornings or afternoons. Once the parish office receives your intake information, a priest will confirm his and the church's availability to schedule the funeral.

Are you working with a funeral home?*

It is strongly encouraged for families to work with funeral homes when making funeral and burial arrangements.

Name of Funeral Home

If you are not working with a funeral home, please write "N/A" here.

Funeral Home Point of Contact

If you are working with a funeral home, please indicate who the point of contact is. Otherwise, write "N/A" here.

Will there be a visitation/wake?*

Will the deceased be cremated?*

If a cremation is taking place at a location other than the funeral home, please indicate where.

Will the burial (or interment) be immediately after the funeral or on a later date?*

Name of Cemetery*

Cemetery Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Burial

If the date of the burial is not yet known, please be sure to alert the parish office as soon as it has been scheduled.

Time of Burial

:

Other Significant Relatives*

Please list any significant relatives (especially immediate survivors such as spouses, parents, children, and indicate their relationship to the deceased). This information is helpful to the priests when preparing homilies.

Would you like altar servers to serve at the funeral Mass?*

Should burial information be included in the program?*

Would you like the funeral Mass to be privately livestreamed?*

A private livestream link will be shared with you near the funeral date for you to share with any family and friends who may not be able to attend.

Would you like the name of the deceased read during the Prayers of the Faithful at Sunday Mass?*

Would you like the name of the deceased included in the list of prayers for the deceased in our weekly bulletin?*

Would you like the name of the deceased published in the weekly parish e-newsletter (Flocknote)?*

X/Twitter

This field is for validation purposes and should be left unchanged.