Memorial Archives Form

First Name*

Middle Name

Last Name*

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Place of Birth

Sex*

Vault Area*

Date of Inurnment*

Date of Birth*

Date of Death*

Mother's Name

Father's Name

Memorial Epitaph*

Name

Relation to the Deceased

Email Address*

Mobile Number

By submitting this form, I hereby agree:

Agree and consent to the Privacy Policy
Expressly instruct St. Therese Columbarium to publish a memorial of the above-mentioned deceased.
Specifically consent to the use of website tracking methods, for the statistical evaluation of visitor access.
I have the right to request modifications or removal of the memorial if I am the vault owner or an authorized representative.
I acknowledge that St. Therese Columbarium may periodically update the information of the deceased or may request my consent for such updates.

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