Deceased Church Member Report


Please verify all information is correct before submitting. If you do not have any deceased members, please indicate by filling in the space with "None."
Name of Person Reporting *
First Name
Last Name
E-mail of Person Submitting Report*
Church Name*
Assembly Year*
Deceased Names (Please list below the names of all church members deceased since the last District Assembly - This information is NOT for the NMI Memorial Roll.) *
Please initial this box to verify all information is correct.*
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