Dushore, PA

Immaculate Heart
of Mary Parish

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Funeral Records Input (Funeral Home Use ONLY)
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- Name of Deceased REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Date of Death REQUIRED Please fill out this field. Please enter valid data.
- Date of Burial REQUIRED Please fill out this field. Please enter valid data.
- Place of Burial REQUIRED Please fill out this field. Please enter valid data.
- Arrangements Made By: REQUIRED Please fill out this field. Please enter valid data.
- Type of Service REQUIRED Funeral Mass Service at the Funeral Home Graveside Service N/A Please fill out this field.
- Next of Kin Information
  
  Name of Nearest Relative REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field. Please enter valid data.
  
  Zip Code REQUIRED Please fill out this field. Please enter valid data.
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