Please fill out the information below and return by Monday, October 15.

Please enter the names of elders (active or inactive) in your congregation who died between November 1, 2008 and October 1, 2009.

Please complete this form even if there were no deaths.

Thank you for your help.

Note: This list is to include elders only

Name of person completing this form (*)

Please enter your name
Email (*)

Please enter your email address
Please enter Church name and City (*)

Please enter the name of your Congregation and the City you are located in.

Please enter the elder's name and date of death. Please place a semicolon ";" between individuals

If no elders have died during the given time person, please enter the word "None"

Elders name, date of death; (*)

If no elders have died, please type the word "None" otherwise please enter the name and date of death for each elder who has died in the past 12 months.