Assembly Necrology Form

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Necrology Form

As a member in good standing of St. Timothy Assembly, upon your death, a chalice, or other religious item, will be donated in your name to the Religious Order or Mission of your choice. Please complete the below information so that the Assembly knows your wishes. If your wishes are not on file at the time of your death, the officers of St. Timothy Assembly will select where to donate the memorial object on your behalf.

Sir Knight Information

Please provide your information.

Your Name

Your Phone Number

Your Address

City

State

Zip Code

Date you became a 4th Degree Knight

Reason you joined the Knights of Columbus

Favorite thing about being a Knight

Next of Kin Information:

We request your next of kin information as a confirmation of information on your death and internment is correct, and that the chalice ceremony is available during or after the funeral Mass.

Kin's Name

Kin's Address

Kin's City

Kin's State

Kin's Zip Code

Kin's Phone Number

Kin's Relationship

Chalice Destination Information:

Where would you like the chalice to be donated? If you have a specific priest, seminary, or order, please let us know. If not, we will donate it to a diocese for a newly-ordained priest.

Destination Name

Address

City

State

Zip Code

Acknowledgement:

I acknowledge that the above information is true to the best of my knowledge

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