Columbarium Application

Memorial Presbyterian Church

Application for Columbarium Use

Please take a moment to review the General Policies, Regulations and Rules for the use of the columbarium before filling out the application.

Name (first individual) *
Name (first individual)
Name (second individual, if applicable)
Name (second individual, if applicable)
Address
Address
Date
Date
Having read the “GENERAL POLICIES, REGULATIONS AND RULES FOR THE USE OF THE COLUMBARIUM,” (“Rules”) of The Bertha E.R. Strosacker Memorial Presbyterian Church Midland, Michigan 48640 (“MPC”) I/we do hereby apply to be granted the use of a niche, the Memorial Garden, and/or the Memorial Wall, in said Columbarium and submit with this Application Form:
The Grantee(s) or other Designee(s) whose cremains are to be inurned in the niche, interned in the Memorial Garden and/or whose names are to be honored and remembered on the Memorial Wall is (are):
The Grantee(s) or other Designee(s) whose cremains are to be inurned in the niche, interned in the Memorial Garden and/or whose names are to be honored and remembered on the Memorial Wall is (are):
First Individual: Given Name (Maiden Name Optional) Family Name
Birth Date
Birth Date
Death Date
Death Date
Second Individual
Second Individual
Given Name (Maiden Name Optional) Family Name
Birth Date
Birth Date
Death Date
Death Date
Inscription
Clergy, U.S. Military...
Relationship to MPC
MPC OFFICE ONLY
Approvers By
Approvers By
Date
Date

Upon approval by MPC a payment of $1,000 is required to secure the selected niche or $300 for placement on the a Memorial Wall.