Celebrating a Life Lived

The purpose of this form is to make it easy for members to report

a recent death of a loved one. Additionally, this form will ensure

that the church has all the necessary information.

If you would still like to contact the church directly, please do so

by calling the church office at 713.224.0052 and speak directly to

Eleanor Jones or email her at info@phvision.org .

Pleasant Hill Baptist Church
1510 Pannell St
Houston, Texas 77020
Phone: 713.224.0052
Fax: 713.224.0060

Member Name: Member Phone:

Member Email: Member Address:

Member City: Member Zip:

Love One (Deceased) Details

Name: Relationship: Passed Away:

Funeral Home Details

Funeral Home Name:

Funeral Home Address:

Funeral Home City: Funeral Home Zip:

Funeral Home Phone: Funeral Home Email:

Funeral Home Contact:

Memorial Service Details

Service Location:

Service Time: Service Date:

Service Address:

City: State: Zip: