HSLC Columbarium Niche Order Form

Cremation and inurnment in a Columbarium provides an appropriate means by which a family can ensure their departed one’s remains are in a place of dignity and tranquility. Each niche holds up to two urns with one engraved nameplate. The nameplate may include one name (Single), two names using the same last name (Companion), or two names with separate last names (Shared). Click here for an example. The price of one columbarium niche is $3500. A brief prayer service of blessing is included with the purchase of a niche.

Items marked with an * are required.

Purchaser

First Name

Last Name

Phone

(###)

###

####

Address Line 1

Address Line 2

City

State

Zip Code

Niche engraving style

Single is for one person, Companion is for two persons with the same last name, and Shared is for two persons with separate last names.

Inurned name on top

Name to be engraved

Print it exactly as you wish it to appear. Titles before or after the name are discouraged.

Date of birth (if known)

YYYY

Date of death (if known)

YYYY

Inurned name on bottom (if companion or shared)

Name to be engraved

Print it exactly as you wish it to appear. Titles before or after the name are discouraged.

Date of birth (if known)

YYYY

Date of death (if known)

YYYY

If Companion, last name that will be shared between inurned persons

Next of kin/contact person #1 (required)

Name

First Name

Last Name

Relationship

(child, grandchild, family friend, etc.)

Phone

(###)

###

####

Address Line 1

Address Line 2

City

State

Zip Code

Next of kin/contact person #2 (required)

Name

First Name

Last Name

Relationship

(child, grandchild, family friend, etc.)

Phone

(###)

###

####

Address Line 1

Address Line 2

City

State

Zip Code

Next of kin/contact person #3 (if applicable)

Name

First Name

Last Name

Relationship

(child, grandchild, family friend, etc.)

Phone

(###)

###

####

Address Line 1

Address Line 2

City

State

Zip Code

Notes

Anything else you need us to know

I confirm that I am a past or present member of Holy Spirit Lutheran Church, or a member of the immediate family of a past or present member, such as a spouse, parent, grandparent, child, sibling, niece, nephew, or grandchild.