Application Form

Columbarium Niche Form

Thank you for your interest in St. Pius X Parish Columbarium.
Please complete this form and a Comumbarium Trust member will contact you.

Required *

First Name: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Alternate Phone Numberr:

Please print name and dates EXACTLY as it should appear on the niche:

First Name: *

Middle Initial:

Last Name: *

Date of Birth: *

Date of Death: *

Military Branch: Army Navy Marine Corp Air Force Coast Guard

Engraved Emblem:

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625 E. Haycraft Ave, Coeur d'Alene, ID 83814 - 208-765-5108

St. Pius X Catholic Church