Request for Burial Form

Burial Request Form
Relative of Deceased
NameSurname
Funeral Home Address
Addreess
Addreess Line 2
DistrictProvince / State
Post Code
E-mail
example@mail.com
Phone Number
Please enter a valid phone number.
Deceased:
SurnameFirst Name
Date of Death
AyGünYıl
Please enter a valid date
Hour Minute
Date of Burial
Please select the type of death ceremony:
CremationFull Burial
Do you have reserved plot?
YesNo
Location of Plot
Addreess
Addreess Line 2
DistrictProvince / State
Post Code
Spouse of deceased is alive?
YesNoDeceased is not married
Spouse of deceased name
AdSoyad
Date of death of the spouse of deceased
AyGünYıl
Tarih
Plot of the spouse of deceased
Addreess
Addreess Line 2
DistrictProvince / State
Post Code
It is the responsibility of the Funeral Director to:
- Supply all burial permit copies/cremation certificates
- Excavation & Closure of grave plots
- Ensure that plot information & location are correct and communicated to the ACME Cemetery

PLEASE NOTE:
All burials in the older sections of the cemetery will be the responsibility of the Funeral Director or Family to locate and approve.

The ACME Cemetery will work with the Funeral Director as best as possible to try to locate sites within the older part of the cemetery, however, the ACME Cemetery will not be held responsible for any plot that may be incorrectly marked, or for any costs associated with such incorrect markings.

By signing this form you are accepting responsibility for all items listed above.
Date
MonthDayYear
Date
Signature of relative of deceased
Temizle
Should be Empty:

Burial Request Form