Deceased's Details
Deceased's Title
Miss Mrs Ms Mr Dr
Deceased's Name
Address
Post Code
Age
Place where death occurred
Date of Death
Interment Details
Day and date of interment
Time of arrival at Cemetery
Name of Minister and Denomination (if applicable)
Service Location (i.e. Chapel / Church / Graveside)
Grave and Details
Grave Section and Number
Depth Required
Actual Coffin Dimensions
Casket Dimensions
New Grave Required (Exclusive Right of Burial)
Full Name(s) of Purchaser(s)
Address
Post Code
Tel No
Note: The person(s) named above will be registered as the grave owner(s) with the deed being made in his/her/their name(s). No
memorial may be arranged and no further interment may take place without the signed consent of the grave owner(s)
Purchased Graves, Regulations Covering Burial
1. The Exclusive Right of Burial is granted for a period of 30 or 50 years dating from the first burial.
Signature
Date
Re-opening of a Purchased Grave
Name of person 1st interred
In section
Grave number
Who is my (state relationship to this 1st interred)
The following undertaking must be given where the Deed is not available or the grave owner is deceased
I
Of
Post Code
Tel No
Hereby authorise the Cemeteries Supervisor to open grave no:
Grave number
for the interment of the above named deceased, and I hearby indemnify the Burnham Joint
Burial Committee against any cost, expense, claim or damage which they may incur as a result of this and acting on the
authority I now give.
Signature
Date
Submit
