CLAY CROSS PARISH COUNCIL

CLAY CROSS CEMETERY

APPLICATION TO FIX A MEMORIAL

This application must be delivered in duplicate to:

Joanne Bradley, Cemetery Administration, North East Derbyshire District Council Streetscene Team, Rotherside Road, Eckington, Derbyshire S21 4HL

GRAVE NUMBER ……………………

1.  TO BE COMPLETED BY THE MEMORIAL MASON
I (We) agree to be responsible and to pay for any damage which may be occasioned to the property of the Council or to any adjacent vault, grave, tomb, monument or memorial by reason of any negligence on the part of my (our) employees or the employees of any sub-contractor employed by me (us) in connection with the work referred to in this application.
I (We) also agree to erect the memorial (new or replacement) in accordance with the National Association of Memorial Masons (NAMM) Code of Working Practice and approved anchor system.
Signed ………………………………….. Name of Mason ……………………………………………….
Address …………………………………………………………
………………………………………………………… Telephone No. ……….…………………
2.  PROPOSED INSCRIPTION:
3.  DRAWING AND MEASUREMENTS OF PROPOSED MEMORIAL + DESIGN/TYPE OF STONE AND FINISH
4.  Is there currently a memorial on the grave referred to in this application? If so, please give details
Name on existing memorial ……………………………………………………………………………

HEADSTONE/KERBS/VASE (Please delete not applicable)

5. Date when memorial to be placed on grave space ……….…….…… TIME AM/PM
6.  TO BE COMPLETED BY THE GRAVE OWNER
I hereby apply for the right to erect/place/inscribe a memorial subject to the Rules and Regulations for the Cemetery of Clay Cross Parish Council. The Right for which I now apply is not to confer on me any right to retain the memorial after erection or placing. For any such Right to retain I rely solely on the Exclusive Right of Burial in the grave and hereby certify that the application is correct. I further agree to comply with the Cemetery Regulations applicable to the type of grave I have purchased as received at the time of purchase.
Additional copies of the regulations appertaining to the applicable section may be obtained from the Cemetery Superintendent.
Signed ……………………………………….. Name of Applicant …………………………………………..
Address ………………………………………………………
………………………………………………………
………………………………………………………

NOTES TO MEMORIAL MASONS

1.  All fees in connection with the above memorial must be enclosed with this application form unless agreement has been made to invoice.
2.  One copy of this application will be retained by the Cemetery Office. The other copy will be returned, with the signed permit, to the Memorial Mason.
3.  If a Memorial Mason is found without a permit, permission to continue with the work will be denied. Any memorial fixed without approval may be removed.
4.  On completion the DECLARATION must be completed, signed and returned to the Cemetery Office without delay.
5.  The Memorial Mason shall ensure that the grave number is inscribed on all memorials.
6.  All memorial work will be carried out during the permitted times as stated in the Rules and Regulations.

FOR OFFICE USE ONLY

Amount Paid ………………………………………

Receipt No. ………………………………………..

Date .………………………………………………

(Cemeteries – Memorial Form)