______CEMETERY

This notice of interment must be delivered to Rose Hill Crematorium, Cantley Lane, Doncaster at least 48 hours prior to the day of interment.

EXCLUSIVE RIGHT OF BURIAL

PLEASE ENSURE THAT ANY MEMORIALS ON EXISTING GRAVES ARE REMOVED PRIOR TO EXCAVATION OF THE GRAVE. IF A MEMORIAL HAS NOT BEEN REMOVED A CHARGE WILL BE MADE.

1. / Day, date and hour proposed for the
Interment / Day ………………… Date ………………… Hour …………
2. / Full forenames and surname of deceased
3. / Date of Death / Age ……………….
4. / Description. Occupation & Marital Status
5. / Permanent Address
6. / Place Death Occurred
7. / Name & Address of Purchaser or Owner
of Grave Space, please state
relationship to deceased
8. / Name of Officiating Minister / Religious Denomination
9. / Chapel* / YES/NO
10. / Grave Section and Number / Section ………………. Number ………………
11. / Exclusive Rights For * / 50 Years  75 Years
12. / New or Re-open Grave* / NEW GRAVE/ RE-OPEN / PRE-PURCHASE
13. / Private or Public Burial* / PRIVATE / PUBLIC
14. / Number or Interments for new or re-
open graves* / ONE/TWO/THREE
15. / Size of Coffin (METRIC) / Length …………………. Width …………………
16. / Locking Handles* / YES/NO
17. / Please state if CASKET / YES/NO
18. / Cremated Remains* / YES/NO
19. / Name, Address and Signatureof Funeral Director
* Please delete as applicable

SPECIAL REQUESTS

21.
ORGAN …………………………
MUSIC IN ………………………
MUSIC DURING…………………
MUSIC OUT ……………………
OWN TAPE/CD …………………
COLLECTION PLATE ………………
LARGE FUNERAL …………………… / 23. Re-Open Grave – Please name people already interred in grave.
22. Did the deceased have an
infectious Disease? If yes state
the disease
……………………………………. / 24. Please Indicate if there are Disabled
Provisions Required - Yes  No
*Please delete as applicable
If Yes please indicate requirements
……………………………………….

I ……………………………………………………………………………………………………………

(APPLICANTS NAME IN FULL PLEASE)

Of ……………………………………………………………………………………………………….

……………………………………………………………………………………………………………

POST CODE …………………………………..

SIGNED ……………………………………… RELATIONSHIP TO DECEASED …………………

PLEASE NOTE : - GRAVE OWNER MUST BE OVER 18 YEARS OF AGE

hereby request you to issue to me a formal grant of exclusive right of burial in

Grave Space No ………… in Section …………of the above cemetery.

IN THE CASE OF OPENING AN EXISTING GRAVE SPACE THE FOLLOWING MUST BE COMPLETED BY THE OWNER OF THE GRAVE WHETHER OR NOT THE GRAVE DEED HAS BEEN PRODUCED.

I hereby declare that I own and have the right to authorise the opening of Grave No ….. Section …… for the

interment of the above mentioned deceased and I hereby undertake to indemnify the Doncaster Metropolitan

Borough Council against all loss, claims or demands which they may suffer or which maybe made against them by reason of their compliance with the request. I understand also that any memorial which is on the grave must be moved by the funeral directors to enable the burial to take place.

Name in full …………………………………………………………

Signed …………………………………………….. Relationship to deceased ……………………

Address…………………………………………………………………………………………………

……………………………………………………………………………………………………………