NORTH EAST DERBYSHIRE DISTRICT COUNCIL

FORM OF INDEMNITY

To be completed by the registered owner or the person responsible for arranging the interment.

Grave space no…………………………..Cemetery …………………………………………………………………………………………………

I, ………………………………………….. being the Registered Owner or Executor of the Registered Owner/Next of Kin to the Registered

Owner where the Registered Owner is the Deceased (delete as appropriate), of ………………………………………………………………

……………………………………………………………………………………………………………………………………………..(full address)

hereby declare that the Deed of Grant for the above numbered grave space has been lost or misplaced and cannot be produced as requested.

I hereby request that North East Derbyshire District Council permit the interment of ……………………………………………………………

In consideration of such permission granted I hereby undertake to hold and keep the Council, their Officers and Agents harmless and indemnified against all actions, proceedings, claims and demands, costs, damages and expenses which may be brought against it and/or them of which it and/or they may pay, sustain or incur by reason of having granted the said permission.

Signed ……………………………………………………………………… Date …………………………………………………………………..

Witness to the signing thereof: Signed ……………………………………………………………… Date ......

Address ………………………………………………………………………………………………………………………………………………….

SCALE OF CEMETERY FEES AND CHARGES – OPERATIVE FROM 1st APRIL 2017 (INTERMENTS MON-FRIDAY ONLY)

EXCLUSIVE RIGHTS OF BURIAL AND/OR PURCHASE OF PLOT

1. Single Plot £525.00

2. Double Plot £525.00

3. Triple Plot £525.00

4. Cremated Remains £313.00

Term of exclusive right (50 years) increased in 10 year blocks up to a maximum of 80 years

INTERMENT FEES

1. Adult – 1st interment treble plot £639.50

2. Adult – 1st interment double plot £612.00

3. Adult – 1st interment single plot £562.00

4. Re-open grave – 2nd interment £612.00

Last interment £562.00

5. Child to 7 years £83.50

6. Child 7 – 16 £111.00

7. Stillborn Free

8. Cremated Remains £127.24

9. Sprinkling of Cremated Remains in Grave £66.71

10. Out of Parish fees double

MEMORIALS & INSCRIPTIONS

1. Erection of a headstone not exceeding 900mm x 600mm x 75mm thick (3ft x 2ft x3”) £168.62 2. Placing of a memorial in the memorial garden, mounted on the slabs provided.

Memorials to be typically 450mm square by 150mm high tapering to 25mm (18”x18”x 6”)

with integral vase, to a maximum of 600mm square by 250mm. £103.15

3. A vase block not exceeding 300mm (12”) square with inscription £82.77

4. For each additional inscription after the first £57.44

5. Provision of bronze memorial plaque for wall or rose beds POA

6. Temporary grave marker £90.18

7. Kerb set (not in Lawn areas) £143.91

8. Headstone with Kerb set (not in Lawn areas) £312.53

MISCELLANEOUS CHARGES

1. Search/Copy of Records £24.71

2. Transfer of Exclusive right £33.35

3. Provision of bronze memorial plaque (Administration charge) £28.41 4. Provision of bronze memorial plaque (Installation charge) £13.53

5. Exhumation adult (Administration fees) POA

6. Exhumation child Free

7. Casket Surcharge for Burials and Exclusive Rights £125.38

8. Brick Lined Vault (Extra dig charge) £56.21

9. Late Interment fee (after first half hour, per half hour) £28.41

NORTH EAST DERBYSHIRE DISTRICT COUNCIL – NOTICE OF INTERMENT

HASLAND/ TEMPLE NORMANTON CEMETERIES

KILLAMARSH CEMETERY (AS AGENT FOR KILLAMARSH PARISH COUNCIL)

NB: This form together with the certificate obtained from the registrar and the appropriate fee should be delivered to the Cemetery Administrator, Streetscene Depot, Rotherside Road, Eckington, Derbyshire, S21 4HL at least two working days prior to the day of the funeral.

1. PARTICULARS OF DECEASED

FULL NAME ………………………………………………………………………………………………….…………………………………………

IF A CHILD (UNDER 16 OR STILLBORN) NAME OF PARENTS OR GUARDIANS …………………………………………………………..

……………………………………………………………………………………………………………………………………………………………..

OCCUPATION …………………………………………………………………….. AGE ………………….. SEX …………………………………

ADDRESS ……………………………………………………………………………………………………………………………………………….

PLACE WHERE DEATH OCCURRED …………………………………………………………………………………………………………….....

DATE OF DEATH ……………………………………………………………………….

2. PARTICULARS OF INTERMENT

DAY ……..…………………………… DATE ………………….. TIME ……………..AM/PM COFFIN SIZE …………………………………...

3. NAME OF UNDERTAKER …………………………………………………………………………………………………………………….

ADDRESS ………………………………………………………………………………………………………………………………………………..

WILL THE UNDERTAKER BE IN ATTENDANCE YES/NO

4. NAME OF MINISTER ATTENDING …………………………………………………………………………………………………………..

(please indicate if minister not attending)

5. UNPURCHASED GRAVE A PURCHASED GRAVE IS NOT REQUIRED FOR THIS INTERMENT AND I AM AWARE THAT OTHER PERSONS MAY BE INTERRED IN THE GRAVE AND THAT A MEMORIAL CANNOT BE ERECTED

SIGNATURE OF PERSONS RESPONSIBLE FOR FUNERAL ……………………………………………………………………………………

DATE …………………………… ADDRESS ………………………………………………………………………………………………………….

6. PURCHASED GRAVE – NEW

FULL NAME OF PURCHASER ……………………………………………………………………………………………………………………….

ADDRESS ……………………………………………………………………………………………………………………………………………….

RELATIONSHIP TO DECEASED ………………………………………………………… NO. OF INTERMENTS …………….………………..

SIGNATURE OF PURCHASER ……………………………………………………………………………………………………………………….

7. PURCHASED GRAVE – RE-OPEN

GRAVE NO……………………………………. GRANT NO………………………..………… INTERMENTS TO DATE ……………………….

NAME ……………………………………………………………………………...DATE OF LAST BURIAL ………………………………………..

I CONSENT TO THE INTERMENT OF THE DECEASED IN THE ABOVE GRAVE (OWNERS SIGNATURE OR NEXT OF KIN IF DECEASED IS GRAVE OWNER)

NEXT OF KIN …………….………………………………………….. RELATIONSHIP TO DECEASED …………………………………………

ADDRESS ………………………………………………………………………………………………………………………………………………..

THE GRANT OF EXCLUSIVE RIGHT OF BURIAL SHOULD BE PRODUCED WITH THIS NOTICE, IF THE GRANT IS MISLAID THE INDEMNITY OVERLEAF MUST BE COMPLETED

Office use only: Date rec’d ……..……… Fee calculated ……….….. Rec’t No ……………….. Date …….……. Reg Bur ………………

Reg. Graves ………… Reg. P.G ………………. Grant No…………….. Date …………. Part C to ………..…. . Registrar ………………...

All personal information provided to North East Derbyshire District Council will be held and treated in confidence in accordance with the Data Protection Act 1998. It will only be used for the purpose for which it was given.