Notice of Interment

NOTICE OF INTERMENT

CEMETERY: / ______
PARTICULARS OF DECEASED
Full Names: / ______
Address: / ______
______
______
Age: / ______/ Sex: ______
Date of Death: / ______
Address at which death occurred: / ______
______
______
If a stillborn or minor state names and residence of parents: / ______
______
______
______
PARTICULARS OF INTERMENT
Date of interment: / ______
Time of arrival at cemetery: / ______
Name of officiating Minister: / ______
PARTICULARS OF GRAVE SPACE
(a)New□(b)Re-open □(c)Purchased □
Grave No: ______/ Section: ______
Consecrated □Non Consecrated □R/C□Garden of Remembrance □
Whether grave has been selected: ______

Whether any monument is erected: ______
Required position of ash casket within grave space: ______
Date of last interment (if any) ______
Name of last person interred: ______
Exact size of coffin: / Length:______ft ______inWidth: ______
EXCLUSIVE RIGHT OF BURIAL
If new grave is to be purchased, details of new owner to be completed below.
Name: (Block Capitals) / ______
Address: / ______
______
______
Email address: / ______
Telephone No: / ______
Relationship to deceased: / ______
Signature of new owner: / ______
EXISTING GRAVES
Grant of Right produced? / Y / N
Is current owner the deceased? / Y / N If yes, please complete details of applicant below.
Name: / ______
Address: / ______
______
______
Email address: / ______
Telephone No: / ______
Relationship to deceased: / ______
Signature of applicant: / ______

GUIDANCE NOTES FOR FUNERAL DIRECTORS
The information below MUST be given to the applicant BEFORE the interment is confirmed.
Council’s burial fees and charges (available to view on Council’s website)
If the deceased previously lived in the District of North West Leicestershire, depending on how long it has been since they last had lived in the District will determine the level of burial fee.
How longhas it been since they last lived at the NWLDC address:
Under 1 year □1-5 years □Over 5 years □
Under 1 year - Single fees apply
1-5 years - Double fees apply
Over 5 years - Triple fees apply
Evidence of residency must be provided by Funeral Director / Applicant.
Exclusive right of burial must be purchased before memorials will be permitted.
Lawned Sections
The consecrated sections within Broom Leys and Hugglescote cemeteries are lawned. Graves will be turfed over as soon as possible after settlement and weather permitting.
For ease of maintenance on lawned sections no kerbsets, fences, grave surrounds will be permitted. Vases/ ornaments will only be permitted at the memorial end of grave.
I have been advised and understood the current Council’s burial fees and grave guidance notes.
Signature of Applicant______
STATEMENT OF UNDERTAKER
I certify that the information given is correct and has been understood by the deceased family/applicant.
Full name and address of undertaker: ______
______
Signed: ______Date: ______
PLEASE NOTE
All arrangements for interments are subject to the Rules and Regulations and Burial Fees made by the Burial Authority, copies of which are available from the Council Offices or on the Council’s website.