Dursley Town Council
Dursley Cemetery
To the Clerk of the Town Council
Notice of Interment
Please make arrangements for an internet in accordance with the following particulars:1. First name(s) and Surname of person to
be interred
2. Rank or profession of person to be
interred (If a minor, name and residence
of parents)
3. Age of person to be interred
4. Date of death
5. Place where death occurred
6. Usual place of residence
7. Day of week and date of the month on
which the interment is to take place
8. Hour of the day at which the funeral will
arrive at the burial ground
9. Name of Minister (if any) intending to
officiate
10. Whether new grave or re-opened grave
11. Number of grave space intended to be
occupied
12. Whether in consecrated or
unconsecrated ground
13. Whether the Exclusive Right of Burial in
perpetuity has been purchased and who
is now the owner of such right.
14. Proposed depth of grave (single 6ft,
double 8ft)
15. Size of coffin/grave*
*Delete as appropriate
Signature of Applicant/Funeral Director ………………………………………………….. Date……………………………….
NB – 3 Clear days’ notice of interment must be given in writing, not counting Saturdays, Sundays and
Bank Holidays
Funeral Director’s contact details:
Notice of interment April 2014