OFFICE USE ONLY
APPLIC ATION FOR A
BURI AL RIGHT
BR No:…………………………….
Receipt No: ……………….……….
Date: …………………...................
APPLICATION TYPE
☐ New Purchase (reservation)
☐ Open Reserved Grave
☐ Ashes into existing Grave
☐ New Purchase (immediate use)
☐ Open existing grave (2nd Interment)
BURIAL DETAILS
Cemetery
Section
Other details
Denomination
Plot Number
DECEASED DETAILS
DECEASED DETAILS: (Please print full legal name clearly)
Surname
Last Address
Date of Birth
Date of Burial
Marital Status
GRANTEE DETAILS
Name
Address
Home Phone
Email
Relationship to Deceased
Given Name/s
Gender (Male/Female)
Date of Death
Religion
Occupation
Mobile
Reservation for self ☐
STATUTORY DECLARATION OF GRANTEE
I ………………………………………. of ……………………………………….. in the State of NSW, do solemnly
and sincerely declare that: [please cross out any text that does not apply]
☐
I am the Executor of the Estate of the late
☐
I am not the Executor of the Estate and I am not aware of who the Executor of the Estate is; or
☐
I am the next-of-kin of the deceased. My relationship to the deceased was
☐
I am not the Executor of the Estate but the named Executor,………………………………….., has consented to
me obtaining the burial right; or
☐
I am the Administrator; or
☐
I am the legal personal representative of the deceased.
☐
And I am entitled to make all decisions in relation to the burial and disposition of the deceased named at above.
And I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions
of the Oaths Act 1900.
Declared at
; or
; or
on
Signature of declarant
I, …………………………………………, a …………………………………………, certify the following matters concerning the
making of this statutory declaration by the person who made it: [please cross out any text that does not apply]
☐
I saw the face of the person or I did not see the face of the person because the person was wearing a face
covering, but I am satisfied that the person has a special justification for not removing the covering.
☐
I have known the person for at least 12 months or I have confirmed the person's identity using an identification
document and the document I relied on was
Describe identification document relied on
Signature of authorized witness
Date
Page 1
FUNERAL DIRECTOR/SERVICE PROVIDER DETAILS
Company Name
Postal Address
Phone
Fax
Email
PART 2 – BURIAL DETAILS
TYPE OF BURIAL RIGHT
New Lawn Burial:
(Aberdare or Kurri Kurri Next Available)
Re-Open Lawn Burial:
(Name and/or Location)
New General Cemetery Burial:
(Preferred Location)
Re-Open General Cemetery Burial:
(Name and/or Location)
Reserved Burial Right No:
BURIAL DETAILS
Proposed Date of Burial
Proposed Time and Location of Funeral
Proposed Time of Arrival at Cemetery
Family at Graveside?
CASKET/COFFIN DETAILS
Coffin or Casket?
Please provide the inside measurements of the
Casket/Coffin (Length, Width & Depth):
ADDITIONAL INFORMATION/SPECIAL INSTRUCTIONS
LODGEMENT INFORMATION
HOW TO LODGE YOUR APPLICATION
This Application for Burial Right
must be lodged with Cessnock
City Council by a Licenced
Cemetery Contractor at least 48
hours prior to the proposed
burial.
You may lodge this application by
either:
Fax: 02 4993 2505
Email:
cemetery@cessnock.nsw.gov.au
Council will contact the Funeral
Director/Service Provider if any
further information is required in
relation to this application.
Approval
If approved, Council will issue a
Permit for Burial to the Funeral
Director/Service Provider.
Fees
Fees are calculated in accordance
with Council’s adopted fees and
charges.
Payment Method
Council will invoice the Funeral
Director/Service Provider once the
Permit for Burial has been issued.
Page 2
How to Contact Us
Phone: (02) 4993 4220
Fax: (02) 4993 2500
Email:
cemetery@cessnock.nsw.gov.au
Office Hours
9am to 5pm Monday to Friday
*Payments and Cemetery enquiries
are accepted until 4.30pm
Fees
Fees are calculated in accordance
with Council’s adopted fees and
charges.