2015/16 Cemetery Services
Application for Installation of Memorial / Plaque
Important information – read before completing application form.
Application form must be completed in full.
Council will provide a proof of concept for the plaque within 10 business days of receiving a fully complete application. Plaques will not
be ordered until confirmation and payment are received.
Select Cemetery
Beerwah Cemetery
Kulangoor Cemetery
Witta Cemetery
Buderim Cemetery
Mapleton Cemetery
Woombye Cemetery
Caloundra Cemetery
Mooloolah Cemetery
Yandina Cemetery
Diddillibah Cemetery
Nambour Garden Cemetery
Other, provide location:
Eumundi Cemetery
Old Nambour Cemetery
…………………………………………
Gheerulla Cemetery
Peachester Cemetery
Location within Cemetery
Yes, please provide details: Section
Row
Site
No, I have a site however do not know the site location.
Do you know
the site location?
No, I need to select a site for Ashes interment.
No, Private use outside Sunshine Coast Council Cemetery
1. Applicant details
Surname
Given names
Postal address
Suburb
State
Business phone
A/H phone
Postcode
Mobile
Email address
Relationship to deceased
DOB:
Preferred Contact:
Phone
Mobile
Email
2. Details of deceased
Surname of deceased
Given names
Date of birth
Place of birth
Date of death
Place of death
Male / Female
Cause of Death
Privacy
Council will use any personal information provided by you for the intended purpose only and for remaining in contact with you. Council
is authorised to collect this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your
personal information is only accessed by persons authorised to do so. Council may provide information about you to any relevant
Queensland State Department. Your personal information is dealt with in accordance with council’s privacy policy.
1 of 5
2015/16 Cemetery Services Application for Installation of Memorial / Plaque V1 01/07/2015
3. Burial Rights Confirmation to be completed by Burial Rights Holder





I am the person in whose name the Burial Right was/will be issued
I act with the full authority of the family of the deceased Burial Right Holder
Written authority is attached from the Burial Right Holder
The deceased is the Burial Right Holder
Other:…………………………………………………………………………………………………………………………….
Executor Details:
Name:
Postal address:
Suburb
Business phone:
4. Declaration of Burial Rights Holder
I ………………………………………… of……………………………………………………………acknowledge I am
the Burials Rights Holder or approved successor and am authorised to act on behalf of the deceased. I
acknowledge Council is acting in good faith on the declaration provided and does not accept responsibility for
acting on the information provided. I accept any responsibility should a dispute between family members
arise.
Signature:
Date:
5. Memorial details
BURIAL MEMORIAL ONLY: Options as per provided fact sheet
Is there currently a memorial in
place?
Burial Site Memorial
 Lawn Base “flat on lawn”
 Base and Desk “sloped”
 Semi Monumental Upright
“Traditional headstone”
 Full Monument
 Desk only “certain areas only”
Material
 Granite
 Concrete
 Tiled
Photo’s & Motifs
 Porcelain
 Laser
 Size 70,80,90,100mm
 Motif………………………..
2 of 5
Yes “provide details
below”
………………………….
 No




New / additional plaque for existing memorial
If replacing an existing plaque do you require it
returned?
Yes
No
Refurbishment of existing memorial
Other options
 Tree burial (Kulangoor only)
 Detachable plate for existing plaque
 Prepurchased Reserved Headstone “Dependant on site selection”
 Additional Plaque only
 ……………………………………………………………………
Memorial Granite Colour choice
 Black
 Balmoral Red
 Rose Red,
 Blue Pearl,
 Light Grey,
 Paradise,
 Butterfly Blue,
 Emerald Pearl,
 Sapphire Brown,
 Viscount. “White ish colour”
Style
 Drawing No.
“If known”
 Sketch Provided
2015/16 Cemetery Services Application for Installation of Memorial / Plaque V1 1/07/2015
6. Plaque details (continued)
ASHES MEMORIAL ONLY: Options as per provided fact sheet
Plaque Type
 Granite Plaque “Etched”
 Wall
 Granite Plaque “Raised lettering”
 Garden
 Granite Plaque Laser - black only
 Rock
 Bronze Plaque
Size if known?
 Alloy Plaque
 Full Colour
mm x
mm
Please note ashes are to be supplied to Councils cemetery office or may be brought to the interment on the day.
Applicants and their respective Funerals Director are responsible for the safe delivery of Ashes for interment to Council.
No ashes can be accepted by council until all relevant fees are paid
Plaque going on to
Ashes location:
Funeral director:___________________
Family member:____________________
No Ashes
Do you wish to be present at the ashes installation?


Yes. If yes, council will contact the applicant.
No. If no, council will notify you once completed.
Do you require a bronze vase / flower holder for columbarium
wall memorials? (additional cost of $ 99.00 each)


Yes
No
Is this application to refurbish an existing memorial?


Yes
No
Does the deceased have a reservation? (Ashes Memorial only) 

Yes
No
7. Wording for memorial
Line 1 ___________________________________________________________________________________________
Line 2 ___________________________________________________________________________________________
Line 3 ___________________________________________________________________________________________
Line 4 ___________________________________________________________________________________________
Line 5 ___________________________________________________________________________________________
Line 6 ___________________________________________________________________________________________
Line 7 ___________________________________________________________________________________________
Line 8 ___________________________________________________________________________________________
Line 9 ___________________________________________________________________________________________
Line 10 __________________________________________________________________________________________
Note: ashes “254mmx152mm” plaques includes 7 lines of text, burial memorial plaques “381mm x 279mm” includes 10 lines of text.
8. Declaration of applicant
I understand that no product will be ordered or construction commenced until the provided invoice is paid in full. I
understand that the completion of the memorial will take 10 to 12 weeks once paid in full and I also acknowledge that I
am the burial rights holder or acting with the permission of the burial rights holder of the burial site. I have read and I
understand the information provided to me on the attached information sheet. Further evidence of Burial Rights holder
may be requested and required at council’s discretion.
Signed
3 of 5
Name
Date
2015/16 Cemetery Services Application for Installation of Memorial / Plaque V1 1/07/2015
Plaque / memorial fees
Plaques
Plaque - Provision and installation of single / double bronze columbarium plaque
(plaque in wall with 10 lines of inscription and single motif)
Plaque - Provision and installation of single / double inscription lawn plaque "Flat
Concrete Lawn Base"- up to 7 lines of inscription and single motif
Plaque - Provision and installation of single / double ornamental garden plaque concrete
pier "inclusive of interment of single ashes"
Plaque - extra lines for lawn plaques (per line)
Refurbishment of existing bronze Plaque.
Above Ground Vaults including monument, headstone, plaque/inscription 200 letters and
single ribbon
Plaque - Provision and installation of single / double inscription lawn plaque (Tiled) - up
to 7 lines (Adult and Children)
Plaque - Provision and installation of single / double inscription lawn plaque (Granite) up to 7 lines (Adult and Children)
Memorial Boulder plaque (Caloundra, Woombye)
Additional Bronze Plaque (381x279)
Additional Bronze Plaque (254x154)
Detachable Plates (Any Size)
Ceramic / Porcelain Photo for plaque
Tree Burials plaque including granite
Plaque - Custom made plaques - "Non standard"
Plaque - Provision and Installation of single /double inscription lawn plaque (Concrete
Desk and Base) up to 7 lines (Adult or Child)
Supply and install Bronze flower holder - Ashes Wall
Refurbishments
Install stones/feature pebbles to double monument- plus selected stone @ Cost
Install stones/feature pebbles to single monument- plus selected stone @cost
Water blast and clean single Monument (only)
Water blast and clean / repaint base & desk
Water blast and clean / repaint and single monument
Water blast and clean base & desk/semi monumental (only)
Water blast and clean Double monument (only)
Water blast and clean repaint double monument
Concrete products
Concrete Full Surround (including plaque, single only, double size price on application)
Purchase of Concrete Lawn Base (Flat)
Purchase of Concrete Desk (Adult)
Purchase of Concrete Pier
Purchase of Concrete Vase
Purchase of Concrete Desk (Child)
Concrete Memorial base and desk (External plaque provided) Supply & install
Tiled Full Surround (including plaque, single only, double size on application)
Granite products
Granite Semi Monumental Headstone (Upright any colour from standard range including
provision for a plaque)
Granite Garden Pier for Ashes Gardens (All standard colours - not including plaque)
Granite Memorial 2nd Inscription to existing
Granite Lawn Base (Flat, All standard colours 530mm x 430mm- not including plaque)
Granite Memorial Desk and provision for plaque - Kulangoor Hex Garden
Install additional flower holes in memorial - each
Ashes
Additional fees (relating to interments of ashes). Weekend Surcharges Saturday 8 am -12
noon only (per min 4 hours)
Interment of ashes in an existing burial plot
Scattering of ashes in cemetery grounds (No family attendance)
Removal of Ashes and / or Postage to other facility (Registered Post)
4 of 5
2015/16 Cemetery Services Application for Installation of Memorial / Plaque V1 1/07/2015
Cost inc. GST
$879.00
PLQ
$896.00
PLQ
$854.00
PLQ
$40.00
$289.00
PLQ
PLQ
POA
PLQ
$1,865.00
PLQ
$2,874.00
PLQ
$698.00
$554.00
$457.00
$294.00
$269.00
$1,851.00
POA
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
$989.00
PLQ
$99.00
PLQ
Cost inc. GST
$189.00
$164.00
$198.00
$198.00
$285.00
$168.00
$256.00
$305.00
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
Cost inc. GST
$3,201.00
$260.00
$289.00
$158.00
$54.00
$183.00
$672.00
POA
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
PLQ
Cost inc. GST
$2,879.00
PLQ
$622.00
$586.00
$680.00
$1,881.00
$83.00
PLQ
PLQ
PLQ
PLQ
PLQ
Cost inc. GST
$545.00
BUR
$355.00
$144.00
$94.00
BUR
BUR
BUR
Transferring ashes with existing plaque
Interment of Additional Ashes. "each"+ interment
OFFICE USE ONLY
$160.00
$88.00
BUR
BUR
PLQDate application received
Memorial completion date
Date application processed
Date proof forwarded
Information when ordering and installing headstones, memorials and plaques
1.
Who can order a plaque or memorial?
2.
The ordering of a plaque / memorial must be completed by the burial rights holder / applicant or a representative
with written authority from the burial rights holder / applicant.
When will my headstone / memorial be ordered?
3.
Plaques and memorials will only be ordered on receiving a signed, dated and approved plaque proof and full
payment of invoice.
How long before my order is installed?
4.
Generally installation of memorials will take 12 to 14 weeks from date of full payment being received however
special request or customer works may take longer.
Can I place my own memorial?
5.
Yes, memorials can be placed by any who has been issued with the required approval pursuant to Councils Local
Law 1 applicants in most cases will require appropriate insurance cover. You are free to obtain private works
quotes from a memorial supplier directly.
I have seen some positions with lots of trinkets and personal items as well as planted trees and shrubs, can I
do this?
6.
The planting of trees and shrubs and the placement of items including crosses, trinkets and other artefacts is not
permitted without cemetery approval and will be remove by an authorised officer.
What if I want to refurbish or add a plaque to an existing memorial?
7.
We encourage families to take care and maintain memorials and if you are doing minor adjustments and repairs
which do not require large plant you can simply complete a Notice of Intension Form “NOI” to advise the cemetery
of what you are doing.
Will the cemetery look after my memorial?
8.
No, the care and maintenance of plaques, memorials and monuments is the responsibility of the family or the
representative of the deceased.
There is a family member objecting to the headstone, what do I do?
9.
Sunshine Coast Council acts in good faith when it relies on advice provided by applicants and does not accept
any responsibility for allowing a plaque / memorial that might be the subject of a later dispute between family
members, Executors and/or assigns, in this instance you need to seek independent legal advice.
Can I place artificial flowers on the headstone?
Artificial flowers are not permitted to be placed onto headstones. Fresh flowers only are to be placed.
10. Can I place additional vases on my headstone?
Items including vases, trinkets, jars and existing plants will be removed should they be placed without prior
permission from the cemetery where they create a safety, amenity or operational nuisance cemetery
management.
11. After I lodge my memorial application when will I receive a proof for consideration?
You will receive a proof for checking 10 days after your application is received by the cemetery staff. If you would
like changes made, please contact us to make necessary changes. We will prepare a new proof and send back
to you until you are happy with the design. We require a signed copy of the proof be returned to us prior to your
order proceeding.
5 of 5
2015/16 Cemetery Services Application for Installation of Memorial / Plaque V1 1/07/2015