WARRINGTON BOROUGH COUNCIL BEREAVEMENT SERVICES

CEMETERIES AND CREMATORIUM OFFICE, WALTON LEA CREMATORIUMCHESTER ROAD, WALTON, WARRINGTON, WA4 6TB

TELEPHONE 01925 267731 FAX 01925 267732

NOTICE OF INTERMENT

THIS FORM MUST BE CAREFULLY AND ACCURATELY COMPLETED AND DELIVERED TO THE CEMETERIES AND CREMATORIUM OFFICE NO LATER THAN 3PM THREE DAYS BEFORE THE INTERMENT IS DUE

TO TAKE PLACE (EXCLUDING SATURDAYS, SUNDAYS AND PUBLIC HOLIDAYS)

WARRINGTON BOROUGH COUNCIL WILL NOT BE RESPONSIBLE FOR ANY MISUNDERSTANDING WITH REGARD TO ORDERS OR INSTRUCTIONS GIVEN BY TELEPHONE UNLESS IMMEDIATELY

CONFIRMED IN WRITING.

A TABLE OF FEES AND CHARGES IS AVAILABLE FROM THE BEREAVEMENT SERVICES SECTION

Interment Request For

…………………………………………………… Cemetery

Please read the form carefully and ensure all information is correct before signing.

GJ00214

Please tick appropriate box: Full Burial Cremated Remains

Name in full : Mr/Mrs/Miss ……………………………..................................................……………...…...

Address: .................................................................................................................................................

...............................................................................................Postcode..................................................

Occupation …………......................................................... Age ............................ Sex ...................

Marital Status ..................... Date of Death …………........ Place of death …………………...............

Cause of death: ……………………………………………..................................................………………

Day of interment ……………………………….....................................................……………………......

Date of interment …………………………………….

Time of interment …………………………………………………….....................................................….

Will relatives be present? ……………………….....................................................……………………….

Denomination ……………………………....................................…………………………..............……..

Where is service to be held? ………………………...............................................................……………

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

Name of Minister ………………………………………………..................................................………….

Denomination ………..........……….. Section ………......................... Grave No. ..............................

Name of registered owner ……………………………....................................................………………....

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

……………………………………Postcode………..............................Tel: .......................................…….

Signature ………………………………………………………..................................................…………...

Please note, if the owner has previously died, the ownership must be legally transferred prior to the interment taking place.

Please tick as appropriate

Poly Urn

Casket Poly Urn with plate and rings

Wicker Metal Urn with plate and rings

Other (please state) ........................................................ Wooden Casket

......................................................................................... Other (please state) .............................................

Length ..............Ft ............ Inches ..............................................................................

Width ............................... Inches Length ................................... Inches

Depth ............................... Inches Width ................................... Inches

Depth ................................... Inches

Please note: that when the Funeral Director has made the booking on behalf of the family it is remains to the cemetery.

Denomination ………………………………………………………............................................................…..…...

Please sign and tick the appropriate box to indicate the type of grave required.

Description of Grave Signature

New lawn grave – purchase of Exclusive Right of Burial for a 50 year period.

Interment in public grave

Interment in a cremated remains grave– purchase of Exclusive Right of Burial for a 50 year period.

Full name of applicant (including middle names) : Mr/Mrs/Miss ………………..……....................…………........

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

……………………………………………….................…………………………Postcode.................................……

Tel.No. ..................................................... Email address ...................................................................................

I hereby agree to abide by the cemeteries rules and regulations, details of which have been provided to me. I understand that I may not plant the grave or erect fencing, kerbs or place any other objects on or around the turfed area of the grave. I understand that if I wish to erect a memorial on the above grave space, the work must be carried out by a BRAMM registered stonemason and that I will be wholly responsible for its maintenance and safety. I hereby authorise Warrington Borough Council to remove the headstone should

Signature ………………………………………..........…………............................................................…………

Relationship to deceased …………………………………………………….............................................……....

Signature of Funeral Director who is responsible for the completion of this form

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

Name & Address of Funeral Director …………………................................................…………………………..

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

Telephone No. ……………………………………..............................................…………………………………….

LengthWidth

Depth

Notice of Interment

i o certi c te

Grave Grant/ Lost deed declaration

Casket Plate ordered

Casket Plate delivered

Entered in Register

Entered on to BACAS

Digging slip issued

Letter re deceased owner

Invoice prepared

Receipt issued

Remarks on digging slip entered into BACAS

Grave Grant prepared

Grave Grant sent to family

ITEM FEE PAYABLE

ERB

Interment Fee

Transfer/Lost deed declaration

Headstone

Kerbs and Landings

Casket plate/End rings

Hire of Chapel

Other

Issue Date : October 2013

Full Burial: OffCremated Remains: OffName in full MrMrsMiss: Postcode: Occupation: Age: Sex: Marital Status: Date of Death: Place of death: Cause of death: Day of interment: Time of interment: Will relatives be present: Denomination: Name of Minister: Denomination_2: Section: Grave No: Name of registered owner: Postcode_2: Denomination_3: Postcode_3: TelNo: Email address: Relationship to deceased: Telephone No: Notice of Interment: Notice of Interment_2: iTQoTBM certimcBte: iTQoTBM certimcBte_2: Grave Grant Lost deed declaration: Grave Grant Lost deed declaration_2: Casket Plate ordered: Casket Plate ordered_2: Casket Plate delivered: Casket Plate delivered_2: Entered in Register: Entered in Register_2: Entered on to BACAS: Entered on to BACAS_2: Digging slip issued: Digging slip issued_2: Letter re deceased owner: Letter re deceased owner_2: Invoice prepared: Invoice prepared_2: Receipt issued: Receipt issued_2: Remarks on digging slip entered into BACAS: Remarks on digging slip entered into BACAS_2: Row13: Row13_2: Row14: Row14_2: FEE PAYABLEERB: FEE PAYABLEInterment Fee: FEE PAYABLETransferLost deed declaration: FEE PAYABLEHeadstone: FEE PAYABLEKerbs and Landings: FEE PAYABLECasket plateEnd rings: FEE PAYABLEHire of Chapel: FEE PAYABLEOther: FEE PAYABLERow9: Cemetery: Telephone: Coffin: OffCasket: OffWicker: OffPoly urn: OffPoly urn with plate and rings: OffMetal urn with plate and rings: OffWooden casket: OffDate of internmemnt: Length in Ft: Length in Inches: Total: Width in inches: Depth in inches: New lawn grave tick: OffInternment in public grave tick: OffInternment in a cremated reamains grave - tick: OffEngraving signature: Lenth in inches2: Width in inches2: Depth in inches2: New lawn sig: Public sig: Cremated sig: Rules sig: funeral dir sig: Other please state2: Where is service to be held 1: Where is service to be held 2: Other please state: Other please state 2: Full name of applicant including middle names MrMrsMiss: MrMrsMiss: Name Address of Funeral Director 1: Name Address of Funeral Director 2: Address 1_1: Address 1_2: Address 2_1: Address 2_2: Other 2_1: Address 3_1: Address 3_22: