Crowle & Ealand Town Council
Application for Burial / Cremation
Name of Deceased
Prefix
First Name
Middle Name
Last Name
Occupation of the deceased
Age of the Deceased
Date of Birth
-
Month
-
Day
Year
Date of Death
-
Month
-
Day
Year
Date of Interment
-
Month
-
Day
Year
Approx time of Interment
Hour Minutes
AM
PM
AM/PM Option
Has an existing Grave or Plot been pre-purchased (Grant of Exclusive Right of Burial)
Yes
No
If yes please attach a copy of the grant
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Plot Number
Details of person responsible for the Funeral
Prefix
First Name
Last Name
Address
Street Address
Street Address Line 2
Town
County
Post Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Is Exclusive Right required
Yes
No
If Yes: Name of Purchaser
First Name
Last Name
Address of Purchaser
Street Address
Street Address Line 2
Town
County
Post Code
Relationship to deceased
Does purchaser have sole authority for these arrangements
Yes
No
If no who else has authority
Funeral Directors Name
Funeral Directors Address
Street Address
Street Address Line 2
Town
County
Post Code
Date
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date
-
Month
-
Day
Year
Date
Any additional documents required
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please contact the office to book an appointment with the Burials Officer:
Emma Von Sembach Clerk to the Burials Board rfo@crowleandealandcouncil.org
Crowle Community Hub, 52-54 High St, Crowle
Tel. 01724 710020 Available Monday 9am -5pm
Submit
Should be Empty: