Interment Request / Grave Marking
Funeral Home/Company Name
*
Name of Person Requesting Interment/Grave Marking
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Owner of Gravesite/Mausoleum Space
*
First Name
Last Name
Name of person(s) to be Interred
*
First Name
Last Name
Year of Birth
Year of Death
Cemetery or Mausoleum
*
Please Select
Mausoluem
St. Patricks
St. Josephs
St. Wenceslaus
Dickinson Cemetery
Dickinson South Cemetery
Description of Location (Cemetery: Section, Lot, Block, Grave or Mausoleum: Building, Inside/Outside, Space #)
*
Date of Burial
*
-
Month
-
Day
Year
Date
Additional Comments:
Submit
Should be Empty: