Interment Request / Grave Marking/ Burial Site Purchase
Type of Request
*
Grave Marking
Interment Request
Purchase Burial Site
Purchase Vase
Other
Name of Person Requesting Interment/Grave Marking/ Burial Site Purchase
*
First Name
Last Name
Funeral Home/Company Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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
Old Mausoluem
New Mausoleum
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 #)
*
Would you like a name plate ordered? (Please ensure correct spelling of name and YOB/YOD).
*
Yes
No
Other
Date of Interment (if 'purchase only' use today's date)
*
-
Month
-
Day
Year
Date
Additional Comments
Additional Comments:
Submit
Should be Empty: