St. Ann's Cemetery Burial Order Form
cemetery@saint-anns.org
Deceased's Name:
*
First Name
Middle Name
Last Name
Suffix
Date of Birth:
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
If Available
Date of Death:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Age:
Estimate is Fine
Deceased's Address (If Available):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veteran?:
*
Yes
No
Which Deployment?
Please Select
Peace Time
Afghanistan War
Iraq War
Gulf War
Vietnam War
Korean War
WW II
WW I
Spanish-American War
Civil War
Date of Interment:
*
Type of Burial:
*
Please Select
Casket
Cremains
Metal Casket
Name of Vault Company:
Please Select
East End Vault
Fort Miller
Other (Enter in Comments Section)
If not listed, enter in the Comments section.
Do they own a plot?
*
Yes
No
Deed owner's name:
Plot Location:
Sec: Plot: Grave: or Sec: Range: Grave: or Niche/Crypt
Name of Person Requesting Burial:
*
First Name
Last Name
Address of Person Requesting Burial:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Person Requesting Burial-Email:
example@example.com
Person Requesting Burial -Phone Num:
Please enter a valid phone number.
Format: (000) 000-0000.
Is the FUNERAL MASS taking place at St. Ann's?
*
Yes
No
Will the family be attending the BURIAL?
*
Yes
No
Does the family want St. Ann's clergy at the graveside burial?
*
Yes
No
Funeral Home Name:
*
Please Select
None
Frank E. Campbell
F. J. Chapey & Sons FH
Kearns FH
Mangano FH
Moloney's FH
Raynor & D'Andrea FH
O'Shea FH
Other (Enter in Comments Section)
If not listed, enter in the comments section.
Funeral Home Contact Name:
*
Funeral Home Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Funeral Home Phone Number:
Comments:
Please enter any additional information here.
Submit
Should be Empty: