Burial Permit

Burial Permit

City of Rockwall
FUNERAL HOME INFORMATION
Name of Funeral Home*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
Funeral Home License Number*
BURIAL INFORMATION
Deceased Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date of Death*

MonthDayYear
Date
Addition
Lot Number
Space
Date/Time of Service*

MonthDayYear

AM/PM Option
Permit Fee
YesNo
Branch of Military Service*
Applicant Signature*

Clear
Date Signed

MonthDayYear
Should be Empty: