Burial Application Form

Burial Application Form

Kanarraville Town Cemetery
Deceased Information:
Full Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Date
Place of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Death Date*

MonthDayYear
Date
Place of Death*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age
Gender

MaleFemale
Veteran*

YesNo
If "Yes" which Branch
Father's Full Name*

First NameMiddle NameLast Name
Mother's Full Name*

First NameMiddle NameLast Name
Spouse's Full Name (If applicable)

First NameMiddle NameLast Name
Funeral Information:
Name of Mortuary*
Mortuary Phone Number*
Name of Vault Company*
Vault Company Phone Number*
Type of Vault
Funeral Location and Time*
Desired Burial Date and Time*
Burial Type, Fees and Payment Information
Certificate of Burial Rights (CBRs) Number, if known
Burial Type and Open/Close Fee* - *Additional Costs may apply*

Casket - $300Urn - $150Casket and Urn -$300
Applicant Information

Person completing this form
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Applicant Email*
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Funeral Information: