Burial Application Form

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
Veteran
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
Format: (000) 000-0000.
Name of Vault Company
Vault Company Phone Number
Format: (000) 000-0000.
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
Applicant Information

Person completing this form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: