Services
Cemetery Application
Cemetery Application Form
- 1. Christian and Surname of person to be interred:
- 2. Age of Person to be interred:
- 3. Date of death:
- 4. Address of Deceased:
- 5. Place where death occurred:
- 6. Date and Time when funeral will arrive at Cemetery:
- 7. Number of interments in grave space:
- 8. Name and address of Funeral Director:
- Telephone number/s:
- Signed
(on behalf of funeral director) - I request a burial at Pleasley Parish Council’s Cemetery and am aware that NO form of edging kerbs can be erected around the grave.
- Signed
Date
(on behalf of family) - Address:Post Code:
- Telephone no:
| Office use | ||
|---|---|---|
| Date received | Approved | Grave number |
| Grave number | Cheque received | Registration form received |
| Registration form sent to Registrar | ||
| Entered in burial book | Entered on spreadsheet | |
Please print, complete and send to :
Ian Weekes, Clerk to the Council,
The Verney Institute, 13 Newboundmill Lane, Pleasley, Mansfield Nottinghamshire NG19 7PL