HORTON KIRBY GARDEN OF REMEMBRANCE

 

Notice of Interment

 

I hereby give notice of intention to Inter the Ashes of the person named below in the above Garden of Remembrance or existing Burial plot

 

Name in full……………………………………………………………………………………

*Address…………………………………………………………………………………………

*   If this address is not within the Parish please contact this office immediately to clarify that the policy directives are being complied with.

 

Age……      Sex………         Occupation……………………………………………………..

IMPORTANT. If, retired also state former profession, or occupation, or type of work

 

Place of Death…………………………………………….Date of Death…………………….

Date and Time of Interment……………………………………………………………………

Service in ………………………………………………………………………………………

Plot required for ………. Interments. (number)

For new plot: Full name and address of purchaser(s) and relationship to deceased

…………………………………………………………………………………………….……

 

………………………………………………………………………………………………….

If existing plot re-opened: Grave no/ Garden plot no. ………& full name and  full address including postcode of purchaser(s) of exclusive right of burial (use reverse of this form if necessary)

 

…………………………………………………………………………………………….……

 

I enclose a copy of the Garden of Remembrance policy that has been signed by the next of kin. # This section to be signed by the funeral directors (not the next of kin)#

 

Signed #………………………………      Name (please print)………………………………….

For Funeral Directors (please include company name, address, postcode and phone no.)

…………………………………………………………………………………………….……

………………………………………………………………………………………………….

 

HORTON KIRBY AND SOUTH DARENTH PARISH COUNCIL

Parish Office, Village Hall, Horton Road, South Darenth, Dartford, DA4 9AX (01322 865193)

Please make cheques payable to HK&SD PC

 

 

For Parish Council use:                             Date fee received……………………….

      Residency conditions checked ……………………………………………………..

Type your text here …