HORTON KIRBY BURIAL GROUND

 

Notice of Interment

 

I hereby give notice of intention to bury the person named below in the above Burial Ground

 

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 ………………………………………………………………………………………

Grave for ………. Interments.      Dimensions of Coffin………………………………………

For new Grave: Full name and address of purchaser(s) of reserved grave and relationship to deceased

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

 

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If grave re-opened: Grave 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 burial ground 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.)

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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 ……………………………………………………..