Notice of Interment

NOTICE OF INTERMENT

CEMETERY______

PARTICULARS OF DECEASED

Full Names:______

Address:______

______

______Post Code: ______

Age:______Sex:______

Date of Death:______

Address at which death occurred:______

______

______Post Code: ______

If a stillborn or a minor state names

and residence of parents:______

______

______Post Code: ______

PARTICULARS OF INTERMENT

Date of interment:______

Time of arrival at cemetery:______

Name of officiating Minister:______

PARTICULARS OF GRAVE SPACE

(a) NewA D(b) Re-open (c) Purchased

Denomination:______Grave No: ______Section: ______

(A)Grave (D) Grave - Beamed Childs Cremated Remains Muslim crate

Whether grave has been selected: ______

Whether any monument is erected: ______

Required position of ash casket within grave space: ______

Date of last interment (if any):______

Name of last person interred:______

Exact size of coffin:Length: ______ft ______inWidth:______

EXCLUSIVE RIGHT OF BURIAL
If new grave is to be purchased, details of new owner to be completed below.
Name: (Block Capitals) / ______
Address: / ______
______
______Post Code: ______
Email address: / ______
Telephone No: / ______
Relationship to deceased: / ______
Signature of new owner: / ______
EXISTING GRAVES
Grant of Right produced? / Y / N
Is current owner the deceased? / Y / N Please complete details of applicant below.
Name: / ______
Address: / ______
______
______Post Code: ______
Email address: / ______
Telephone No: / ______
Relationship to deceased: / ______
Signature of applicant: / ______

GUIDANCE NOTES FOR FUNERAL DIRECTORS ON CHARGES FOR RESIDENTS AND NON RESIDENTS

The information below MUST be given to the applicant BEFORE the interment is confirmed.

Council’s burial fees and charges (available to view on Council’s website).

In respect of the Fees and Charges set out under INTERMENT, to ensure that residents who contribute towards the Loughborough Special Rate are recognised by an appropriate charge, the following sliding scale for interment fees applies:

Single Fees

Anyone living in the Loughborough Council Tax area at time of death. For residents living in care homes outside the area for less than twelve months prior to date of death, evidence must be provided by the Funeral Director / applicant to qualify for single fees e.g. Council Tax bill.

Double Fees

Anyone living elsewhere in the Borough of Charnwood at the time of death. For residents living in care homes outside the area for less than twelve months prior to date of death, evidence must be provided by the Funeral Director / applicant to qualify for double fees e.g. Council Tax bill.

Treble Fees

For all non-residents of the Borough of Charnwood.

All D graves are lawned. Graves will be turfed over as soon as possible after settlement weather permitting.

For ease of maintenance on lawned sections no kerbsets, fences, grave surrounds be permitted.

I have been advised and understood the current Council’s burial fees and grave guidance notes.

Signature of Applicant: ______

STATEMENT OF UNDERTAKER

I certify that the information given is correct and has been understood by the deceased family/applicant.

Fullname and address of undertaker:______

______

______Post Code: ______

Signed: ______Date: ______

PLEASE NOTE

This notice completed and accompanied by required fees must be delivered to the cemetery office 48 hours prior to time of interment.

All arrangements for interments are subject to the Rules and Regulations and Burial Fees made by the Burial Authority, copies of which are available from the Council Offices or on the Council’s website.

Notice of Interment - CHARNWOOD