Burgaw Cemetery Burial Permit

Town of Burgaw

Burgaw Cemetery Burial Permit Application
About this form: To be completed by the Funeral Home prior to burial or interment of ashes.
Funeral Home Details
Company Name
Contact Name
Mailing Address
Phone Number
Email
example@example.com
Details of the Deceased
Full Name
Last Address
Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Age
Gender

MaleFemale
Veteran

YesNo
Service Branch
Burial or Interment Details
Type of Burial/Interment

Burial of BodyInterment of AshesDisinterment
Name of Lot Owner
Lot location (if known)
Other Lot Information (to aid in locating plot)
Does the Funeral Home require marking of the plot for locating?

YesNoRush?
Funeral Details
Funeral Date

MonthDayYear
Date
Funeral Time
Monument Deposit
Monument Deposit Permanent markers made of concrete, granite, marble, or brass is required. A deposit of $500.00 will be paid by the family of the deceased or funeral home at the time a permit is issued for burial. If no marker is purchased or erected within 12 months of burial, the Town of Burgaw will erect a marker (cost not to exceed deposit) and the deposit will be forfeited. If a permanent marker is already erected, a deposit of $300.00 will be paid by the family of the deceased or the funeral home at the time a permit is issued for burial. When proper lettering on the marker has been completed, the deposit will be refunded. If lettering is not completed within 12 months of the burial, the Town of Burgaw reserves the right to engrave the marker (cost not to exceed deposit) and the deposit will be forfeited. $500.00 Marker Deposit $300.00 Marker Deposit
Marker Deposit

$500.00 Marker Deposit$300.00 Marker Deposit
Acknowledgement
The Town of Burgaw makes no inquiries into the ownership of previously sold cemetery plots. It is the responsibility of the individual and/or funeral home to ensure that the deceased are buried in the correct
Signature

Clear
Date

MonthDayYear
Date
Town of Burgaw

109 N Walker St, Burgaw, NC 28425

Phone (910) 259-2151

Fax (910)259-6644

Email cabbood@burgawnc.gov
Should be Empty:

Town of Burgaw

Funeral Home Details

Details of the Deceased

Burial or Interment Details

Funeral Details

Monument Deposit

Acknowledgement