Cemetery Marker Permit Application

Town of Burgaw

Burgaw Cemetery Marker Permit Application
About this form: To be completed by the monument company or family of the deceased prior to placement of a monument.
Applicant Details
Company Name
Contact Name
Mailing Address
Phone Number
Email
example@example.com
Details of the Deceased
Full Name
Date of Death

MonthDayYear
Date
Name of Lot Owner (if known)
Location (if known) Block
Location (if known) Lot
Date Monument is planned to be set

MonthDayYear
Date
Do you need the location of the grave marked?

YesNo
No headstone and/or footstone shall be set without the person, firm, corporation or entity setting the headstone or footstone obtaining a permit from the town prior to the erection of the headstone or footstone. It shall be the responsibility of the company setting the stone to contact the town prior to this activity. The company will be responsible for cleanup and repair to any area damaged during this activity.

A base of concrete or granite, not less than four (4) inches thick and extending six (6) inches outside and installed flush with the ground level, must be placed under all monuments which are not installed flush with the ground.

All footstones will be set flush with the ground surface and set in a way to prevent the settling of the stone.
Acknowledgement
Signature

Clear
Date

MonthDayYear
Date
Marker Deposit Refunded

To make a request for the return of the Marker Deposit, please fill out and submit the Marker Deposit Request Form.
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

Applicant Details

Details of the Deceased

Acknowledgement