Burgaw Cemetery Veteran's Monument Request Form

Town of Burgaw

Burgaw Cemetery Veteran's Monument Request Form
About this form: To be completed by the family of the deceased to request deceased name to be placed on the Veteran's 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
How Name Should be Listed on the Monument (if different from above)
Name of Lot Owner (if known)
Location Block
Location Lot
Veteran's Service Details
Veteran?

YesNo
Service Branch
Acknowledgement
Signature

Clear
Date

MonthDayYear
Date
The Town of Burgaw agrees to etch the name of any Veteran who is buried in the Burgaw Cemetery at the request of the family. Please understand that this request will be fulfilled based on contractor availability and Town resources.
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