DORMINGTON & MORDIFORD GROUP PARISH COUNCIL Parish Clerk: Mrs Chris Bucknell 12 Cliveden Grove, Hereford HR4 0NE Tel: 01432 267549 Mobile: 07777 669 662 E-mail:
[email protected]
Note: This notice along with the appropriate fee must be sent to the above address before any burial arrangements can be made. Please allow at least 48 hours. Before any burials can take place the Council must have received a Certificate for Burial or Cremation or a Certificate of Cremation. NOTICE OF INTERMENT Name of the deceased: ............................................................................................. Address: .................................................................................................................... .................................................................................................................................. Occupation: ............................................................................................................... Age of deceased: ...................................................................................................... Address where death occurred: ................................................................................ .................................................................................................................................. Date of death ............................................................................................................ Day, date, time of funeral ........................................................................................... Name of person who will officiate .............................................................................. Grave No/Garden of Remembrance Plot No.. ........................................................... Depth of Grave .......................................................................................................... Is an Exclusive Right of Burial required Yes / No If yes, name and address of owner & relationship to deceased ................................. .................................................................................................................................. .................................................................................................................................. If no, please complete declaration overleaf. Name and contact details of Funeral Director ........................................................... ..................................................................................................................................
Signed…………………………………….……….
Date………….
DORMINGTON & MORDIFORD GROUP PARISH COUNCIL Parish Clerk: Mrs Chris Bucknell 12 Cliveden Grove, Hereford HR4 0NE Tel: 01432 267549 Mobile: 07777 669 662 E-mail:
[email protected]
Note: Consent of the owner of the Exclusive Right of Burial is needed for burials where the deceased is not named on the grant. Declaration by owner of Exclusive Right of Burial, or next of kin of the deceased: I (full name)…………………………………………………………………………..……………. Of (address)………………………………………………………………………………………… ………………………………………………………………………………………………………… ………………………………………………………………………………………………………… Complete one of the following, deleting where applicable: 1. Am the owner/successor in title to the previous owner/ the personal representative of the previous owner, of the Exclusive Right of Burial with Grant No……. which is dated ……. I hereby consent to the burial of the body/cremated remains of the person described overleaf in grave space number……..at Mordiford Burial Ground. 2. Am the next of kin (state relationship) of the person described overleaf. I have been unable to locate the owner of the Exclusive Right of Burial for grave space number………… at Mordiford burial ground. I hereby indemnify Dormington and Mordiford Group Parish Council against all claims, demands, charges, costs, expenses, actions, liability or losses which the said Council may hereby suffer by reason of re-opening the above grave and interment of the body/cremated remains therein.
