Interment Request Form

Casket or Cremains?

Decedent’s Name

Date of Death

Relationship to Lot Owner

Possession of original deed or other documentation may be required as proof of lot ownership.

Lot Owner’s Name

Requestor’s Name

Requestor’s Address

Requestor’s Phone Number

Section

Lot

Grave

Provide details of grave placement

Arrival DATE at cemetery

Arrival TIME at cemetery

If Funeral Home has been engaged to handle arrangements:

Funeral Home Name

Funeral Home Rep. Name

Funeral Home Phone Number

Your Email Address

By checking this box I hereby certify that I am the OWNER or REPRESENTATIVE of the owner of the above cemetery lot and that OWNER has given authority to make disposition of the remains of said decedent as above indicated. I hereby certify and represent that I have the legal right to make this authorization and I agree to hold Village Cemetery harmless from any liability on account of such authorization and interment.

Interment Request Policies

Communications Policy: Please note that submitting this request form does not guarantee a scheduled burial. Arrangements are considered finalized only after you receive written approval via email from an authorized cemetery representative.
Communications made via telephone, text message, or in-person conversation are non-binding.
Documentation: Funeral Homes should inquire if family has a copy of the deed or documentation showing a claim to the lot. If no documentation is forthcoming, the Funeral Home should contact the cemetery with identifying information (lot owner name, names of people buried in the lot, etc.) so we may assist in locating the grave and verifying rightful claim.
Opening of Graves: No grave will be opened, and no funeral service will be permitted to proceed, unless this form has been submitted and formal approval from an authorized cemetery representative has been received.
Notice Requirements:
Tuesday–Saturday Burials: Minimum 72 hours notice prior to the service time is required. Exceptions will be made only for required religious observances or verified extenuating circumstances.
Monday Burials: Requests must be submitted no later than 12:00 PM the prior Thursday. Exceptions will be made only for required religious observances or verified extenuating circumstances.