Interment Application, Kaipara District Council

Interment Application

~ 10min. to complete the form

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Cemetery

Certificate of Purchase No:

Interment Warrant No:

Name of Person to be Interred:

Date of Death:

Age:

Occupation:

Residence:

Country of Birth:

Grave Lot No:

Block:

Area:

Date of Burial:

Day of Burial:

Time:

Please select one.

Service

Cemetery

Size of Grave:

Name of Minister to Officiate:

Name of Trustees of Estate or Solicitors for Trustees:

Next of Kin:

Full Name of Owner of Plot:

Address of Owner of Plot:

Remarks:

Funeral Director:

Postal Address:

By submitting my application, I accept the terms & conditions and that the information I have provided is correct.

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