Notice of Interment

Notice of interment for Millbrook Cemetery

Details of the Deceased

Full name of the deceased(Required)

(Christian name or names and surname of the person to be buried)

Prefix First Middle Last

Occupation(Required)

(e.g. profession, tradesman - if under 18 please provide the name of the parents).

Age of the deceased(Required)

(if in years, last birthday)

Last Residence(Required)

(address where last resided)

Street Address Address Line 2 City County / State / Region Post Code Country

Next of Kin Name(Required)

First Last

Next of Kin Address(Required)

Street Address Address Line 2 City County / State / Region Post Code Country

Address Where Death Occurred(Required)

Street Address Address Line 2 City County / State / Region Post Code Country

Date of Death(Required)

Funeral Information

Date on Which the Burial is to Take Place(Required)

Time the Funeral will arrive at the Cemetery(Required)

Name of the Minister Intended to Officiate

(if appropriate)

First Last

Grave Information

Grave Space to be Occupied - Section & Number(Required)

If the grave is already purchased state the number of the grave, grant reference and date purchased.

Grant Number

Date Purchased

Type of Burial(Required)

State whether consecrated or un-consecrated ground(Required)

Length of Coffin/Casket(Required)

Width of Coffin/Casket(Required)

Proposed Depth of Grave(Required)

If any other person has been buried in the same grave space, state the name

Funeral Director

Name of Funeral Director

(if applicable)

First Last

Address of Funeral Director

(if applicable)

Street Address Address Line 2 City County / State / Region Post Code Country

Confirmation

Processing this data is necessary for compliance with a legal obligation under the Local Authorities Cemeteries Order Act 1977.

Email of Signee(Required)

Name of Signee(Required)

First Last

Phone

This field is for validation purposes and should be left unchanged.