Cemetery Permit Form

Name(Required)

First Last

Email(Required)

Phone(Required)

Christian Name and Surname for the Memorial:(Required)

Last permanent address of person to be buried: (If a minor – the name and residence of parents)(Required)

Payee(Required)

I, the undersigned Mason hereby make application for consent to(Required)

Erect a new memorial

Add a new inscription to existing memorial

Renovate existing memorial

Remove memorial to workshop

If you chose "Erect a new memorial" please provide more information including size and dimensions

If you chose "Add a new inscription to existing memorial" please provide details of the wording for the Memorial

Please provide details of the company you are using for the work inc Contact, Company Name, Address, Email and Phone number(Required)