Please use your browser to print this page and send completed form  To. Higher Ground Meadow,  Hackney, Corscombe, Dorchester, Dorset DT2 0QN









HIGHER GROUND MEADOW.

NOTICE OF INTERMENT




Full name of deceased         ______________________________________

Full address of deceased      ______________________________________

______________________________________

______________________________________

Date of death and age          ______________________________________

Pre-purchase ref if applicable ______________________________________

Place of death                      ______________________________________

Next of kin & relationship      ______________________________________

Address of next of kin           ______________________________________

 ______________________________________

Telephone or e-mail              ______________________________________



Name of Funeral Director & contact No     ____________________________

 ______________________________________

Description of coffin or urn     ______________________________________

Exact external dimensions of coffin:     Length__________Depth__________

Width at: Head_____________Shoulder______________Foot ____________

Type of Grave:  Meadow______________   Woodland___________________

Date and Time of interment            _________________________________

Name of officiator                 ______________________________________


I (WE) BEING THE APPLICANT, HAVE READ,UNDERSTOOD AND AGREE TO ABIDE BY THE CEMETERY REGULATIONS, PARTICULARLY THOSE APPERTAINING TO THE PLACEMENT OF MEMORIALS AND FLOWERS ON GRAVES, ALSO TO THE ENVIRONMENTAL SUITABILITY OF COFFINS.


I (we)clearly understand the way in which Higher Ground Meadow is managed by an annual cut for hay followed by sheep grazing to encourage the wild flowers and benefit the wildlife.


Signature of next of kin ___________________________________