Full name of deceased   ______________________________________
Full address of deceased______________________________________
                                 ______________________________________
                                 ______________________________________
Date of death and age   ______________________________________
Pre-purchase ref if applicable __________________________________
Place of death              ______________________________________
Next of kin                  ______________________________________
Address of next of kin   ______________________________________
                                ______________________________________
Telephone or e-mail      ______________________________________

Name of Funeral Director & contact No __________________________
                                 ______________________________________
Description of coffin      ______________________________________
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 ___________________________________

Please use your browser to print this page and send completed form

To. Higher Ground Meadow, Underhill Farm, Corscombe,
    Dorchester, Dorset, DT2 0PA.