Application for issue of burial warrant
Please read this first
This form will be scanned by electronic equipment. It is important that you use a blue or black pen to complete this form,
and print clearly.
Tararua District Council does not provide a lowering device or mats to dress the grave site.
tararua district council po box 115 dannevirke 4942 ph 06 374 4080 fax 06 374 4137 cemeteries@tararuadc.govt.nz
Ofce use only
Burial warrant number Interment ID
Invoice number Receipt number
Interment fee
5 feet/6 feet/Ashes/RSA
Purchase of plot
Adult/Child/RSA/Ashes/Other
Other fees
Out of District/Concrete/Afterhours Total fees
$ $ $
$
Block Section Plot
Applicant details (Please print in CAPITALS)
Full name of deceased person
Late residence
Rank or occupation
Serviceperson Service number (if known)
/ / / /
Age Date of birth Date of death Marital status
Cemetery details
Dannevirke - Mangatera Norsewood Pongaroa Ormondville
Woodville Woodville - RSA Pahiatua - Mangatainoka Pahiatua - Mangahao
Eketahuna - Mangaoranga RSA Eketahuna - Marchant St Alfredton
Section in cemetery: Lawn RSA Ashes Children’s Niche wall Memorial wall
Plot (tick one): New Reserved Interred with
Special plot provisions (applies to Pahiatua and Woodville): Head to head East facing Not applicable
Depth: Normal Extra Size of casket:
Interment details
Name of funeral director Ofciating minister
/ / :
M
Shovels required?
Date of interment Time of interment
Signature
/ /
2 0
Signature Date
click to sign
signature
click to edit
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