D
D
D
APPLICATION FOR AN ENTRY IN THE BOOK OF REMEMBRANCE
(Please write legibly and in block letters)
1. Date entry to appear
For Office Use
Crem No
2. Please tick choice of book:
Receipt No
Rochdale Book of Remembrance
Date
Middleton Book of Remembrance
Miniature Book of Remembrance
3. Note:- The name counts as and is charged for as one line. No more than 35 letters or
figures can be accommodated upon each line. Entries must consist of 2, 5 or 8 lines.
Surname and First
Name
Surname First Name
Two Line Entry
2
3
4
Five Line Entry 5
6
7
Eight Line Entry 8
4. Please record in the Book of Remembrance the entry set out above (3) under the date
indicated (1).
5.
Please supply ……….. number of Memorial Cards in total.
Number of Type A Memorial Cards:
Number of Type B Memorial Cards:
Number of Type C Memorial Cards:
6. I enclose a: Cheque or Postal Order for £
Cheques and Postal Orders should be made payable to Rochdale Borough Council.
7. Please provide a telephone number
8. Please sign and date.
Signature
Date
The Council reserve the right to vary any inscription or to refuse any entry that is considered
unsuitable
.
Applicant Name and Address
On completing this form please return it to:-
Rochdale Cemetery Office
Bury Road
Rochdale OL11 4DG
Find out how we use your personal information at rochdale.gov.uk/privacy
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