29 Bowler Avenue, Gore 9710
PO Box 8, Gore 9740
Phone 03 209 0330
Email cemeteries@goredc.govt.nz
www.goredc.govt.nz
Application for Monumental Work 1
RURAL CITY LIVING
Monuments
NZS 4242 2018
with NZS 4242 2018, New Zealand Standard for Headstones and Cemetery Monuments, and also in accordance
with NZS 9201.14:1999 Model General Bylaws for Cemeteries and Cermatoria. I further understand that
Appendix Four:
Specification
Name of Deceased:
Plot Number: Block Number:
Particulars of Work
First inscription
Scale sketch showing all aspects of work to be carried out (brochure of applicable monument may be
substituted). Dimensions of intended work must also be included and Full Inscription to be placed on
Monument.
For Office Use Only
Monumental Permit Fee GST Inclusive
Application for Monumental Work 2
Single Double Ashes
Headstone
Kerbing
Marbles/Chips etc
Slab
Renovation
Additional Inscription (detail below)
Bronze Plaque
Others (describe)
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