Burial Request Form

NOTE: DO NOT FILL OUT THIS FORM UNTIL AND UNLESS A FAMILY HAS A BURIAL SPACE AT THE CEMETERY. ANY REQUESTS SUBMITTED WHERE THE FAMILY DOES NOT HAVE A BURIAL SPACE WILL BE CANCELLED AND RESUBMISSION WILL BE REQUIRED

Phone

This field is for validation purposes and should be left unchanged.

Holy Family Cemetery requires A MINIMUM of a 72-hour notice to open a grave. Saturday burials must be scheduled by noon on Thursday. Notifications are not accepted on Saturdays, Sundays, or holidays. No grave will be opened until a Burial Request Form has been completed and received by Holy Family Cemetery. Burials are NOT permitted on Sundays under any circumstances. Please see the calendar at the bottom of this form for days in which Holiday rates will apply.

SECTION 1: Decedent Information

Full Legal Name of Deceased(Required)

First Middle Last Suffix

Race(Required)

White

Black/African American

Asian

American Indian/Alaska Native

Other Pacific Islander

Gender(Required)

Male

Female

Military / Veteran(Required)

Yes

Burial Type(Required)

Adult Casket

Adult Cremation

Baby Burial

Marital Status(Required)

Spouse of Deceased(Required)

Prefix First Middle Last

Date of Birth(Required)

Place of Birth

City State

Date of Death(Required)

Place of Death

City State

Mother's Name

Prefix First Middle Maiden Last

Father's Name

Prefix First Middle Last Suffix

Cause of Death(Required)

Is the family in possession of the contract/deed?(Required)

Yes

Burial space Information

Please provide the burial space information if available

Building

Section

Block/Row/Unit

Lot

Burial Space Owner

Whose name is the burial space in (either on deed or contract)? This will help us locate the file quicker NOTE: If the decedent is not the listed owner of a burial space, the burial space owner MUST sign an interment order.

Copy of Contract/Deed

Max. file size: 128 MB.

You may upload a copy pf the contract/deed if provided to you by the family

SECTION 2: Burial Information

Monday – Friday: Interments are permitted between 8:00 a.m. and 3:00 p.m.

Funeral directors should arrange the time for arrival at the Cemetery, so services conclude by 4:00 p.m. An overtime fee of $200 per hour will be assessed for processions entering the Cemetery after 3:00 p.m.

Saturdays: Burials from 8:00 a.m. to 1:00 p.m. will incur a $350 overtime fee. After 1:00 p.m. until 3:00 p.m., the overtime fee will be $500. No processions are permitted to enter the Cemetery after 3:00 p.m.

Holidays: Holidays officially observed by the Cemetery, including Memorial Day weekend, will only be scheduled on a case-by-case basis with the appropriate fee assessed. Under no circumstances will burials be permitted on New Year’s Day, Good Friday, Thanksgiving Day, or Christmas Day. No burials are permitted after 1 pm on days designated as holidays by the Cemetery.

Overtime fees will be calculated based on time actually entering the cemetery, not time scheduled. If a funeral arrives and an overtime fee is assessed, the funeral home scheduling the service will be responsible for these charges.

Name of Funeral Home(Required)

Other Funeral Home Name(Required)

Funeral Director(Required)

First Last

Funeral Director's Email Address(Required)

Will there be a funeral service?(Required)

Yes

Date of Funeral Service(Required)

Location of Funeral Service(Required)

Time of Funeral Service(Required)

Priest/Deacon/Minister performing the Funeral Service(Required)

At the time of interment, would you like one of our deacons on staff to provide a Catholic graveside service?(Required)

Deacons can assist with graveside services as available. Please confirm with the Cemetery when requesting an on-site deacon to help with rites of commital.

Yes

Choose a Burial Appointment Date and Time(Required)

There will be a fee of $300 for any service that continues for more than two (2) hours past the scheduled burial time.

SECTION 3: Contact Information for Next of Kin

Name of Next of Kin(Required)

First Middle Last Suffix

Relationship to Deceased(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

SECTION 4: Billing Party

Who will be responsible for payment of fees?(Required)

Funeral Home

Family

Mausoleum Interment Fee* - $850
Tomb Interment Fee* - $1,200
Ground Interment Fee* - $2,000 (includes vault)
Cremation Niche Interment Fee* - $525
SATURDAY: (before 1 pm) add $350 (1 pm – 3 pm) add $500
HOLIDAYS: add $550 (must be before 1 pm)

* Interment Fees are only applicable to contracts that do not include them as part of the agreement. Overtime fees apply to all agreements

Burial Transit Form

Max. file size: 128 MB.

If you possess it, please upload a copy of the Burial Transit Form

SECTION 6: Acknowledgement and Consent

Additional Information

Please enter any additional information we may need to know not asked on this form.

Date(Required)

Signature(Required)

By typing my name above, I agree that this will serve as my written signature to this request