Cemetery Department Internment Order and Grave Marking Request

Select Town *

Name Of Deceased *

First

Middle

Last

Maiden Name (if applicable)

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Of Death / Age *

Date / Time Of Burial *

Date

Time

Burial *

Full Burial
Cremation

Cemetery Name / Lot Information *

Grave # Cremation in Full Burial Lot Location add Head_______Center)_______Foot_______ *

Phone *

Family Contact Email *

Name *

First

Last

Military Status

Is Deceased a Veteran *

Yes
No

Has VA Military Marker Been Ordered? If YES< mail completed Form to Robbin Kelley Administrator, Harwich Cemetery Department 732 Main St. Harwich, MA 02645 *

Yes
No

Please Indicate

Multiple Choice *

Military Branch of Service

Authorization For Burial

Email *

Funeral Service Contact Info *

Phone *

Name Of Legal Representative *

First

Last

Phone Number *

Administrative Fee

Price: $ 100.00

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact Name *

First

Last

Opening Contractors Name For Full Body Burial *

Signature

Date / Time

Multiple Choice

First Choice
Second Choice
Third Choice

sample

Cemetery Department Internment Order and Grave Marking Request

Military Status

Authorization For Burial