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HomeMy WebLinkAboutBRU 93 027 Repealed By No04 154 11M~1 JI:3 !:[)JREPE&! R'ti at . =~æ~c I THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 A BY-LAW to establish the rules and regulations of the Port Bruce Cemetery, Part of Lot E, Concession 7, Registered Plan No. 3R-5974, Township of Bruce. WHEREAS The Corporation of the Township of Bruce acquired and established the use of certain lands within the Township of Bruce and have designated such lands as the Port Bruce Cemetery; AND WHEREAS Section 50 of The Cemeteries Act, (revised) R.S.O., 1990, Chapter C.4, authorizes municipal Councils to pass by-laws governing maintenance, management, regulation and control of cemeteries; AND WHEREAS the Council for The Corporation of the Township of Bruce considers it necessary to establish regulations governing the cemetery in order to ensure the efficient administration and operation of the cemetery, as well as the maintenance of the dignity and decorum of which the cemetery is preserving; NOW THEREFORE the Council for The Corporation of the Township of Bruce ENACTS as follows: l. Schedule "A" - The Regulations; 2. Schedule "B" - Contract for Purchase of Interment Rights; 3. Schedule "c" - Certificate of Interment Rights; 4. Schedule liD" - Notice of Permission for Interment By-law introduced and read a First time this SEVENTH day of DECEMBER, 1993. By-law read a Second time this SEVENTH day of DECEMBER, 1993. By-law read a Third time and finally passed, signed, sealed, and numbered 93-27 this SEVENTH day of DECEMBER, 1 f3tt;flK¿~ CLERK REEVE - .- '~E~, <-- . -- - - THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 SCHEDULE "A" 1. DEFINITIONS In this by-law: 1.1 CARE AND MAINTENANCE FUND - shall mean that fund in which all money received for the care and maintenance of the cemetery shall be invested and the interest earned therefrom shall be used for the permanent care of the grounds, markers and monuments and held in trust by the treasurer. 1.2 CEMETERY - shall mean the Port Bruce Cemetery being composed of Part Lot E, Concession 7 in the Township of Bruce. 1.3 CERTIFICATE OF INTERMENT RIGHTS - shall mean the certificate issued by the Township to the purchaser of interment rights to a lot or lots as prescribed as Schedule "A" to this by-law. 1.4 CERTIFICATE OF INTERMENT RIGHTS HOLDERS - shall mean those persons who hold the rights to inter human remains in a specified lot. 1.5 CHAIR - shall mean that person appointed by the Committee from its members to act as Chair. 1.6 COHHITTEE shall mean the Township resolution of of the Bruce Cemetery Council for the Committee as appointed by Township. 1.7 INTERMENT RIGHTS - shall mean the right to require or direct the interment of human remains in a lot. 1.8 LOT - shall mean an area of land in the cemetery containing, or set aside to contain, human remains. . 1.9 MARKER - shall mean any granite or bronze plaque set flush with the ground to be affixed to a burial lot. 1.10 MONUMENT - shall mean any permanent memorial structure of granite or marble projecting above ground level. 1.11 PLOT - shall mean two or more lots in which the rights to inter have been sold as a unit. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 2 TO SCHEDULE "A" -- 1.12 SECRETARY - shall mean the person selected by the Township Council from the Township staff to act as the Committee secretary. 1.13 SUPERINTENDENT - shall mean that person appointed by the Township who is charged with the management of the cemetery. 1.14 TOWNSHIP - shall mean The Corporation of the Township of Bruce. 2.0 GENERAL ADMINISTRATION 2.1 The cemetery shall be governed by the terms of this by-law and The Cemeteries Act, (revised), R.S.O. 1990, Chapter C.4. 2.2 The Township hereby establishes the Bruce Township Cemetery Committee which shall have the responsibility to establish policies concerning the cemetery on behalf of the Township and in accordance with the policies. procedures and rules as established by the Township from time to time. 2.3 The Township Council will appoint four members from the public and one member from Council to serve as the Cemetery Committee. The members chosen from the public will have four year terms, which end in alternating years, and the council member's term will coincide with the Council's term. 2.4 The secretary shall keep minutes of the Committee meetings. 2.5 The Clerk's Office shall record burials, sales of lots and plots, shall prepare and issue certificates of interment rights and shall keep copies of all minutes and correspondence. . 2.6 The treasurer for the Township shall be the treasurer for the cemetery and shall be responsibl e for the proper receipt, disbursement and recording of all cemetery funds in accordance with the Township and provincial policy as well as general accounting rules and principles. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 3 TO SCHEDULE "A" 2.7 The Committee shall appoint a chair from among its members for a two year term. 2.8 All monies received for the care and maintenance of lots shall be placed in a trust fund in a chartered bank; such account to be known as the "Care and Maintenance Fund" and shall be invested from time to time by the Township's treasurer in accordance with Township policy. 2.9 All interest and investment income received from the Care and Maintenance Fund shall be directed toward the ordinary expense of maintenance and improvement of the Cemetery, pursuant to Section 35, Subsection (4) of the Cemeteries Act, R.S.O., 1990, Chapter C.4, as amended, and associated regulations. 2.10 It shall be the duty of the Superintendent to supervise all work in connection with the cemetery and keep a record of all lots, graves, burials and interment rights purchases. 2.11 The Superintendent shall submit to the Clerk's office, each month, an account of all interment rights sold, all interments and disinterments and to submit week 1 y all time sheets for employees together with any other information requested by the Clerk. 3.0 3.1 CEMETERY OPERATIONS AND MAINTENANCE The Superintendent or an alternate chosen Superintendent shall be present at all funerals to ensure that the proper arrangements are being by the cemetery. by the in order provided ~ 3.2 Except with the prior written consent of the Cemetery Committee, all work within the cemetery shall be performed only by authorized cemetery personnel. 3.3 No person shall plant trees or shrubs in the cemetery except with the written approval of the Superintendent. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 4 TO SCHEDULE "A" . 3.3a 3.4 3.5 3.6 3.7 3.7a Any trees or shrubs now on lots which become, by means of their roots or branches or in any other way, detrimental to the efficient maintenance of the cemetery, or constitute a hazard to machinery, employees or visitors, or is prejudicial to the general appearance of the cemetery, may be removed by the Superintendent. Ninety (90) days prior to said removal, the Superintendent shall contact the Certificate of Interment Rights holder in writing at his/her latest recorded address in the cemetery's records and provide the Certificate of Interment Rights holder with the opportunity to make adjustments to rectify the problem, the cost of which is to be assumed by the Certificate of Interment Rights holder. Flowers placed on a lot at a funeral shall be removed by the cemetery staff after a weeks time to protect the sod and maintain a neat appearance of the cemetery. No certificate of interment rights holder or other person shall place any flower bed, monument, grave marker, inscription, etc., on any lot, plot or grave until all charges have been paid. No certificate of interment rights holder or other person shall erect or place any enclosures of iron, wire, concrete or other materials on or around any lot. From April 15th to the following November 1st, only fresh cut flowers may be placed on lots. From November 1st to the following April 15th one winter wreath with metal holder or stand may be placed on a lot, but shall be removed by Apri 1 15th or be subject to removal and disposal by the cemetery staff. No object such as benches, flower urns, trell ises, artificial flowers, wood or metal stands, glass vases or candl es that wi II interfere wi th the efficient maintenance of the cemetery are to be placed on the lot. 3.8 All lots in the cemetery shall be cared for by the cemetery staff and shall include the mowing of grass, cl ipping around monuments and refi 11 ing sunken graves only. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 5 TO SCHEDULE "A" . 3.9 Certificate rights holders shall pay for the care of their lots in perpetuity at a rate in the fee schedule to this by-law subject to periodic changes. 3.10 Contractors shall not enter or on Sundays unless by Superintendent. the cemetery in the evenings special permission of the 3.11 Contractors or other persons shall remove all implements or materials used in doing any work within the cemetery without delay and if this is not done, the Superintendent may remove same. 3.12 The Township shall not be responsible for loss or damage to any portable articles left upon any lot or grave. 3.13 Contractors, masons, and stone cutters shall lay planks on the lots and paths over which heavy materials are to be moved, in order to protect the surface from injury. 4.0 4.1 BURIALS AND DISINTERMENTS Interment rights shall be purchased from the Township according to the plans and Tariff of Rates as approved by the Ministry of Consumer and Commercial Relations registrar. 4.2 Purchasers of interment rights acquire only the right and privilege of burial of the dead and of constructing monuments, subject to the rules and regulations in force and approved by the Ministry of Consumer and Commercial Relations. 4.3 The clerk and secretary, on payment of the sale price of interment rights, shall issue a certificate of interment rights upon which shall be fixed the Township' s corporate seal. ~ 4.4 Each purchaser of interment rights shall be given a copy of the interment rights and shall abide by all the existing rules of the cemetery and any rules and regulations which may hereafter be enacted by the Township, and approved by the registrar. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 6 TO SCHEDULE "A" 4.5 Care and maintenance shall be incl uded in the purchase of interment rights. 4.6 Each interment right holder may apply in writing to the Township to have their right repurchased at any time before they are used. The Township will, upon receiving this notice, repurchase the interment rights within 30 days, after receiving the request. The repurchase price of the interment rights shall be the amount paid by the purchaser for the rights less the amount the owner paid into the Care and Maintenance Fund. 4.7 If the Township cannot determine the amount paid by the purchaser for the interment rights, the repurchase price shall be $50.00. 4.8 No certificate of interment rights holder shall sell a lot or plot or grave. Transfers of interment rights shall be only by transfer from the Township or by a will or bequest. 4.9 Any certificate of interment rights holder who wishes to transfer the certificate of interment rights of his/her lot or plot, shall provide the Clerk the request in writing with the name and address of the party to whom the transfer shall be made together with proof of ownership or authority for transfer and shall pay a sum as set forth in the fee schedule to this by-law for this service. 4.10 In case of transmission of ownership by will or bequest of an interment rights lot, the Township reserves the right to require production of a notarial copy of the will or other evidence sufficient to prove ownership. 4.11 whenever an interment is to be made, the certificate of interment rights holder or his/her agent shall give wri tten notice to the Superintendent at 1 east forty-eight (48) hours in advance giving all the particulars as to location and size of case, and ensure the appropriate interment fees are paid. The Township shall not be responsible for having graves prepared for funerals unless such notice is given. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 7 TO SCHEDULE "A" 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 ~ 4.20 4.20a No interment or disinterment Township without satisfactory being first produced. shall proof of be made by the interment rights The certificate of interment rights holder or his/her agent must present a burial permit issued by the division registrar, to the Superintendent or the al ternate in attendance at the lot before an interment will be permitted. The Township may refuse any interment in any lot against which unpaid charges appear. No person, other than an Township shall open any lot removal. employee or agent of the for the purpose of burial or Burials between November 1st and April 30th will take place only if weather conditions permit. Funeral directors are requested to suggest committal services be held at the funeral home if a conflict in times occurs. The Township assumes no responsibil i ty for damages should a lot be opened in the wrong location due to wrong or insufficient information and any expense in connection with an error of this kind shall be paid by the parties ordering the interment. Every certificate of interment rights holder or agent of an interment rights holder shall arrange to arrive at the cemetery not later than 4:00 p.m. in order that burial may be completed within the regular hours of work. There shall be one interment per lot except remains, two of which may be placed above the burial where permission has been granted certificate of interment rights holder or the immediate family. cremated original by the holder's The maximum interment for each lot shall be one human remains and two cremated remains or three cremated remains. The maximum interment for each cremation lot shall be two cremated human remains. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 8 TO SCHEDULE "A" . 4.21 4.22 4.23 4.23a Each grave shall be at least 1.5 metres deep. The use of oversize shells or vaults will not be permitted. No certificate of interment rights holder or other person shall make or cause any disinterment without the written consent of the local medical officer of health and the rights holder except on an order from the court as provided for in the regulations under The Cemeteries Act. The certificate rights holder shall assume any costs involved. Whenever a disinterment is to be made, the certi ficate of interment rights holder or his/her agent shall give wri t ten notice to the Superintendent at I east five regular working days in advance giving all the particulars to location, and ensure that the appropriate disinterment fees are paid. 4.24 All fees charged by the Port Bruce Cemetery shall be outlined in the fee schedule to this by-law, which is subject to periodic changes, and filing with the Registrar. 5.0 5.1 5.2 --e 5.3 5.4 RULES FOR VISITORS Port Bruce Cemetery is sacredly devoted to the burial of the dead, and the provi s ions 0 f thi s by-l aw wi 11 be strictly enforced in all cases of disturbance, wanton injury to property, disregard of the rules of conduct unbecoming to a cemetery. All visi tors shall conduct themselves in a quiet, orderly manner and shall not disturb any other visitor or any service being held, by noise or other disturbances. Visitors shall travel through the cemetery by way of the roads and paths only and shall not walk or drive over any burial lots. Children under twelve years of age must be accompanied by an adult who shall remain in close contact with them and shall be responsible for their action. . THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 9 TO SCHEDULE "A" 5.5 No person shall pick any flower or disturb any tree, shrub or plant within the cemetery and shall not deface any monument, fence, or other structure in or belonging to the cemetery. 5.6 No person shall remove any flower or plant container or other objects from a cemetery plot without receiving permission from the Superintendent to do so. 5.7 No person shall carry or discharge firearms within the cemetery ground except where used for the firing of volleys at a burial. 5.8 No animals shall be allowed in the cemetery. 5.9 No person shall use the cemetery for the purposes of a picnic party or other large assembly. 5.10 When a society or association desire to hold a memorial service or other event, they shall make application to do so to the committee at least 15 days prior to the desired date and permission shall be granted at the approval of the committee. The association or society securing the permission shall be responsible for any damage done to property in the cemetery at that time. 5.11 The cemetery may be visited each day from sunrise to sunset. 5.12 Any compl aints by certi ficate of interment rights hol ders should be made at the Municipal Offices in Underwood. Controversies with workers or others on the grounds are to be avoided. . 6.0 6.1 RULES FOR VEHICLES The committee reserves the right to close the roads of the cemetery at any time to vehicular traffic, due to adverse weather conditions or when such traffic might substantially interfere with a committal service in progress. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 10 TO SCHEDULE "A" 6.2 The drivers of all vehicles entering the cemetery shall obey the instructions of the Superintendent, and shall keep to the route allotted to them. They shall not attempt to turn around on any roadway or pass another vehicle and shall not exceed a speed limit of twenty kilometres per hour. 6.3 vehicles forming part of a funeral procession shall take the route allotted to that funeral and shall move in unison with the funeral director in charge of the funeral. 6.4 Proprietors of vehicles and their drivers shall be held responsible for any damage done by them. 6.5 off road motorized vehicles, such as dirt bikes, terrain vehicles and snowmobiles, are not allowed in cemetery. all the 6.6 No person shall drive a vehicle in the cemetery when the roads are blocked off with barriers. 6.7 Any monument dealer, contractor or individual who damages any lot, tombstone, monument or other structure or otherwise does injury in the cemetery, shall be personally responsible for such damage or injury. 7.0 MARKERS AND MONUMENTS 7.1 The safety of all monuments wi II be the responsibi 1 i ty of the Township. 7.2 All monuments shall be placed on the foundations provided for regular or cremation burial. 7.3 No monument will exceed 48 inches in height, from ground level to the top of the monument, and the size of the base of the monument and the location of the monument on the foundation shall be approved by the Superintendent prior to installation. 7.4 No inscription shall be placed on any monument which is not in keeping wi th the decorum and digni ty of the cemetery. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 11 TO SCHEDULE "A" 7.5 In accordance with Section 38 of The Cemeteries Act and Regulations, a prescribed amount shall be paid into the Care and Maintenance Fund of the cemetery before the installation of a marker. The prescribed fees are set out in the schedule Fee By-law. 7.6 In accordance with Section 48 of The Cemeteries Act and Regulations, if a monument in the cemetery presents a risk to public safety because it is unstable, the Township shall do whatever is necessary by way of repairing, resetting or laying down the monument so as to remove the risk. 7.7 No person shall erect more than one monument on each lot, and, except as noted in Item 7.9, all lettering shall face the lot to which the monument belongs. 7.8 All monuments must be of granite or marble. 7.9 No lettering permitted on opposite lot. other than the the back side of family name, the monumen t shall facing be an 7.10 Footstones and corner markers will not be permitted. 7.11 All markers shall be of bronze, mounted on a base set flush with the ground or shall be of granite set flush with the ground. 7.12 A marker shall be attached to the base so that a uniform border of two inches wide is shown on all sides. The marker shall be attached securely by four or more fasteners to a concrete, granite or natural stone base that is not less than three and one-half inches and not more than five inches in thickness. -. 7.13 Only one marker will be permitted on each cremation lot. 7.14 No marker for a cremation lot shall exceed 30 inches in length and 20 inches in width. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 12 TO SCHEDULE "A" 7.15 No monument or marker shall be erected on any lot until all outstanding charges have been paid. 7.16 No person shall remove, inscribe or clean any monument, marker or memorial of any kind without first obtaining permission from the Superintendent and without first producing a letter in writing from the certificate of interment rights holder giving permission and a full description of the work proposed. 7.17 Cleaning or restorative procedures undertaken by a party other than the Township must first have approval of the Township to ensure the techniques used are acceptabl e and within the guidelines of The Cemeteries Act. 8.0 8.1 MISCELLANEOUS Anyone found contravening any provision of this by-law shall be guilty of an offence and shall be liable upon conviction to a penalty not exceeding five thousand ($5,000.OO) dollars, exclusive of costs, under the Provincial Offences Act. 8.2 That this by-law shall come into full force and effect upon wri t ten approval of the Minister of Consumer and Commercial Relations. 8.3 The short name for this by-l aw shall be the "Bruce Township Cemetery By-law, 1993". =e -. .... "A" 'TIW" Fl'" "ç:¡" t=a By-/ew Na.. C>.:>.-;n ~ =- Ii :~~'~:h"C n.... Clerk I THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 SCHEDULE "B" -- THE CORPORATION OF THE TOWNSHIP OF BRUCE CONTRACT FOR PURCHASE OF INTERMENT RIGHTS OR CEMETERY SUPPLIES OR SERVICES OWNER OF CEMETERY - THE TOWNSHIP OF BRUCE OWNER'S ADDRESS R. R. '3, TIVERTON, ONTARIO, NOG 2TO PURCHASER'S NAME (S) PURCHASER'S ADDRESS NAME OF CEMETERY LOT DESCRIPTION SECTION LOT HUMBER{S) DATE OF PURCHASE DAY MONTH YEAR Personal information contained on this form is collected under the authority of the Cemeteries Act (Revised), R.S.O. 1990. Chapter C.4, and will be used to determine eligibility of the sale of interment rights or cemetery supplies or services. Questions about this collection should be directed to the Clerk-Treasurer, Township of Bruce, R. R. '3, Tiverton, Ontario, NaG 2TO. (Telephone 519-368-7066). -. THE CORPORARTION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 2 TO SCHEDULE "B" . CONDITIONS OF CONTRACT Purchase price - $ plus G.S.T. Percentage of purchase price is set aside for care and maintenance fund - $150.00 plus G.S.T.. The resale of interment rights by a purchaser is not permitted. By-law No. 93- governs the operation of the exercise of interment rights within the cemetery. No. 93- is attached for your information. cemetery and the A copy of by-law It should be noted that the by-law restricts the markers permitted within the cemetery and construction of small markers. size and type of the method of A certificate of interment rights will not be issued until the interment rights have been paid in full. An interment rights holder may require by written demand, the owner to repurchase the rights at any time before they are used. These rights wi 11 be repurchased wi thin 30 days after recei ving the demand. The repurchase price of interment rights shall be determined by establishing the amount paid by the purchaser for the rights less the amount the owner paid into the care and maintenance fund in respect of the interment rights. If the owner cannot, using reasonable effort to determine the amount paid by the purchaser for the interment rights, the repurchase price is $25.00. Upon request for interment the following must be provided: Certificate of Interment Rights, Burial Permit or Certificate of Cremation, and Notice of Permission for Interment. Signature of Purchaser Signature of Cemetery Official ~. linn ~.. n ThIs Ie ect.dI .. "?," t;o By-law No. <:>'->'-'::'ì p~...¡:f ~~:;.ì7£:~m:r Clerk ~)(;8'---- THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 SCHEDULE "c" THE CORPORATION OF THE TOWNSHIP OF BRUCE CERTIFICATE OF INTERMENT RIGHTS Certificate Number PURSUANT TO The cemeteries Act (Revised), R.S.O. 1990, Chapter C.4, and Regulations and all amendments thereto. THIS CERTIFICATE OF INTERMENT RIGHTS BETWEEN THE TOWNSHIP OF BRUCE, a body licenced under the laws of the Province of Ontario, have its Municipal Office at underwood and hereinafter called The Township of Bruce, PARTY OF THE FIRST PART AND INTERMENT RIGHTS HOLDER{S), hereinafter called PARTY OF THE SECOND PART In consideration of the sum of Dollars ($ ), plus GST, receipt of which is hereby acknowledged and which included the sum of Dollars ($ ), plus GST for Care and Maintenance which is deposited with the Trustee, The Township of Bruce agrees to assign to the Party of the Second Part the Burial or Interment Rights in the Port Bruce Cemetery: Section (L feet x W Lot Number{s) feet) as shown on the approved plan of the Port Bruce Cemetery. Date of Purchase: Day Month Year The PARTY OF THE SECOND PART by the acceptance of this indenture indicates that the BY-LAW governing the operation of the Cemetery has been received and read, and agrees to be guided by the said BY- LAW as well as the provisions of The Cemeteries Act as if these were included as part of this indenture. THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 PAGE 2 TO SCHEDULE "c" .' With respect to the erection or installation of markers, The Party of the Second Part agrees to abide by By-law No. 93- of The Township of Bruce, wherein restrictions on the erection or installation of markers are given, and which by-law is attached hereto. IN WITNESS WHEREOF, THE TOWNSHIP OF BRUCE has caused its Corporate Seal to be hereunto affixed by the hands of its proper Signing Officer this day of in the year of our Lord, , and the Party of the Second Part has affixed his/her signature{s). PARTY OF THE FIRST PART - THE TOWNSHIP OF BRUCE: PER Clerk Administrator PARTY OF THE SECOND PART: If a purchaser transfers interment rights, the certificate of Interment Rights must be returned to the cemetery owner who will issue a new certificate to the transferee. "c" BoIwd- .. ThIs Ie G.J . ... . (" t=a By-Iew "kL Q~~,:¡., t'I ~ this ì~h ~ r:It \,\p.cp.~ ~, ~::.~ Æ ~ Clerk ~'M~'~'- -- THE CORPORATION OF THE TOWNSHIP OF BRUCE BY-LAW NO. 93-27 SCHEDULE "D" ~ THE CORPORATION OF THE TOWNSHIP OF BRUCE NOTICE OF PERMISSION FOR INTERMENT I, HEREBY, GIVE MY PERMISSION FOR THE INTERMENT OF DECEASED NAME: LAST PLACE OF RESIDENCE DATE OF BIRTH: PLACE OF BIRTH: DATE OF DEATH: AGE: SEX: LOT OWNER'S NAME: FUNERAL DIRECTOR NAME: ADDRESS: ORDER RECEIVED BY: FROM: DATE: MEDICAL OFFICER NAME: ADDRESS LOCATION CEMETERY NAME: LOT NO. SIZE OF OUTER CONTAINER: TYPE OF VAULT: SUPPLIER: TIME OF INTERMENT: TYPE OF SERVICE: DAY/MO/YR NEXT OF KIN NAME: ADDRESS: RELATIONSHIP TO DECEASED: TELEPHONE: SIGNATURE: ~.. '~[)'1 ,.".. Is Set 8y-1Bw No. this 1Aq~ '11_'- - .. 1'" .. t\'. to q"",. ;)ì! J Î)~fIiIIo,",,",-~T' COPY OF CERTIFICATE OF INTERMENT RIGHTS ATTACHED ( ) COPY OF BURIAL PERMIT OR CERTIFICATE OF CREMATION ATTACHED ()