Required fields are marked with asterisks (*)

Interment Order

Are you applying as an individual or on behalf of a funeral home?

Individual

Funeral Home

Interment Information

Name of Cemetery

Type of Interment

Full Burial

Cremation

Requested Date of Interment

Time of Interment

Grave Location or New Purchase

Grave Location

New Purchase

Outer Enclosure

Deceased Information

Name of Deceased

Maiden Name

Date of Death

Place of Death

Date of Birth

Place of Birth

Gender

Age

By checking Yes, I am attesting that the information provided on this form is true and correct and submitting is equivalent to my authorized signature.

Yes

Date

Collection of Information

The personal information you choose to provide on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). The information you provide will be used in the issuance of an internment. Questions about this collection can be directed to the Clerk’s Department, Town Hall, 37 Main Street East, Huntsville, ON, P1H 1A1. 705-789-1751.