Holy Cross Burial Permit Request

*=required

Today's Date: *

Deceased's Information

Last Name: *

First Name: *

Middle Name:

Maiden:

Last Known Address: *

City: *

State: *

Zip: *

Date of Birth: *

Date of Death: *

Veteran: * Yes No

Contact Information

(Who should be contacted about this form)

Last Name: *

First Name: *

Address: *

City: *

State/Zip: *

Phone: *

Email: *

Funeral Home Name (or Relationship to Deceased): *

Space Information

Burial Type: * Full Burial Cremation

Date and Time of Funeral: *

Expected Time at Cemetery: *

Vault Company Used: *

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