DUC - Interment Authorize

Required fields are marked with asterisks (*)

Authorization to Open Grave

This forms holds the authorization to open a grave for an Interment in the Dorchester Union Cemtery.

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of Municipal Act, 2001. This information is collected and maintained for the purposes of submitting and investigating a by-law complaint. Questions or concerns about the collection of this information can be directed to the Clerk at 4305 Hamilton Road, Dorchester ON N0L 1G3, Phone: 519-268-7334 ext 254 or clerk@thamescentre.on.ca

Please Provide the Below Information for the Authorized Applicant with the Authority to Auhtorize Opening of the Interment

Full Name

Street Number

Street Name

City/Town

Postal Code

Email Address

Full Legal Name of the Interment of

Authorizing for Interment at the location of:

Section

Range

Row

Grave(s)

Position (for Cremains only)

I hereby hold the necessary authority to authorize the opening for the above interment.

Authorized Applicant Signature

Clear

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