DUC - Order for Interment

Required fields are marked with asterisks (*)

Authorization to Order Interment

This forms holds the authorization to order for 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

Note: Arrangements for interments cannot be confirmed until receipt of this completed form has been provided to the Municipal Office via email cemetery@thamescentre.on.ca or fax 519-268-3928.

Payment and burial permit/cremation certificate are required prior to interment taking place.

Full Legal Name of Deceased

Funeral Director/Home or other such person making the arrangements

Phone Number

Requested Burial Date *Note: 2 business days' notice required (16 working hours in advance)

Cemetery Service Time

Grave/Niche Location

You may contact the Cemetery staff at cemetery@thamescentre.on.ca to request the mapping index for reference. Location MUST be completed.

Section

Range

Row/Column

Grave/Niche

Urn Dimensions

Next of Kin Information

Name

Full Address

Phone Number

Relationship to deceased

Signature

Clear

Date