BURIAL SITE

Name: Monument Meadow Natural Burial Ground
Site address: Churton Road, Farndon, Chester, Cheshire CH3 6QP
Postal address: c/o Barnston Estate, Laurel Bank, Crewe Hill Lane, Farndon, Chester, Cheshire CH3 6PD
Telephone: 01829 270 579

Details of Applicant

Full Name

Address & Postcode

Telephone

Details of Grave & Coffin

Preferred location for the grave (if any):

Burial Plot Number:

Type of grave: Single burial plot Double burial plot (eg husband & wife with adjacent plots) Family burial plot

If Family Burial Plot - number of adjacent plots required

Type of Coffin (eg wicker coffin, shroud)

Name(s) of the person/people to be buried:

Religion of the Deceased (if any)

Specific requests or instructions:

Details of Ashes for Interment

Name of the person whose ashes will be scattered

Ashes Burial Plot Number:

Material of urn

Specific requests or instructions

Details of Next of Kin

Name

Address & Postcode

Telephone

Relationship

Other

The Death Certificate is to be left in the care of

Declaration

Name of applicant

Declaration I, the applicant, have read, understood and agree to abide by the Monument Meadow Natural Burial Ground Terms and Conditions.