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 THE DECEASED

Full Name

Last Address & Postcode

Date of Death

Age at date of Death

DETAILS OF NEXT OF KIN

Full Name

Relationship to the Deceased:

Address & Postcode

Telephone

DETAILS OF FUNERAL DIRECTOR

Name

Address

Telephone

DEATH CERTIFICATE TO BE PRESENTED

(please tick one box below:)

Death Certificate Type Registrar’s Certificate Coroner’s Certificate

DESCRIPTION OF THE COFFIN & INTERMENT

Shape of coffin

Exact external measurements coffin

Length

Depth

Width at Head

Width at Shoulders

Width at Feet

Pre-purchased grave number (if applicable):

Day and Date of Interment:

Time of Interment

Name of Officiator at Interment Ceremony (if applicable):

DESCRIPTION OF ASHES URN FOR INTERMENT

Description: (size, shape, material of urn)

DECLARATION

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

We will get back to you....