Cemetery Form - Application for Installation/Alteration of a Monument

APPLICATION FOR INSTALLATION/ALTERATION OF A MONUMENT

Applicant Details (Right of Burial Holder)

Applicants Family Name:

Applicants Given Name:

Postal Address:

Address 1

City

ZIP / Postal Code

State / Province

Country

Phone Number:

Email Address:

Relationship to the Deceased:

Please Note:

All monumental works must be approved by Dorset Council, prior to works commencing. Allow 10 working days for application to be processed.

All major monumental works shall be carried out by an appropriately trained monumental mason. Consideration will be given to application made by non-masons if the work is minor.

Monument Details

Details of Requested Works:

Is the work being undertaken by a monumental mason?

Yes

If not, please provide details:

Monumental Masons Name:

Phone Number

Estimated Start of Works Date:

Estimated Cost of Works:

Please Note:

Grave Boundary Marking is mandatory and must be performed by authorized Council Officers

No works are to commence until written authorisation has been received

Plan of Works

Please illustrate the proposed works to be undertaken - include specifications, dimensions and material types to be used.

APPLICANT DECLARATION

Declaration

I, the applicant, am over the age of 18

I hereby certify that the monument will be constructed/repaired in accordance with Australian Standards AS 4204-1994

I acknowledge that the applicant is responsible for all above mentioned works to remain within the bounds of the nominated grave.

All works must comply with the Dorset Council Cemetery Guidelines.

Any damage to adjoining graves caused during the above mentioned works will be the responsibility of the applicant to repair or replace

Applicant Name

Date

Signature

Living in Dorset

Services

Community

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Visiting Dorset

Services

Community

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Business community in Dorset

Services

Community

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Cemetery Form - Application for Installation/Alteration of a Monument

APPLICATION FOR INSTALLATION/ALTERATION OF A MONUMENT

Applicant Details (Right of Burial Holder)

Monument Details

APPLICANT DECLARATION