APPENDIX C: BURIAL PERMIT

Applicant Name:                           

Mailing Address:                           

Phone #:                   

Signature of applicant                            Date

Permit fee required: $25.00

Name of Deceased:                           

Cemetery Section:                            Plot #:         

Name of Funeral Agency:                        

Permit approved by:                           

Signature                                 Date

(Ord. passed - - )