Town of Jamestown Cemetery Application for Burial

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The Town shall issue no burial order unless written application containing the following information is furnished to the Town Clerk.

Certificate of Death from the appropriate agency can be e-mailed to: townclerk@jamestownco.org

Arrangements must be made by the person who will prepare the grave site ("Authorized Excavator") and the Cemetery Chair, Town Clerk or elected official for site selection and inspection.

Decedent to be Interned *

First and last name

Age *

Date of Birth *

YYYY

Date of Death *

YYYY

Place of Death *

Funeral Home Name

Funeral Home Contact Name

Funeral Home Address

Funeral Home Telephone

Funeral Home E-Mail

Authorized Excavator *

Authorized Excavator Telephone *

Authorized Excavator E-Mail *

Date/Time Internment Scheduled

YYYY

Graveside Service

Yes

Other:

Clear selection

Plot Identification *

Notes *

Signature of Applicant (by filling in your name you certify the information you provided) *

Date *

YYYY

Submit

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