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- Burial Plot Request Form

Home
About Us
Burials and Plots
Member Info
Donations
Contact
- Burial Plot Request Form

Burial Plot Request Form

This form is to be completed by an individual requesting a burial plot for a deceased loved one. All information is used solely for cemetery records and coordination purposes.

Section 1 – Deceased Individual Information

Full Legal Name of Deceased:

Date of Birth:

Date of Death:

Place of Death (City & State):

Veteran Status (if applicable):

Yes No

Section 2 – Burial Details

Requested Burial Date:

Requested Burial Time (if known):

Funeral Home or Service Provider (if applicable):

Type of Burial:

Casket Cremation (urn burial) Cremation (in-ground placement)

Clergy or Officiant Name (if applicable):

Section 3 – Burial Plot Information

Burial Plot Location (if pre-selected or known):

Is this burial plot already owned or pre-paid?

Yes – Pre-paid / Previously owned No – Payment is required Unsure

Name of Original Plot Owner (if different from deceased):

Approximate Date of Original Purchase (if known):

Section 4 – Requestor / Responsible Party Information

Full Name of Requestor:

Relationship to Deceased:

Mailing Address:

Phone Number:

Email Address:

Section 5 – Payment Information (Committee Use)

Payment Status:

Pre-paid – No payment required Payment required Pending verification

Amount Due (if applicable):

Payment Method:

Cash Check Other

Date Payment Received:

Section 6 – Additional Notes or Special Requests

Additional information, requests, or considerations:

Acknowledgment & Signature

I certify that the information provided above is accurate to the best of my knowledge. I understand that burial scheduling is subject to Lewis Cemetery Committee approval and verification of plot ownership or payment.

Requestor Signature:

Date:

Submit Request

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City of Alma
Alma Cemetery

Mailing Address

Lewis Cemetery Committee

P.O. Box 1962

Alma, AR 72921

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