OFFICE USEVersion: 1.0
| EROB Deed | | Register of Burials | |
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| Green Form OR Coroner's Form | | Location & Grave Space ref | |
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| Coffindimensions | | KPS booked | |
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| St Thomas' Chapel required | | FD & Invoice Date | |
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This application is made subject to the Herne Road Cemetery Regulations of Crowborough Town Council and must be delivered to Crowborough Town Council, Council Offices, Pine Grove, Crowborough, East Sussex, TN6 1DH at least seven days prior to any interment. This application must be accompanied by either a Notification of Burial or Coroner's Order.
| Personal Information of the Deceased |
| Full name of deceased | |
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| Permanent address of deceased at time of death | |
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| Was the deceased a parishioner? | YES | | NO | | (Refer to Parishioner Guidelines at the end of the form) |
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| Age of deceased | |
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| Date of Death | |
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| Place of Death | |
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| Interment Details |
| Date of Interment | |
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| Time of Interment | |
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| Hire of St Thomas’ Chapel | YES | | NO | | If YES, complete St Thomas’ Chapel Hire Form |
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| Depth of burial | SINGLE | | DOUBLE | | RE-OPEN | |
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| Exact Coffin dimensions | LENGTH: | WIDTH: | HEIGHT: |
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| Officiating Minister – if applicable | |
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| Funeral Director Details |
| Contact name
Name of Funeral Director
Address
Telephone number
Email Address | |
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| Signature of Contact: | Date: |