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Disinterment Application Form

This form is in compliance with Funeral, Burial and Cremation Services Act 2002, (and) Cemeteries, Burial Sites and Crematorium Regulatio, Section 19.

Name of funeral home or cemetery

Contact phone number (999-999-9999)

Contact name

Name of the deceased

Date of death

Cause of death

Interment location

Plot number

Name of person requesting disinterment

Phone number (999-999-9999)

Date

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

I would like to receive email communication from KFL&A Public Health.

Yes