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2. This form must be submitted to the Westlawn Cemetery 48 hours prior to any burial.  Upon completion of submission, this Burial Request Form will be sent to Tom Bailey at the Westlawn Cemetery.

4. Name*
5. Phone Number*
7. Email Address
8. Name of Deceased*
10. Deceased's Address*
11. Place of Death*
13. Date of Death*
    Date of Death
14. Date of Birth*
    Date of Birth
16. Type of Burial*

    1. Full Burial
    2. Cremation
17. Ashes to be Buried With

    1. Separate
    2. Relative
19. If Relative, with Whom?
21. Is the Deceased a Veteran?

    1. Yes
    2. No
22. Currently Own a Lot at Westlawn Cemetery?

    1. Yes
    2. No
24. Date of Burial Request*
    Date of Burial Request
25. Estimated Time of Arrival
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field