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2. Requestor's Name*
3. Date of Request*
4. Phone Number*
6. Street Number
7. Street Name
8. Street Type
9. Email Address
11. City
12. State
13. Zip
15. Service Requested

    1. Show Available Locations (by appointment M - F / 8:00 a.m. - 9:30 a.m. / advance notice required)
    2. Purchase Selected Location(s) (Check here, take form to City Hall)
    3. Flag / Mark for Burial
    4. Flag / Mark for Headstone / Marker Placement
    5. Remove/Replace Crypt Door (additional fee may apply)
    6. Research Requested
16. Requestor Note to Public Services
    Enter preferred date / time. Staff will call or email to confirm or discuss date / time to meet family.
18. Details of Research / Service Requested*
    Provide all relevant information not included elsewhere.
20. Property Location
    Block / Bldg
21. Cemetery / Mausoleum
    Section / Crypt
22. Cemetery / Mausoleum
    LOT(S) / NICHE(S)
23. Rockwell
    FAMILY PLOT NAME
25. Name of Deceased
26. Date of Birth
27. Date of Death
29. Date of Interment / Burial
30. Record of Interment
    Funeral Director type full name to confirm as official record of interment.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field