Form Center

2. (I/We), the undersigned hereby request consent form the City of Belleview to proceed with the following burial in:
4. OLD Cemetery

   Check, if applicable

   1. CEMETERY 1 (OLD Cemetery)
6. BLOCK
   Block Number in two digits. Leave Blank if unknown.
7. LOT
   Lot Number in two digits. Leave Blank if unknown.
8. SPACE
   Space Number in two digits. Leave blank if unknown.
10. NEW Cemetery

    Check, if applicable

    1. CEMETERY 2 (NEW Cemetery)
12. UNIT
    Unit Number in two digits. Leave Blank if unknown.
13. BLOCK
    Block Number in two digits. Leave Blank if unknown.
14. SPACE
    Space Number in two digits. Leave Blank if unknown.
16. Funeral Home or Monument Company Information
    Please provide the following contact information.
18. Date of Application*
    Date of Application

    Date of Application
19. Business License Number with City of Belleview
21. Contact First Name*
22. Contact Last Name*
24. Company Name*
25. Email Address (Recommended)
27. Address
28. City
30. State
31. Zip Code
32. Phone Number
33. Fax Number
35. DECEDENT INFORMATION
    Please provide the following Decedent Information.
37. Name of Decedent*
38. Date of Death*
    Date of Death
39. Date of Birth*
    Date of Birth
41. Date of Burial*
    Date of Burial
42. Casket or Urn*
    -- Select One --CasketUrn

    Please Select
44. Cemetery Space Owner First Name
45. Cemetery Space Owner Last Name
46. Owner's Relationship to Decedent
48. Responsible Family Number Name
49. Address
51. City
52. State
53. Zip Code
54. Phone Number
56. Family Buried in Same Area
    Please provide available information concerning other family members in nearby spaces for reference purposes.
58. Signature of Applicant*
    Please type your name in the field provided. By typing your name, your are signing the Application to Request a Cemetery Space Marking.
60. We strongly encourage you to choose the option to receive a copy of your Request via email. After submitting this form, you will receive a Confirmation that the request has been submitted. .
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field