Name of Deceased

 *

Name of Deceased

First Name

Last Name

Interment Date

 *

Interment Date

Interment Time
Please specify AM or PM

 *

Interment Time Please specify AM or PM

Interment Time Please specify AM or PM

AM

PM

Do you need to purchase a grave space?

Do you need to purchase a grave space?(Select an Answer) Yes No

Bill Grave Space To:

Bill Grave Space To:

Name:

Address:

City/State/Zip:

The cemetery is authorized to prepare for the following interment:

 *

The cemetery is authorized to prepare for the following interment:

Block Number:

Grave Number:

Lot Number:

Full Burial:

Cremation:

I/We hereby acknowledge that I/we have the legal right to authorize interment for the
deceased, and I/we authorize Yankton Municipal Cemetery to perform these services.

 *

I/We hereby acknowledge that I/we have the legal right to authorize interment for the deceased, and I/we authorize Yankton Municipal Cemetery to perform these services.

I Agree

Printed Signature & Relationship

Date

Funeral Director

 *

Funeral Director

I Agree

Printed Signature

Company

Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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