Cemetery Work Request Form

April 27, 2016

This form must be on file with the City of De Leon, before any working can take place at the the De Leon Cemetery or the Garden of Memory Cemetery.

Select a cemetery * Required
- De Leon Cemetery
- Garden of Memory Cemetery
Name * Required
First Last
Requesting to start work on * Required
MM slash DD slash YYYY
Nature of work * Required
Location site * Required
Name of worker * Required
First Last
Address of worker * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact number for worker * Required
Funeral Home Information
Funeral Director * Required
First Last
Deceased name * Required
First Last
Date of birth of the deceased * Required
MM slash DD slash YYYY
Date of deceased * Required
MM slash DD slash YYYY
Date of service * Required
MM slash DD slash YYYY

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