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2. Monte Vista Cemetery Interment Request Form

   This form is used to initiate the burial process at Monte Vista Cemetery. It requires detailed information about the deceased, the plot, and the desired burial arrangements. This form is typically completed by a funeral director or a designated representative of the deceased's family.

4. Applicant Information:
6. Name
7. Email Address
9. Relationship to Deceased:
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
19. Deceased Information:
21. Name:*
23. Date of Birth:
    Date of Birth:

    (If known)

24. Date of Death:*
    Date of Death:
26. Place of Birth:
27. Place of Residence:
29.  

    1. Military
30. Military Branch:
    -- Select One --ArmyAir ForceNavyMarinesCoast GuardNational Guard

    (If known)

32. Interment Information:
34. Section:*
35. Lot:*
36. Grave Number:*
38. Date of Interment:*
    Date of Interment:
39. Type of Interment:*

    1. Casket
    2. Cremation
    3. Infant Casket
    4. Infant Cremation
41. Funeral Home:*
42. Funeral Director*
44. First Name*
45. Last Name*
47. Phone Number
48. Fax Number
50. Email Address
52. Address
54. City
55. State
56. Zip Code
58. Comments/Notes:
60. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
62. Electronic Signature
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field