Willow Glen Cemetery Interment Data Sheet

Interment Data Sheet

0 - Funeral Director Information

Funeral Home:

Phone:

Director:

1 - Decedent's Information

First Name*

Last Name*

Middle Name:

Maiden Name:

Veteran:

Death Date*

Death Street:

Death City:

Death State:

Birth Date:

Birth City:

Birth State:

Home Street:

Home City:

Home State:

2 - Burial Information

Burial Date*

Burial Time:

Cremation:

Vault Maker:

Vault Model:

3 - Lot Owner Contact Information

Name:

Street:

City:

State:

Zipcode:

4 - Comments

Comments: