Required fields are marked with asterisks (*)

Cemetery Funeral Permit

Please contact the Cemetery Supervisor first at (303) 335-4777 or by email to confirm that the requested funeral date and time are available.

If you have questions about this form, contact the Parks Department:

Phone: (303) 335-4768
Email the Cemetery Supervisor
Email the Parks and Open Space administrative assistant

Deceased information

First name

Last name

Address

City

State

Zip code

Veteran?

Yes

Date of birth

Date of death

Age

Place of birth

Plot owner and responsible party information

Name of owner of plot(s):

Name of party responsible for deceased interment:

Relation to deceased:

Address

City

State

Zip code

Phone number

Mortuary information

Name of mortuary

Name of agent:

Legal description of plot(s):

Block:

Lot:

Plot:

Funeral and burial information:

Date requested for funeral:

Time requested for funeral:

Vault type:

Size of urn (if applicable):

Full-Size burial?

Yes

Cremation burial?

Yes

Release – authorization of plot(s):

The undersigned authorizes and directs the City of Louisville Parks and Recreation Department to open and close the above mentioned burial plot(s) and to perform the interment and agrees to indemnify and hold harmless the City of Louisville, its officers, employees, agents, or servants, and to pay any and all judgments rendered against said persons on account of any suit, action, or claim caused by, arising from, or on account of acts or omissions of the undersigned related to this interment, and to pay to said persons their reasonable expenses, including but not limited to, reasonable attorneys’ fees and reasonable expert witness fees, incurred in defending any such suit, action, or claim. The undersigned further assumes and agrees to pay any outstanding balance for burial fees, which are due and owing 48 hours prior to interment.

Date

Signature of party responsible for interment

Clear