Interment Arrangement Form

**This form must be completed by the Owner or legal heir of plot or niche being used for interment. Cemetery staff must receive this form at least 72 hours prior to any interment***
**This document must be signed and returned to the Eagle Cemetery District **
Fill out the from below or Download this form and send it in to:
EAGLE CEMETERY DISTRICT
PO BOX 514
EAGLE, CO 81631

or
Email it to carriecossette@gmail.com

Questions: 970-471-5374
Legal Description of Plot or Niche:*
Type of Burial Service:*
- Casket
- Cremains
- In Ground
- In Columbarium
Requested Interment Date:*
MM slash DD slash YYYY
Funeral Home Contact:
Name of Deceased:*
First Last
Date of Birth*
MM slash DD slash YYYY
Date of Deceased*
MM slash DD slash YYYY
Veteran Details if applicable:
Additional Comments
Name*
First Last
Owner/Relation?*
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
By entering a name in the field below, you confirm that the data provided is correct and you approve Eagle Cemetery District to take the next steps.
Electronic Signature*
**This document must be signed and returned to the Eagle Cemetery District **
Contact us with any questions.
Email: carriecossette@gmail.com
Telephone: 970-471-5374
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