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HomeMy WebLinkAboutAgenda - Cemetery Sextons - 03/20/2024SEXTONS MEETING AGENDA March 20, 2024 at 3:00 p.m. Participation Options In Person: 180 Market Street, Room 301 Assistive Listening Service Devices available upon request Electronically: https://meet.goto.com/SouthBurlingtonVT/sextonsmeeting03-20-2024 Dial in using your phone: +1 (224) 501-3412 Access Code: 577-395-029 Regular Session 3:00 p.m. 1.Welcome and introductions 2.Agenda Review: Additions, deletions or changes in order of agenda items 3.Comments and questions from the public not related to the agenda 4.*** Elect a chair, vice chair, and clerk 5.History and functioning of the Sextons and cemetery operations 6.Discussion of roles and responsibilities of the City Council (currently the City Cemetery Commission), Sextons, City Clerk, and City Manager 7.***Review of Draft Rules and Regulations 8.Discuss timeline for future Council discussion and potential action 9.Discussion of future revenues 10.Other Business 11.Adjourn ***Attachments included 1 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx City of South Burlington, Vermont Rules and Regulations (Approved by City Council on x/x/xxx) Table of Contents Section 1. Applicability. ................................................................................................................... 1 Section 2. City Cemeteries. ............................................................................................................. 1 Section 3. Definitions. ..................................................................................................................... 2 Section 4. Fee Schedule for Burial Plots. ........................................................................................ 2 Section 5. Sale of Burial Plots. ......................................................................................................... 3 Section 6. Burial Procedure. ........................................................................................................... 3 Section 7. Transfer of Burial Plot(s). ............................................................................................... 4 Section 8. Memorials. ..................................................................................................................... 5 Section 9. Re-establishment of Burial Plot Ownership. .................................................................. 6 Section 10. Return of Burial Plots to City of South Burlington. ...................................................... 6 Section 11. Rules for Use and Visitation of Cemeteries. ................................................................ 7 Section 12. Amendments. ............................................................................................................... 8 Appendix. Cemetery Forms ............................................................................................................ 9 Affidavit of Sale of Burial plot, CITY OF SOUTH BURLINGTON, VT ........................................... 10 Burial plot Purchase Form, City of South Burlington, VT .......................................................... 11 Deed of Burial plot, City of South Burlington, VT ..................................................................... 12 Section 1. Applicability. The care, use, protection, and management of all cemeteries in the City of South Burlington is overseen by the South Burlington City Council acting as the South Burlington Cemetery Commission per state statue when no cemetery commissioners are electedappointed. This policy applies to all persons using or visiting City Cemeteries. This Policy also applies to current and prospective burial plot owners in the City of South Burlington. 18 V.S.A. § 5378. All burial inquiries should be directed to the City Clerk. Section 2. City Cemeteries. a.There are two (2) cemeteries in the City of South Burlington, both of which have perpetual care: •Eldredge Cemetery located at 1140 Airport Drive. Burial plots may be purchased in this cemetery. •Shelburne Road Cemetery located at 1047 Shelburne Road. Burial plots may be purchased in this cemetery. 2 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx b. South Burlington Cemeteries are open all year from sunrise to sunset. Access to cemeteries may be limited as gates and driveways will not always be cleared of snow accumulation. Section 3. Definitions. a. “Base” means the above ground structure that is placed on the foundation and supports the memorial. b. “Burial plot” or “plot” means a numbered division of land within a South Burlington cemetery to mark where remains are interred. Purchasing a burial plot gives the recipient of the plot(s) the right to be interred in a South Burlington cemetery as granted by the City Council and pursuant to the South Burlington Cemetery Policy. c. “Deed of burial plot” or “deed” means a document used to convey the right to be interred in a South Burlington cemetery burial plot that is made from the City of South Burlington and to the holder of the deed. A deed of burial plot is contingent upon adherence to South Burlington City policies, as they may be amended from time to time. d. “Corner pins” means granite or metal objects used to mark the corners of a burial plot. e. “Foundation” means the underground concrete structure that supports the base and memorial. f. “Marker” means a memorial that is flush with the ground. g. “Memorial” means a monument, marker, tablet, or headstone, including its below ground foundation. h. “Monument” means a memorial and its base as it extends above the surface of the ground. i. “Plot” (see “burial plot”). j. “Transfer” or “burial plot transfer” means the conveyance of a deed of burial plot from one person to another using the Affidavit of Sale of Burial Plot form found in the Appendix of this Policy, excluding the City of South Burlington k. “Vault” means: i. For cremation burials, a container made of durable non-biodegradable material used for the interment of cremated remains. ii. For traditional burials, a vault is a one-piece unit with cover, typically made of concrete, used for the interment of remains with a casket. Section 4. Fee Schedule for Burial Plots. a. The City of South Burlington has established the following prices for purchase of burial plots in all South Burlington Cemeteries: Burial plot Fees Resident: Non-Resident: Single: $500.00 Single: $700.00 Deed Recording Fee $15.00 per deed Corner Pins $120.00 per 4 corner pins with standard letter engraving Cost varies by type of material (granite ~$120/4; stainless steel ~$21/4 Burial Fee $100.00 per interment, all types Commented [CM1]: Where is this Policy - need to make sure these rules and regs don't conflict with this policy. Commented [CM2]: Is there a policy that is separate from these Rules and Regs or is this document intended to be the SB Cemetery Policy? 3 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx Section 5. Sale of Burial Plots. a. Burial plot sale inquiries will be directed to the XXXX who is responsible for the sale of burial plots. 18 V.S.A. § 5367. b. Before authorizing the sale of a burial plot, XXXX will check the cemetery map on file with the City of South Burlington for the requested cemetery to verify plots offered for sale are available. When necessary, plots will also be verified to be clear by driving a metal probe into the ground area of the plot making sure to probe the entire area. c. The size of a burial plot is 3 ½’ x 10’. d. Burial plots offered for sale will be at the discretion of the City CouncilXXXX and/or sextons. Plots may be sold in a strategic manner to facilitate the maintenance of the grounds or to reserve tracks of land to allow for changes or advancements in burial techniques. A vacant, unowned plot is not automatically considered available for purchase. e. Before a sale of a burial plot is finalized the XXXX will provide the buyer with copies of South Burlington cemetery policies and inform the burial plot buyer that South Burlington cemeteries are under the supervision of the City Council and subject to the provisions of their policies. f. When the XXXX and the buyer agree to a plot the buyer will fill out a burial plot purchase form. (Burial plot purchase forms are found in the Appendix section of this Policy). The XXXX will sign this form to verify that all information listed is correct. The XXXX responsible for selling burial plots will calculate the total fee due. It is the responsibility of the buyer to turn in the burial plot purchase form and any applicable fee/payment to the City of South Burlington. The fee will include the following: i. Price of burial plot(s) as approved by the City Council and shown in the current fee schedule; ii. Price of corner pins with four standard letter engravings to be furnished by a pin supply company; and iii. Fee for recording the deed of burial plot in the land records of the City of South Burlington. g. When the City Clerk receives the burial plot purchase form and payment, a receipt will be created. h. The clerk will create a listing for the buyer in the cemetery management software. The clerk will then print a deed of burial plot from the software and contact the XXXX responsible for the sale to sign the deed. After the deed is signed the clerk will record it in the land records. i. Once a deed is recorded, the clerk will mail the copy of the deed to the buyer that will include a copy of these policies. j. The clerk authorizing the sale of the plot will contact a pin supply company to arrange the installation of corner pins Section 6. Burial Procedure. a. All burial inquiries will be directed to the XXXX. b. Burials are allowed between April 1 and November 30 or by permission of the XXXX. c. The burial of embalmed remains in any South Burlington cemetery requires interment in a vault. Vaults must be buried at least 18” below the surface of the ground. Vaults must be fit into our lot sizes of 3.5’ x 10’ Commented [CM3]: The City Council is responsible for the sale of burial plots per the referenced statute. Could there be a process set up where the Sextons receive the applications and then generate a list to for the Council to approve? In that instance, the sextons would do all the work necessary to ensure the desired plot was available and accept the fees following approval by the Council. Commented [CM4]: Does this need to be this specific? Do we anticipate using the referenced software for an extended period of time? Alternative is to simply say that City will provide a deed and the Council Chair will sign the deed. Maybe however, this detail is necessary to outline our own process so it will be followed. Commented [CM5]: Should this be sextons? Commented [CM6]: sextons Commented [CM7]: City Council 4 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx d. Excavation of a burial site may only be done by a funeral home after obtaining a burial permit. The funeral home is responsible for excavation of the burial site including all necessary finish grading, replacing sod and/or planting grass seed. e. Internment in the earth must meet be 6 feet below the natural surface of the ground as measured from the bottom of the outside coffin or body pursuant to 18 V.S.A. § 5319. f. Notwithstanding the requirements in Section 6(d), the family of a decedent may get approval to excavate a grave for cremated remains. With XXXX approval, a grave for cremated remains may be self-dug as long as the following conditions are met: i. The grave must be six (6) inches deeper than the container holding the remains. ii. All necessary finish grading, replacing sod and/or planting grass seed will be completed by the individual responsible for digging the grave. g. The XXXX will work with the family or funeral director to identify the burial plot. If the deceased has not already purchased a burial plot in South Burlington, the City Clerk will follow section 2. Sale of Burial Plots of this Policy to aid the acquisition of a burial plot and deed. h. The XXXX and/or the sextons will stake the plot for burial according to the type of burial. The types of burials allowed per plot are as follows: i. One (1) traditional casket burial per single plot. ii. Up to four (4) cremations buried in a non-vault container per single plot. iii. Up to two (2) cremation buried in a vault per single plot. i. Any burial configurations other than those listed in subsections h(i)-(iii) must be approved by a City Council. Cemetery Commission. j. When staking the plot, XXXX and/or the sextons must take into account, if applicable, the placement of memorial(s) according to Section 8 Memorials of this Policy. k. The completed permit/deed will be forwarded to the clerk and the clerk will use the permit/deed to enter the burial into the cemetery management software. The permit/deed will then be recorded. 18 V.S.A. § 5201. l. A burial will not be approved without a completed burial form. This form will be used in situations when there is no permit/deed available, i.e. burial of cremated remains by family, to enter decedent’s information in the cemetery management software. m. At the discretion of the Cemetery Commission, and based on financial hardship, the City of South Burlington may pay for the burial plot(s) including corner pins, burial fee, excavation, and a marker. The burial plot and marker will be determined at the discretion of the XXXX. Section 7. Transfer of Burial Plot(s). a. All transfer inquiries will be directed to the City Clerk. b. Before authorizing the transfer of a burial plot, the XXXX will verify the ownership of the current deed holder or establish ownership pursuant to Section 9 Re-establishment of Burial Plot Ownership of this Policy. c. If ownership is verified, the current deed holder will fill out the Burial plot Purchase Form (form available in Appendix section of this Policy). The XXXX responsible for the transfer will sign the form to verify all information listed is correct. d. The owner or deed holder will sign an Affidavit of Sale of Burial plot. (Form available in Appendix of this Policy.) Commented [CM8]: How would this work? If the sale of burial plots is by the City Council, shouldn't this be information conveyed to the Council for them to approve? If so, would this burial configuration require City Council approval? Commented [CM9]: Is this referring to a burial transfer permit? I'm not seeing in sec. 5201 that recording of the burial transfer permit is required. 18 VSA sec 5311 requires that the cemetery plat be recorded and 18 VSA 5376 requires that the deeds to the lots be recorded. 5 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx e. The Form and Affidavit will be turned into the City of South Burlington Clerk’s Office with any necessary fee as determined by the Cemetery Commission f. The clerk will record the transfer in the cemetery management software. The clerk will then print a deed from the software and contact XXXX sign the deed. The deed will be clearly marked as a replacement for a previously issued deed with the following notation: This deed replaces a previously issued deed numbered _____of which certain burial plots have been transferred from ________________to the above Grantee. g. After the deed is signed the clerk will record the deed in the land records. h. Once a deed is recorded the XXXX will mail the copy of the deed to the buyer and will include a copy of these policies. i. The XXXX authorizing the transfer will verify that any existing corner pins are removed. When old corner pins are removed the City Clerk will contact a pin supply company to arrange the installation of new corner pins. j. A deed showing a transfer of plot ownership will be issued to any rightful heir so designated in a will or in trust, proof of which will be verified by a City Clerk pursuant to 18 V.S.A. § 5531. A spouse shall be entitled to transfer of ownership from a deceased spouse pursuant to 18 V.S.A. § 5531. Section 8. Memorials. a. All inquiries regarding memorials at any of City of South Burlington’s cemeteries, previously placed or proposed, will be directed to the XXXX. b. Prior to installation, memorials must have approval XXXX to verify correct location and appropriate installation. No memorial will be installed without prior approval of the XXXX. c. A memorial will be installed on all occupied plots. At a minimum a marker will be installed and engraved with the first and last name, date of birth, and date of death of the interred individual. d. Memorials will be installed by the applicable contracting company to ensure a secure placement. i. Unless otherwise approved by the Cemetery Commission, all above ground memorials must be set on a base supported by a foundation. Foundations will be flush with the ground, properly cured, and a minimum of 4” deep. ii. Unless otherwise approved by the Cemetery Commission, the area of the base of the memorial may not cover more than 20% of the area of the plot(s) it designates. The width of the base may not exceed 60% of the plot(s) width. The height of the monument may not exceed 48”. iii. Unless otherwise approved by the Cemetery Commission, markers must be a minimum of 10” by 20” wide, by 4” in thickness. Markers larger than 15” by 30” wide must be at least 6” in thickness. No lettering and/or carving on markers will be raised. e. Each plot, as determined by South Burlington Cemetery Commission, will be entitled to one memorial. This memorial will be placed at the head of the plot as designated by the City Council. f. If more than one memorial is desired on a plot then a marker will be used for each subsequent memorial not placed at the head of the plot. The marker will be flush with the ground to allow clearance for mowing over the marker. g. In cases where a temporary memorial is needed or desired, a wooden monument may be used at the head of a plot as designated by City Council. The wooden monument may be placed for a maximum of six months and may be removed by the City Clerk or designee. Commented [CM10]: Rules and Regs? Commented [CM11]: Sextons or City Council - SB can only have a Cemetery Commission if voted by the legal voters of the City. See 18 VSA 5373 Commented [CM12]: See above comment Commented [CM13]: Same comment as above. Commented [CM14]: Or sextons?? 6 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx h. If a memorial is not installed within three years of internment the City Council will install a marker with the inscription the first and last name, date of birth, and date of death of the interred individual, if the same are known, in accordance withper 18 V.S.A. § 5371. Section 9. Re-establishment of Burial Plot Ownership. a. This Section will address how to re-establish the ownership of burial plots in a South Burlington cemetery plot when a certificate or deed has been lost. All inquiries regarding previously purchased burial plots with no certificate or deed will be directed to the XXXX. b. When no certificate or deed is available the XXXX will use the maps on record at the City Office to verify ownership of burial plots. c. If ownership of plots is verified by XXXXXX, the City Clerk will be instructed to issue a deed. The deed information will be determined as follows: i. The grantor will be the City of South Burlington ii. The dollar sum will state “one or more dollars” iii. The grantee will be the name listed on the cemetery map iv. The plot corresponding to the grantee’s name as indicated on the map will determine the plot number and cemetery name v. The deed will be clearly marked as a replacement for a previously issued deed with the following notation: This deed replaces a previously issued deed which record of was lost by the City of South Burlington and the deed holder. This deed supersedes any previously issued deeds the record of which was lost for this cemetery plot. d. The XXXX who verified the plot information will sign the certificate. e. The deed will be issued and recorded following Section 5 Sale of Burial Plots of this Policy. f. If a name is not listed on the cemetery maps with the City of South Burlington, then ownership of a burial plot will not be re-established without a deed or other proof as accepted by the City Council Cemetery Commission Section 10. Return of Burial Plots to City of South Burlington. a. This Section is applicable to instances where a burial plot owner desires to return ownership of a South Burlington Cemetery plot back to the City of South Burlington. All return inquiries will be directed to the XXXX. b. Before authorizing a return, the XXXX will verify the ownership of the current deed holder or establish ownership following Section 9 Re-establishment of Burial plot Ownership of this Policy. c. In its discretion, the Cemetery Commission may buy back burial plots at the request of a deed holder for the amount that was paid at the time the certificate was acquired. The City will not refund or buy back corner pins or the deed recording fee. d. If the deed does not state the amount originally paid for the burial plots and proof of purchase cannot be provided the XXXX will in all cases pay a flat $100 per single plot for the return. e. When the City Council approves a return of burial plots the XXXX will fill out a Burial Plot Purchase form and submit it to the city office with request for payment. Once payment is issued the XXXX will forward the form and corresponding payment to the clerk. Commented [CM15]: See above comment re: Cemetery Commission. Commented [CM16]: See above comment. Commented [CM17]: Cemetery burial plot? Term used should be consistent throughout document. 7 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx f. The clerk will record the return in the cemetery management software. The clerk will then print a certificate from the software that will be clearly marked as a replacement for a previously issued certificate or deed with the following notation: This certificate replaces a previously issued certificate or deed numbered ___of which the ownership of certain burial plots have been returned to the City of South Burlington by the above Grantor. The City Clerk will sign the certificate and ensure the current owner transferring the plot to the City signs the certificate. g. After the certificate is signed the deed will be recorded in the land records. h. A copy of the recorded deed will be mailed to the seller with the payment. i. Return to Cemetery by Escheat. A plot may return to the applicable City of South Burlington Cemetery by escheat when the whereabouts of a person, or heirs, having legal title to a wholly unoccupied burial plot has been unknown for 20 years pursuant to 18 V.S.A. §§ 5532 and 18 V.S.A. §§ 5533. Section 11. Rules for Use and Visitation of Cemeteries. The main purpose of the cemeteries shall be a burial place for the remains of the deceased and those that want to pay their respects. Other types of low impact secondary uses, such as walking are permissible, provided they do not interfere with the primary use. Any uses other than those stated must receive advance written permission from the South Burlington City Council Cemetery Commission. a. All users and visitors of City of South Burlington Cemeteries are prohibited from the following: i. Gathering, picking or cutting in any manner the fauna or flora. The defacing, damaging or destroying of any plants, lawn fence, structures, trees, bushes or memorials in either cemetery is prohibited. ii. Dumping, depositing, discarding, throwing, or leaving solid waste, including discarded floral arrangements or wreaths, within the City Cemeteries. iii. Use of illegal drugs and alcoholic beverages within City Cemeteries. iv. Camping or tenting of any type within the City Cemeteries. v. Peddling or soliciting of any commodities or services in City Cemeteries. vi. Placement of signs, notices or advertisements of any kind are not permitted without the expressed written permission of the City Council via the City Clerk. vii. Discharging firearms orf weapons of any kind within the cemeteries is prohibited. Exceptions are for military burials only. viii. No vehicle will be driven or parked across or upon any grace, plot or lawn except by permission. Vault and monument dollies are permitted. ix. The City recognizes the beauty of cemeteries, and the desire of the individuals to walk through them. In order to respect others, all pets are to be leashed while in the cemeteries and owners are required to properly dispose of their pet’s waste. x. The City of South Burlington or its employees as well as Sextons will not be responsible for any order or arrangements made over the telephone, nor with thy be responsible for any mistakes occurring from the lack of precise and proper instruction as to the particular space, size or location of any gravce, plot or memorial. Commented [CM18]: See comment below. Commented [CM19]: Are certificate and deed being used interchangeably here? Should we just require them to deed the plot back to the City and the City will record the deed? Because a deed is provided when ownership of the plot is conveyed by the City, I do not think a certificate is sufficient to transfer ownership back to the City. Commented [CM20]: See above comment re cemetery commission. Commented [CM21]: Should this be the Clerk or the Sextons? 8 4nd Draft written 8/23/2022 Approved xx/xx/xxxx - Effective x/xx/xxxx xi. These Rules and Regulations and any amendments thereto, shall be the sole agreement between the City of South Burlington and the holder of the Certificate of Burial. The statement of any employee or agent, shall in no way bind the City of South Burlington. b. The planting of natural flowers is allowed only at the base of memorials and will be removed by November 1st or sooner as deemed necessary by the City Council. c. Cemeteries are open to the public from sunrise to sunset. Section 12. Amendments. a. This Policy may be amended by majority vote of the South Burlington City Council. ADOPTED: __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ ____________________ Signatures Date 9 Appendix. Cemetery Forms 10 Affidavit of Sale of Burial plot, CITY OF SOUTH BURLINGTON, VT State of VERMONT ) ) ss. County of CHITTENDEN) COMES NOW ________________________________________________ and states that he/she/they sold burial plot(s)___________________ in _________________________Cemetery to____________________________________________________________________________ on the ______ day of________________, 20____. Signature_______________________________ Address: ________________________ ________________________ State: _________ Zip: __________ SUBSCRIBED AND SWORN TO before me in South Burlington, Vermont this _______ day of________________, 20____, by_______________________________________. ___________________________ NOTARY PUBLIC My Commission Expires: ________________ 11 Burial plot Purchase Form, City of South Burlington, VT Buyer (Grantee) Seller (Grantor) Name: _________________________________ Mailing Address: Is buyer a Resident?  Yes  No Buyer must complete form and submit to South Burlington City Office with applicable payment. Name: __________________________________ Mailing Address: Is this a transfer?  Yes  No If yes, an affidavit of sale must be attached Lot Information Anticipated Burial Type Cemetery: ______________________________ Section: ________________________________ Row: __________________________________ Plot(s):_________________________________  Casket (1 burial per single plot)  Cremation, container (4 burials per single plot)  Cremation, vault (2 burials per single plot)  Memorial Only Cemetery Commission Review Printed name of Cemetery Commissioner responsible for sale: ______________________________ Date of plot probing:______________________ Date sale/transfer approved:__________________ Signature of City Clerk responsible for sale: _________________________________ Burial plot Purchase Price Burial plot Transfer Fee Burial plot Price: Corner Pins Price: Corner Pins Price: Deed Recording: Fee: Deed Recording Fee: Total: Total: Corner Pins Standard Letter to be engraved on corner pins: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Date corner pins ordered:___________________ Date corner pins installed:__________________ For transfers only: Are corner pins currently in place?  Yes  No If yes, date corner pins of previous owners were removed:_________________________________ Se c t i o n t o b e c o m p l e t e d b y B u y e r Se c t i o n t o b e c o m p l e t e d b y C it y C l e r k Book_______ Page_______ 12 Deed of Burial plot, City of South Burlington, VT KNOW ALL PERSONS BY THESE PRESENTS, that Grantor _____________________ of South Burlington, Vermont in consideration of the sum of ______________ dollars ($______), the receipt of which Grantor hereby acknowledges, grants, bargains, sells, and conveys to the Grantee__________________________________________, his/her/their heirs and assigns the following burial plot in the City of South Burlington. This burial plot is more specifically described as Section ______, Row ______, plot ______ in the_______________________________________ Cemetery, as shown on the map on file at the South Burlington City Office. TO HAVE AND TO HOLD this burial plot to Grantee(s), his/her/their heirs and assigns forever, subject to the South Burlington City Regulations, Rules, and Bylaws and Vermont Law. And Grantor covenants with Grantee that this right is lawfully seized by Grantor, that Grantor has the right to sell and convey this burial plot for the purpose of a burial place, and that Grantor will warrant and defend the same. This certificate and the rights herein granted shall only be transferred with written approval of the City Council of the City of South Burlington, Vermont. In witness whereof, __________________________________, City Clerk appointed by the City Council of the City of South Burlington, and hereby sets hand and seal. CITY OF SOUTH BURLINGTON ________________________ Chair, City Council ______________________ Witness STATE OF VERMONT CHITTENDEN COUNTY, ss. At South Burlington, in said county, this ______ day of ____________, 20____, personally appeared_____________________, City Clerk appointed by the City Council of the City of South Burlington, who executed the foregoing instrument, on behalf of the City of South Burlington and acknowledged the same to be his/her free act and certificate and the free act and certificate of the City of South Burlington, Vermont. Before me___________________________ Notary Public Burial and Memorial Form, City of South Burlington, VT 13 Completed by: ___________________________________ Date:_____________________ Owner of Burial Plot(s) Individual to be Buried (Decedent) Name: _____________________________________ Mailing Address: Cemetery: __________________________________ Section: _________ Row: ________ plot: _________ Deed Number: _____________________ Relationship to deceased: _____________________ Name:___________________________________ Alias/Maiden Name: _______________________ Sex:  Male  Female Date of birth:______________________________ Place of birth:_____________________________ Date of death:____________________________ Place of death:____________________________ A veteran?  Yes  No Branch: ______________ Era: _______________ Married at time of death?  Yes  No Spouse’s Name: ___________________________ Father’s Name: ___________________________ Mother’s Maiden Name: ____________________ Funeral Home Name: __________________________________________ Address: Date plot will be opened:______________________ Date of burial:_______________________________ Burial Type:  Casket  Cremation:  Container  Vault Date of cremation:___________________________ Memorial Information Memorial Company: ____________________________________________________________________ Memorial Type:  Headstone  Marker  Temporary Marker, Date to be removed by:_____________ Material: _______________________ Price $__________ Date memorial to be placed:_______________ Inscription:____________________________________________________________________________ City Review Printed name of City Clerk coordinating burial:____________________________________________ Date of plot probing: _________________________ Date plot staked:_____________________________ Signature of City Clerk: Date: