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2. Instructions
   Please complete this application to the best of your knowledge. Once submitted, the application will be reviewed and you will be contacted with purchase details and payment instructions.
4. Applicant's Name*
6. Applicant's Address*
8. Applicant's Phone Number*
9. Email
11. Rights Holder's Name*
13. Rights Holder's Address*
15. Rights Holder's Phone Number*
16. Email
18. Parcel Intentions
    Limit of two (2) burials per Parcel
20. Parcel Location
22. Block
23. Section
24. Lot
25. Space(s)
27. Rose Garden
29. Please check one

    1. Full Burial
    2. Cremains
    3. Unknown at this time (If Rights Holder chooses "unknown", only one burial will be allowed in this Parcel.)
31. Double Depth

    1. Yes
    2. No

    This option is reviewed by staff
33. Specific Instructions
    Please note any future burials, specific requests, parcel assignments, etcetera.
35. Please Note:
    I understand that any changes to the information provided herein, requires an updated Application Form.
37. Signature*
    By typing your name in the field available, you are hereby authorizing the City of Spearfish, South Dakota to accept this as your electronic signature.
38. Date*
    Date
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field