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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. City*
9. State*
10. Zip Code*
12. Applicant's Phone Number*
13. Email
15. Rights Holder's Name*
17. Rights Holder's Address*
19. City*
20. State*
21. Zip Code*
23. Rights Holder's Phone Number*
24. Email
26. Parcel Intentions
    Limit of two (2) burials per Parcel
28. Parcel Location
30. Block
31. Section
32. Lot
33. Space(s)
35. Rose Garden
37. 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.)
39. Double Depth

    1. Yes
    2. No

    This option is reviewed by staff
41. Specific Instructions
    Please note any future burials, specific requests, parcel assignments, etcetera.
43. Please Note:
    I understand that any changes to the information provided herein, requires an updated Application Form.
45. 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.
46. Date*
    Date
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field