Data Collection Form - First Woodbine Church

Purchaser Data

Name of grave plot Purchaser *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Cell Number

Main Email *

Email

Relationship to deceased or person the plot is purchased for *

Power of Attorney

Click or drag a file to this area to upload.

Please upload a copy of Power of Attorney if any

Lot Purchase Data

Full Name of Plot owner *

First

Last

Full Name of Plot owner

First

Last

How many plots purchased *

Date of purchase of burial plots *

Plot Location

Section *

Block Number *

Grave Number(s) *

Pre Neet/ At Need *

Pre Need
At Need

Type of grave purchased *

Date of First Burial if already done

Date of Second Burial if already done

Additional Burial Information

Please provide us with any additional information you may have.

Date of Plot Purchase *

Who did you purchase opening and closing services from and amount paid?

Please provide us any detail information you may have about opening and closing and amount you paid.

Who did you purchase the vault or grave liner from and amount paid?

Please provide us any detail information you may have about the vault or grave liner and the amount you paid.

Total purchase price of land plus opening & closing & vault or graver liner

Perpetual Care fee Paid (if any)

Payment Method *

Proof of Purchase & Payment *

Click or drag files to this area to upload. You can upload up to 20 files.

Copy of Bank Statement, Credit Card Statement or any other document(s), cash receipt in addition to all the documents provided by cemetery, which proves the purchase and payment.

Cemetery Map showing plots purchased

Click or drag files to this area to upload. You can upload up to 5 files.

Please upload a copy of Cemetery Map if you have one.

Funeral Home Information

Funeral Home Name

Name of Funeral Home Director

Address

Address Line 1

City

State

Zip Code

Phone Number Main

Cell Number

Email

Deceased Information

Name of lot Deceased

First

Last

Date of Death

Name of Next of Kin

Relationship to the Purchaser

Already Buried?

Yes
No

Burial Date

Section, Plot Number and Allocated Grave Number

Full Body or Cremation Burial?

Full Body
Cremation Burial

Tombstone information if already purchased

Memorial Type

Single
Companion

Name, Address and phone number of the monument dealer

Already Installed?

Yes
No

Name on the memorial

First

Last

Date of Birth

Date of Death

Name on the memorial

First

Last

Date of Birth

Date of Death

Granite Color of memorial

Please upload picture(s) of installed memorial

Click or drag files to this area to upload. You can upload up to 10 files.

First Woodbine Church

Purchaser Data

Lot Purchase Data

Plot Location

Funeral Home Information

Deceased Information

Tombstone information if already purchased

Address: