Victorian Numbered Regulations

CEMETERIES AND CREMATORIA REGULATIONS 2005 (SR NO 76 OF 2005) - SCHEDULE 2

SCHEDULE 2

Sch. 2

Regulation 7

Cemeteries and Crematoria Act 2003

Cemeteries and Crematoria Regulations 2005

APPLICATION FOR INTERMENT APPROVAL FOR INTERMENT OTHER THAN IN A PUBLIC CEMETERY

The deceased

Full name:

Sex: *Male *Female

Date of birth:

Date of death:

Last known permanent address:

Applicant for interment approval

Full name:

Address:

Telephone number:

Email:

Relationship to the deceased:

Location of proposed interment

Interment location (property details including address and Certificate of Title folio and volume reference, and if the interment is proposed to take place on Crown land, Crown allotment details):

Location of interment on land (GPS co-ordinates):

Details of other interments at the proposed place of interment

Is there a record of another person having been buried on the land?
*Yes *No

If Yes, provide details and copies of relevant documentation relating to any previous interments on the land.

Is the existing grave clearly marked? *Yes *No

If Yes, provide details, such as existing headstones, fencing of grave.
Sch. 2

Consent of Land Owner or Manager and Details of Interests in the Land

Is the land on which the interment is to take place:
*Crown land *Privately owned land

If the land is privately owned land, are you the owner? *Yes *No

If the land on which the interment is to take place is Crown land, attach a statement from the body responsible for the management of that land that you are authorised to carry out the interment on the land.

Statement attached:

If the land upon which the interment is to take place is not Crown land (i.e. privately owned land) and you are not the owner of the land, provide the following details of the owner and attach a statement from the owner that you are authorised to carry out the interment on that person's property.

Full name of owner:

Address:

Telephone number:

Statement attached:

For all applications, provide the details of any other person with any interest in the land on which the interment is to take place:

Full name:

Address:

Nature of interest in land:

Other matters
Sch. 2

Details of funeral director or the person who otherwise arranged for the disposal of the human remains:

*Company Name:

Full name of contact person:

Address:

Telephone number:

Fax:

Email:

Dimensions of coffin, receptacle or container if any:

Length:     Width:     Depth:

Material of which coffin, receptacle or container is constructed (e.g. wood or metal):

Description of memorial or marker to be placed over the place of interment:

Signature of applicant:         Date:

* Delete if not applicable
Sch. 2

WARNING

Under section 122 of the Cemeteries and Crematoria Act 2003 it is an offence to make a false statement in an application for an interment approval, punishable by a fine of up to 240 penalty units or 2 years imprisonment or both.

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