Archdiocese of Newark - Catholic Cemeteries

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E-mail:
Interment Authorization
(PLEASE PRINT AND COMPLETE IN FULL

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Arrival Time
:
Mass Time
:

Funeral Home Section

Funeral Home Address

Vault Company Section

For Cemetery Office Use Only

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Family & Funeral Director Section

Please check one:(Required)
I/We, the Original Certificate Holder(s), or all heir(s) of the original Certificate Holder, hereby authorizes the opening of (Full Location of Grave/ Crypt/ Niche) to inter the remains of (Name of Deceased) in said location.

Family Names and Addreses

Deponent(s) further agree to hold harmless, and to defend and indemnify, the Roman Catholic Archdiocese of Newark and its officers, employees, representatives and agents from any loss or claim arising from reliance upon the information contained herein.
Name
Address
Clear Signature

Family Member #2

Name
Address
Clear Signature

Family Member #3

Name
Address
Clear Signature

Funeral Director (Witness)

Fun. Dir. Name
Clear Signature
ACH
Electronic Signature(Required)