An Order for Interment Purpose of this application form A cemetery operator must complete and issue this order for interment before it conducts an interment at the site. Section 67 of the Cemeteries and Crematoria Act 2013 provides that an interment must not take place in a cemetery unless the cemetery operator has issued an order for interment. Reservation* - required Pre-Reserved Site No Reservation Pre-Reserved Site Cemetery* - required Please Select Tamworth Attunga Barraba Bendemeer Bowling Alley Point Dungowan Manilla Kootingal/Moonbi Hanging Rock Nundle Somerton Section Plot No Reservation Cemetery* - required Please Select Tamworth Attunga Barraba Bendemeer Bowling Alley Point Dungowan Manilla Kootingal/Moonbi Hanging Rock Nundle Somerton Order for:* - required First interment Re-opening Placement of ashes First Interment / Re-opening Date of Interment* - required Time of Interment (HH:MM AM/PM)* - required Casket/Coffin Size* - required Standard Oversize Depth of Grave* - required Single (6ft) Double (8ft) First Name of Deceased* - required Last Name of Deceased* - required Last Known Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Date of Birth* - required Date of Death* - required Age of Deceased* - required Marital Status* - required Occupation* - required Religion* - required Service Type* - required Church Graveside OtherOther text RecFullName Placement of Ashes Date of Interment* - required Time of Interment (HH:MM AM/PM)* - required Cemetery* - required Please Select Tamworth Attunga Barraba Bendemeer Bowling Alley Point Dungowan Manilla Kootingal/Moonbi Hanging Rock Nundle Somerton Placement of Ashes* - required Columbarium Wall Garden Existing Grave Within Casket/Coffin First Name of Deceased* - required Last Name of Deceased* - required Last Known Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Date of Birth* - required Date of Death* - required Age of Deceased* - required Marital Status* - required Occupation* - required Religion* - required Service Type* - required Church Graveside OtherOther text Next of Kin or Secondary Interment Right Contacts First Name* - required Last Name* - required Street Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Phone Number* - required Email Address Relationship to the Deceased* - required Funeral Director* - required Select Burke & Douglas Funerals, 45 Gunnedah Road, Tamworth Shaun Hamilton Funerals, PO Box 683, Tamworth NSW 2340 Fletcher Brothers Funerals, 63/65 Edward St, Barraba NSW 2347 Lightfoot Funerals, PO Box 262, Gunnedah Other/Family Request - please provide details Funeral Director Details / Requesting Family Details Name of Funeral Director Company/Full Name of Requesting Family Member* - required Street Address* - required Suburb* - required State* - required Select ACT NSW NT QLD SA TAS VIC WA Postcode* - required Phone Number* - required Email Address* - required Arrival Time at Cemetery (HH:MM AM/PM)* - required Please call Council's Cemeteries Desk on (02) 6767 5555 for payment or Check box to receive an invoice for payment. Do you consent to Tamworth Regional Council updating their records with the information provided above?* - required Select Yes No Privacy Declaration Information collected on this form is held in accordance with Privacy and Personal Information Protection Act 1998. Personal information is collected for a lawful purpose that directly relates to our primary function of providing cemetery/cremation services in accordance with the Cemeteries and Crematoria Act 2013. We will not collect any more information than is necessary to fulfil these functions. Except as necessary to carry out these functions, we will not disclose your personal information to anyone without your consent unless legally required to do so. We will take all reasonable steps to protect the security of any personal information held, be it stored in electronic or hard copy format. You may request access to your personal information held by us, except in the circumstances set out in Part 2, Division 3 of the Privacy and Personal Information Protection Act 1998. Terms and Conditions Click here to read Terms and Conditions Acknowledgment/Declaration I acknowledge that all information provided on this form is true and correct to the best of my ability.* - required I have read and understood the Terms and Conditions Mandatory field(s) marked with *