REQUEST FOR BURIAL

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THIS CALENDAR IS FOR REFERENCE PURPOSES ONLY, IT IS NOT INTERACTIVE. PLEASE USE THE FORMS BELOW TO REQUEST YOUR BURIAL DATE.

REQUEST FOR BURIAL:

PLEASE INSURE ALL INFORMATION PLACED ON THIS FORM IS ACCURATE. THERE WILL BE A $50.00 FEE, CHARGED TO THE CUSTOMERS, TO REVISE ANY DOCUMENTS IF WE HAVE BEEN PROVIDED WITH THE WRONG INFORMATION (SPELLING, DATES, ETC.)

FOR FUNERAL DIRECTOR USE

This form is to be submitted ONLY by the funeral director for the requested burial.

* Indicates required field

Full Name of Funeral Director *

Funeral Home Name *

Phone Number of Funeral Director *

Email of Funeral Director *

Confirm Email *

Will the funeral home be providing the vault? *

Yes No

If yes, please list the vault company's name. Otherwise, please list N/A. *

Please list the vault company's phone number. Otherwise, please list N/A. *

Full Name (as it appears on the Death Certificate) of Deceased *

Place of Death (as it appears on the Death Certificate) *

Date of Birth *

Date of Death *

Was the deceased a member of the military? *

Yes No

If yes, what branch? *

Full Name (as it appears on the Driver's License) of Legal Representative of Deceased *

Relationship to Deceased *

Address of Legal Representative (Street Address) *

Address of Legal Representative (City, State, Zip) *

Phone number of legal representative *

Email of Legal Representative *

Confirm Email *

Funeral Location (i.e. funeral home, place of worship, etc.) *

Funeral Time *

Requested Burial Date at Stafford (to be confirmed by the cemetery) *

Requested Burial Time at Stafford (to be confirmed by the cemetery) *

Burial Type *

Full Casket Cremation

Casket Material *

Metal Wood Other

If other, please list the casket material. *

Casket Size *

Standard (27 inch. wide) Oversized (Larger than 27 inch. wide)

If oversized, please list the dimensions. *

Does the deceased own interment rights? *

Yes No

If no, is the family looking for a specific location (i.e. to be close to family, etc.)? *

Additional Comment(s): *

Submit

FOR FAMILY (WITHOUT FUNERAL DIRECTOR) USE

This form is to be submitted by the (family or legal) representative of the deceased, if you are not working with a funeral director.

* Indicates required field

Full Name (as it appears on the Death Certificate) of Deceased *

Place of Death (as it appears on the Death Certificate) *

Date of Birth *

Date of Death *

Was the deceased a member of the military? *

Yes No

If yes, what branch? *

Full Name (as it appears on the Driver's License) of Representative (Family or Legal) of Deceased *

Relationship to Deceased *

Address of Legal Representative (Street Address) *

Address of Legal Representative (City, State, Zip) *

Phone Number of Legal Representative *

Email of Legal Representative *

Confirm Email *

Preferred Date and Time *

Burial Type *

Full Casket Cremation

Burial Plan (i.e. full casket burial, cremation) *

Casket Material *

Metal Wood Other

If other, please list the casket material. *

Casket Size *

Standard Oversized

If oversized, please list the dimensions. *

Does the deceased own interment rights? *

Yes No

If no, is the family looking for a specific location (i.e. to be close to family, etc.)? *

Additional Comment(s): *

I understand that there will be a $50 fee added to the contract if the information listed above is incorrect. *

I understand

Submit

Stafford memorial park

office hours

154 Shelton Shop Road
Stafford, VA 22554

BY APPOINTMENT ONLY

Phone: (540) 659-2191
Email: inforequest.smp@gmail.com

funeral scheduling

To submit a funeral request for your preferred date and time, please click here. We will respond within 24 hours of your request or when our office reopens, whichever occurs first.

Location

directions

From Richmond, VA
95 N to Exit 140 for County Rd 630 towards Stafford
Turn left onto Courthouse Rd
Turn right onto Co Rd 648/Shelton Shop Rd

From Washington, DC
95 S to Exit 143B for County Rd 610W towards Garrisonville
Turn right onto County Rd 610W - Garrisonville Rd
Turn left onto Shelton Shop Road