Burial Requests

Person/Organization Placing Order
Name * Required
First Last
Phone * Required
Email * Required
Funeral Home Conducting Service
(if same as above please provide only contact name)
Funeral Home Name * Required
If you are requesting a cremains burial without the support of a funeral home, please enter N/A.
Funeral Home Contact Name
First Last
Phone
Email
Next of Kin
Name * Required
First Last
Phone * Required
Email
Decedent Information
Name * Required
First Middle Last Suffix
Age * Required
Please enter a number less than or equal to 130.
Age at time of death
Gender * Required
Date of Death * Required
MM slash DD slash YYYY
Is the decedent a military veteran? * Required
Which branch of the service did the decedent serve in?
In what era did the decedent serve?
Is the decedent a resident of Columbia Township? * Required
Ethnic Background
Optional information for genealogy purposes. Select all that apply.
Location of Plot, if known
Cemetery
Section and/or Row
Lot Number
Plot Number
Any additional information you have about the location of the plot
Plot Owner
Name
First Last
Relationship to Decedent
Phone
Email
Burial Information
Type of Burial * Required
Requested Burial Date * Required
MM slash DD slash YYYY

Weekend and winter burials require an additional fee. (See our fee schedule for more information.)
Requested Burial Time * Required

: Hours

Minutes

AM/PM AM/PM

Time must be between 9 a.m. and 3 p.m.
Genealogy Decedent's Information
All of this information is optional but any that is offered will be maintained for genealogy purposes.
Former Name(s)
Birthplace (city/town)
Birth State
Birth Date
MM slash DD slash YYYY
Former Address(es)
Mother's Maiden Name
Prefix First Middle Last Suffix
Father's Name
Prefix First Middle Last Suffix
Maternal Grandmother's Name
Prefix First Middle Last Suffix
Maternal Grandfather's Name
Prefix First Middle Last Suffix
Paternal Grandmother's Name
Prefix First Middle Last Suffix
Paternal Grandfather's Name
Prefix First Middle Last Suffix
Spouse's Name
Prefix First Middle Last Suffix
Number of Children
Please enter a number less than or equal to 100.
Child 1 Name
Prefix First Middle Last Suffix
Child 2 Name
Prefix First Middle Last Suffix
Child 3 Name
Prefix First Middle Last Suffix
Child 4 Name
Prefix First Middle Last Suffix
Child 5 Name
Prefix First Middle Last Suffix
Child 6 Name
Prefix First Middle Last Suffix
List additional children
Number of Siblings
Please enter a number less than or equal to 100.
Sibling 1 Name
Prefix First Middle Last Suffix
Sibling 2 Name
Prefix First Middle Last Suffix
Sibling 3 Name
Prefix First Middle Last Suffix
Sibling 4 Name
Prefix First Middle Last Suffix
Sibling 5 Name
Prefix First Middle Last Suffix
Sibling 6 Name
Prefix First Middle Last Suffix
List additional siblings
Other Relatives of Note
Faith/Establishment
Cremation Date, if any
MM slash DD slash YYYY
Additional Information
Obituary
Paste obituary here or attach below
Documentation
Accepted file types: jpg, jpeg, pdf, png, Max. file size: 25 MB.
This could include burial certificates, cremation certificates, obituaries, or anything pertinent to the other information in this form.
If you need to provide additional information, please contact us at secretary@columbiatwp.com or 269.434.6227.
Comments
This field is for validation purposes and should be left unchanged.

Accepting passenger tires, free of charge, at regular dump hours - until further notice.

Burial Request

Person/Organization Placing Order

Funeral Home Conducting Service

Next of Kin

Decedent Information

Location of Plot, if known

Plot Owner

Burial Information

Genealogy Decedent's Information

Additional Information