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Burial Permit Application

See list of cemetery locations before completing this form.

Burial Permit Application

Application form for all interments in cemeteries within the Dubbo Regional Council LGA.

Name* - required

Business Name* - required

ABN* - required

Address Line 1* - required

Address Line 2

City State Postcode* - required

Contact telephone number* - required

Email* - required

Location of cemetery* - required

Dubbo and district Wellington and villages

Dubbo cemeteries

Dubbo Cemetery Name

New Dubbo Cemetery Old Dubbo Cemetery Tubbagah Aboriginal Burial Ground Rawsonville Cemetery

Dubbo location specifics

Name of Section

Memorial Nursery Peace Serenity Tranquility Remembrance maximum 1 allowed

Number

One Two Three Four Five maximum 1 allowed

Row

Plot Number

Single or Double Depth* - required

Single depth Double depth Re-opening

Wellington cemeteries

Wellington Cemetery Name

Elong Elong Cemetery Euchareena Cemetery Euchareena Cemetery Columbarium Wall Geurie Cemetery Geurie Cemetery Columbarium Wall Holy Family Cemetery Spicers Creek Cemetery Stuart Town Cemetery Stuart Town Cemetery Columbarium Wall Wellington General Cemetery Wellington Lawn Cemetery Wellington Columbarium Wall Wellington Memorial Garden Wellington Rose Garden Yeoval Cemetery Yeoval Cemetery Columbarium Wall

Wellington location specifics

Name of Section

Row Number

Plot Number

Name of Deceased* - required

Last known address of deceased* - required

Occupation of deceased* - required

Gender* - required

Male Female

Age

Date of death* - required

Date of Birth* - required

Next of kin* - required

Applicant* - required

Relationship* - required

Coffin Size* - required

Date of Burial* - required

Service* - required

Time of Church Service* - required

Approximate time of Burial* - required

Plots on hold

Name

Address

Telephone Number

Mandatory field(s) marked with *

Last Edited: 01 Apr 2019

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(02) 6801 4000
(02) 6801 4259
council@dubbo.nsw.gov.au
P.O. Box 81
Dubbo NSW 2830

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Cnr Church and Darling streets, Dubbo

Customer Service Centre - Wellington Office
Cnr Nanima Crescent and Warne Street, Wellington

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