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Park County Public Works 1246 CR 16, Fairplay, CO 80440 Office (719) 836-4274 www.parkco.us BURIAL REQUEST FORM CEMETERY BOARD MEMBER/CONTACT: CEMETERY NAME: NAME OF DECEASED: PLOT# AND LOCATION: MORTUARY: TYPE OF BURIAL: FULL CREMATION URN VAULT COMPOSITION/TYPE: Circle one: WOOD FIBERGLASS CEMENT VAULT (LENGTH) 92” (WIDTH) 36” (HEIGHT) 32” CIRCLE ONE: REMOVE SOIL LEAVE SOIL OPEN DATE: CLOSE DATE: DATE OF SERVICE: TIME OF SERVICE: PERMISSION TO ENTER CEMETERY WITH HEAVY EQUIPMENT: NAME: PARK COUNTY PUBLIC WORKS POSITION: DATE: RESPONSIBLE PARTY FOR BURIAL: NAME: RELATIONSHIP: MAILING ADDRESS: CITY: STATE: ZIP CODE: Full casket burial cost is a minimum of $400.00 and increases to a cap of $2,00.00 dependent on the difficulty encountered for excavation of 10 ft. by 5 ft. by 6 ft. deep. The full amount to be charged will not be available until burial site is completed after the excavation. Cremains casket burial cost is $200.00 for 1 ft. by 1 ft. by 2 ft. deep excavation.