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City of Salem, MA Greenlawn Cemetery ~ INTERMENT ORDER ~ The undersigned hereby requests and authorizes Greenlawn Cemetery, Salem, Massachusetts, subject to its Rules and Regulations, to inter in: Grave No. Lot No. Location on the day of the remains of late of who died at (City & State of Last Residence) on the day of , aged (Day) (Month) (Age) Dated at this day of (City, State) (Day) (Month/Year) I hereby certify that I am the (relationship) of the above named decedent and this is your authority to make disposition of the remains of said decedent as above indicated. I hereby certify and represent that I have the legal right to make this authorization and I agree to hold Greenlawn Cemetery harmless from any liability on account of such authorization and interment. Address: Signature Printed Name Address: Owner or Legal Representative – Signature Owner or Legal Representative – Printed Name If representative, provide relation to original owner: Funeral Director: Owners or legal representative should give personal attention to interment orders. The Cemetery is not responsible for orders and location of graves received by telephone. Interments cannot be made without the Board of Health permit & properly signed orders. Twenty-four hour notice is required before interments can be made. THIS FORM MUST BE NOTARIZED