CITY OF RAEFORD

315 NORTH MAIN STREET

RAEFORD, N.C. 28376

ATTENTION: MISS BETTY SMITH

CITY CLERK

REQUEST FOR CEMETERY SERVICE

The undersigned hereby request of the City of Raeford that a burial plot in number _____

of the ______________________________ section of the Raeford Cemetery be opened

for the interment of the body of ______________________________________.

The plot must be opened before __________ (A.M. – P.M.) on ___________________,

_____________________ 20____. The undersigned agrees to assume full responsibility

for the payment of any charges made by the City of Raeford for the above requested

cemetery service.

LOT FEES:

City Resident, pre-need. . . . . .$250.00/space ______________________ SEAL

City Resident, at-need. . . . . . .$275.00/space

Non-Resident, pre-need. . . . . .$325.00/space ______________________ DATE

Non-Resident, at-need. . . . . . .$350.00/space

NOTE: ONLY THE PERSON ASSUMING LIABILITY FOR THE ABOVE REFERRED TO WILL BE PERMITTED TO REQUEST PLOT OPENING.

THE ABOVE REQUEST APPROVED BY: _______________________

CITY OF RAEFORD

BIRTH DATE: ____________________

DEATH DATE: ___________________