Inurnment Form

If you or a loved one wishes to be inurned at the Chapel of Peace please fill out the information below and submit it.

Today's Date

Your Name

Address

Phone number

Please include your area code

Name, as you would like it to appear on the plaque

We will place an order for a custom plaque, which will read "NAME Birth Yr - Death Yr"

Birth date

Death date

Number of spaces you would like to reserve for inurnment

One empty niche can hold eight of our custom urns

Who will make decisions on your behalf after your passing?

Secondary contact information

Contact information for individual(s) named above

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