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2. Marker Information:

   One grave marker allowed per plot, placed at the head of the grave. All markers must be of granite or real bronze, not smaller than 8 X 16 and not larger than 18 x 42 with a thickness of at least 4 inches, the top being set even with the contour of the ground. Please contact Public Works at 801-849-9463 or email recorder@bluffdale.com for delivery/ installation appointment.

4. Open-Close Fees:

   Fees must be paid before work order is submitted. To pay with VISA or MC, call 801-254-2200.       

   Adult $675  *Saturday- Holiday $800         Infant-Urn $450  *Saturday- Holiday $575

6. Full Name of Deceased:*
8. Date of Birth:*
9. Place of Birth:
11. Date of Death:*
12. Place of Death:*
14. Full Name of Spouse:
16. Full Name of Father:
17. Full Name of Mother:
19. Veteran:*

    1. Yes

    1. No
20. Military Branch/ War:
22. Applicant Name:*
24. Applicant Address:*
26. Applicant Phone Number:*
27. Applicant Email:
29. TRANSFER INFORMATION:

    Upon the death of the plot owner, all plots must be transferred to a living person. (Complete this section if different than Applicant and provide legal documentation such as court order, power of attorney, will, or signatures of all living heirs directing new owner assignment and email to recorder@bluffdale.com).

31. New Owner Name:
33. New Owner Address:
35. New Owner Phone Number:
36. New Owner Email:
38. Original Certificate Number:
39. New Certificate Number:
43. Funeral Director:*
44. Time/Place of Funeral:
46. Phone Number:*
47. Email:*
49. Obituary Date:
50. Burial Type:*
52. Burial Date:*
53. Arrival at Cemetery:*
55. OFFICE USE ONLY
57. Grave Location:
58. Work Order Sent:
60. Receipt
61. Map
62. State List
63. SG
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field