Cemeteries Office
Huddersfield Crematorium
Fixby Road
Huddersfield
HD2 2JF
Tel:   01484 456999 – option 3
Fax:  01484 469836	
		Bereavement.services@kirklees.gov.uk	

Statutory Declaration

Cemetery……………………..………..Section …………Grave No……..……Deed No…….………… Con/Gen (“Grave”)

I …………………………………….…….………………………of………………………………..……………..………..……………

…………………………………………..…..………………. Post Code .……..………………. Tel No. …………..................…….

(State name, address and telephone number of person making the declaration)

Do solemnly and sincerely declare that :

1.  a)  I am the registered owner of the exclusive right of burial (“Owner”)  in the Grave; or 

	b)  ……………………………………………………………… (Name of Owner) owned the exclusive right of burial in the Grave and who is now deceased; or

c)  ………………………………………..………………… (Name of Owner ) or his lawful successor owned the exclusive right 
     of burial in the Grave and transferred it to me by way of the attached signed document or who has signed the form of        
     renunciation overleaf.  
       (Delete a, b or c as applicable) 

And that :

2.  a) The  current Certificate of ownership of the exclusive right of burial in the Grave (“Certificate”) is enclosed for 
         amendment; or

     b) Notwithstanding an exhaustive search for the Certificate amongst all the papers in my possession, control or 
         custody I believe it is lost or mislaid and shall return it to Bereavement Services as soon as it is found. To the best 
         of my knowledge and belief the Owner did not specify any other person in the Certificate or in an indorsement thereon.
       (Delete a or b as applicable) 

And that: 

3.  (This section is not applicable if you are the Owner stating that the Certificate is lost)

a)  I am the………..…………………………(state relationship) of the Owner and the person lawfully entitled to   the exclusive   
    right of burial in the Grave under the terms of the Certificate either by way of a lifetime transfer, the terms of the   
    Owner’s will or the law of intestacy: and

              i)  There are no other persons entitled to any interest in the said exclusive right of burial; or
             ii)   All the other persons entitled to any interest in the said exclusive right of burial have signed the form of 
                  renunciation overleaf: or 
                    (Delete i or ii as applicable) 

     b)  Other………………………………………………………………………………………………………………….	

I shall indemnify Kirklees Council and all its officers and servants from any liability whatsoever arising from my making this declaration.
I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declaration Act 1835.

Declared at ………………………………………………………….………………………….……………………………………..
.
This ……………….…..………………..…..day of ………………………………………….. 20 ……..….……..………….……..

Signature ………………………………………..……………….……..…………………….………………….……………..……..

Before me ………………………………………………….…………………. Justice of the Peace / Commissioner for Oaths

This is Kirklees Council, Civic Centre 1, Albion Street, Huddersfield, HD1 2NF.  
The Council’s Data Protection Office contact details are information.governance@kirklees.gov.uk.

The information provided by you is collected purely for the purposes of Bereavement Services.  We need to collect this information in order to maintain accurate records of your name and contact details.  Completion of sharing your information with us constitutes explicit consent from you for us to process your data for this purpose.  Processing is necessary to protect the vital interests of a data subject or another person.  You have the right to see what information is held about you, to have inaccurate information corrected, to have information removed from our system unless we are required by law or a statutory purpose to keep it and the right to complain to the Data Protection Officer if you feel that your data has not been handled in accordance with the law. Your name, contact details and eligibility are recorded electronically on our system to maintain up to date records.  This information will be kept for a maximum of 15 years or until such time as the data is reviewed by us or removed at your request.

If you require further information then please visit http://www.kirklees.gov.uk/privacy

Form of Renunciation

Cemetery…………………….………….…….Section …….….….…Grave No…….…... Consecrated/General  (“Grave”)

I / We (delete as applicable) hereby renounce all my / our (delete as applicable) interest in the Owner’s right of burial in the Grave and desire that the said exclusive right of burial shall be vested solely in:

………………………………………………………………………….……...…….(name of person making the declaration overleaf)

1. Name  (Mr/Mrs/Miss/Ms)………………………………..………….…….……………………………………..………………….
Relationship to the Owner …………………..……….…………………………………………..…………………………………..
Signature  ……….…………………………..…………………………….….……………………………………..….………………
Witness (Signature, name and address)………………………………….…………………………………………………………

Date……………………………………………….………………………………………………………………………..……………

2. Name  (Mr/Mrs/Miss/Ms)………………..……………….…….……………………………..……………..……………………..
Relationship to the Owner …………………..……….…………………………………………..…………………………………..
Signature  ……….…………………………..…………………………….….……………………………………..….………………
Witness (Signature, name and address)………………………………….…………………………………………………………

Date……………………………………………….………………………………………………………………………..……………

3. Name  (Mr/Mrs/Miss/Ms)………………..………………..…….…….……………………………………..……………………..
Relationship to the Owner …………………..……….…………………………………………..…………………………………..
Signature  ……….…………………………..…………………………….….……………………………………..….………………
Witness (Signature, name and address)………………………………….…………………………………………………………

Date……………………………………………….………………………………………………………………………..……………

4. Name  (Mr/Mrs/Miss/Ms)………………..……………………...…….……………………………………..……………………..
Relationship to the Owner …………………..……….…………………………………………..…………………………………..
Signature  ……….…………………………..…………………………….….……………………………………..….………………
Witness (Signature, name and address)………………………………….…………………………………………………………

Date……………………………………………….………………………………………………………………………..……………

This is Kirklees Council, Civic Centre 1, Albion Street, Huddersfield, HD1 2NF.  
The Council’s Data Protection Office contact details are information.governance@kirklees.gov.uk.

The information provided by you is collected purely for the purposes of Bereavement Services.  We need to collect this information in order to maintain accurate records of your name and contact details.  Completion of sharing your information with us constitutes explicit consent from you for us to process your data for this purpose.  Processing is necessary to protect the vital interests of a data subject or another person.  You have the right to see what information is held about you, to have inaccurate information corrected, to have information removed from our system unless we are required by law or a statutory purpose to keep it and the right to complain to the Data Protection Officer if you feel that your data has not been handled in accordance with the law. Your name, contact details and eligibility are recorded electronically on our system to maintain up to date records.  This information will be kept for a maximum of 15 years or until such time as the data is reviewed by us or removed at your request.

If you require further information then please visit http://www.kirklees.gov.uk/privacy