INTERMENT INFORMATION
(Please submit this information prior to Interment Services via email, text or phone)
Section: ________ Lot: ____ Plot ____
_______________________
Date of Birth: Mo/Day/Year
_________________________________________________
Full Name of Person being interred _______________________
Date of Death: Mo/Day/Year
_________________________________________________ ________________________
Name of Funeral Home Contact/Phone Date/Time of Interment Services
Type: ❑ Full ❑ Cremation
_________________________________________________ Headstone: ❑ in place
Name of Memorial Firm Contact/Phone ❑ to be placed
❑ Would like use of Chapel*
_________________________________________________
Name Grave Digger Contact/Phone
Additional instructions/requests:_____________________________________________________
_____________________________________________________________________________
*NOTE: Our historic chapel is always available to you — it has electricity, but no running water. We will need advance notice to
make it ready for you. A personal donation or an obituary notice requesting donations to RPC is appreciated.
Contact Information Family member information is vital for cemetery records to be complete.
Family Members will receive our Annual Newsletter reporting the financial status of the cemetery.
_________________________________________ _______________________________
Family Member Relationship to Address
Interred _______________________________
_________________________________________ _______________________________
Email Address Phone
__________________________________________ _______________________________
Family Member Relationship to Address
Interred _______________________________
_________________________________________ _______________________________
Email Address Phone
ROCK PRAIRIE CEMETERY
P.O. BOX 45 HALLTOWN, MO 65664 / 6012 LAWRENCE 4012 ASH GROVE, MO 65604
EMAIL: rockprairiecemetery@yahoo.com / Website: RockPrairieCemetery.com
Roxie Sharpe, Secretary 417-234-4077
Revised: 6/15/2022
