Hart Island Grave Visit Request

* Indicates required fields

First Name*

Last Name*

Contact Telephone Number*

Contact Email Address*

Name of Deceased*

Date of Death*

Preferred Date of Visit*

Preferred Time of Visit*

Number of Visitors I Want To Bring: (Up to Four)*

Additional Visitors May Be Permitted. (Please indicated names and relationship status of any visitors over four.)

In an effort to reduce the number of visitors who do not arrive for their scheduled Hart Island burial site visit and do not give notice of a visit cancellation (“no shows”), the Department has instituted the following No Show policy, effective with the Sunday, September 16, 2018 visit: If a visitor has two no shows in any 12 month period, that visitor will be placed in no-show status for the six monthly visits scheduled after the date of the second no show. No show status means that a visitor can only request a “wait list” visit and will be offered a visit if someone cancels and you are next on the wait list.

Submission Confirmation*

By submitting this request form, I affirm a close personal relationship to the deceased whose gravesite I am visiting.