Hart Island Grave Visit Request

* Indicates required fields

First Name*

Last Name*

Contact Phone*

Contact Email*

Name of Deceased*

Date of Death*

Age of Death*

Preferred Date of Visit*

Preferred Time of Visit*

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

Please indicate the names and relationship status of all visitors. Additional visitors may be permitted if space allows. If you would like to bring more than 4 visitors, please indicate in the field below and a staff member will be in contact shortly.*

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.