Funeral Escort Request Form

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The Leesburg Police Department will escort funeral processions that start in the Town of Leesburg AND involve 25 or more vehicles. This service is provided free of charge. We do request two days' notice, if possible.

***For the safety of our officers and of those involved in the procession, the Leesburg Police Department will not escort funeral processions that begin outside of the Town of Leesburg, regardless if they end in, or pass through the Town of Leesburg.***

To request a funeral escort, please complete the form below. A staff member of the Leesburg Police Department will contact you promptly to confirm the details of your request.

Please correct the fields below:

Please correct the field(s) marked in red below:

Requestor's Contact Information

*

Requestor's Contact Information

Name

Email Address

Phone Numberext.

Decedent's name

*

Decedent's name

Date of Funeral

*

Date of Funeral

Start Time of Procession

*

Start Time of Procession

Estimated number of vehicles in procession

*

Estimated number of vehicles in procession

Funeral Home Information

*

Funeral Home Information

Name of Funeral Home

Address

Phone Number

Contact Person

Service Information

*

Service Information

Location (Church/Funeral Home)

Address

Burial Information

*

Burial Information

Cemetery Name

Address

Please include any additional information regarding this funeral escort request?

To receive a copy of your submission, please fill out your email address below and submit.
Email Address

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Town of Leesburg, Virginia

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Funeral Escort Request Form