Request to transfer location of cemetery lot(s)

Request to transfer location of cemetery lot(s)

The person signing this agreement represents and warrants to the City of Orem that he/she has the authority to grant this action and acknowledges that the City, its employees, agents, or representatives will not be held liable or responsible for any and all claims arising from this grant.
Signature
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please transfer cemetery lot(s) from:
Section
Block
Lot
Please transfer cemetery lot(s) to:
Section
Block
Lot
Certificates included?
Checking “No” indicates that the original certificates cannot be located. Grantee represents that by signing this agreement that any certificates resurfacing in the future are void and will have no force or effect.

Checking “Yes” requires that all original or copied certificates are included and attached to this form.
Upload original or copied certificates here

Cancelof
Should be Empty:

Please transfer cemetery lot(s) from: