Application to Purchase a Certificate of Burial Rights

Application to Purchase a Certificate of Burial Rights
IMPORTANT: CAREFULLY READ ALL INFORMATION AND FILL OUT THE FORM IN ITS ENTIRETY.

The person signing this application hereby agrees to indemnify, hold harmless, and defend the City of Orem against any and all third-party claims relating to the granting of permission for burial applied for herein.
Section 1: Applicant & Co-Applicant Information (To be completed by the patron. Please print clearly
Name

First NameLast Name
Middle
Name

First NameLast Name
Middle
Street Address
City
State
Zip Code
Primary Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
I/We, the undersigned, hereby apply for a Certificate of Burial Right and agree to abide by all current and future laws, rules, and regulations of the City of Orem Cemeteries Ordinance and the Cemetery Policy Manual. When any action is taken in relation to the burial right hereby purchased and its associated lot, that action shall be subject to the Cemetery Ordinance and Cemetery Policy Manual in place at the time of the action. I/We understand that no person except me/us or my/our heirs shall be buried in the lot hereby reserved unless a form provided by the City has been signed by me/us or my/our legal heirs. I/We acknowledge that only one burial shall be allowed per lot except for those situations approved by the City Sexton and detailed in the Cemetery Policy Manual. I/We agree that I/we am/are prohibited from selling my/our burial right to anyone other than the City of Orem. I/We acknowledge that at any time, the right of burial may be sold back to the City of Orem. The resale price will be the amount that I/we paid for the burial right, which is disclosed in this application and on the Certificate of Burial Right.
Applicant Signature
Date

MonthDayYear
Date
Co-Applicant Signature
Date

MonthDayYear
Date
Section 2: Official Cemetery Use Only (To be completed by Cemetery Staff)
Plot Location Section
Block Number
Lot Number
Total $
Remaining Balance $
(If not $0, contract must be signed)
Received By
Should be Empty:

Application to Purchase a Certificate of Burial Rights

Section 1: Applicant & Co-Applicant Information (To be completed by the patron. Please print clearly

Section 2: Official Cemetery Use Only (To be completed by Cemetery Staff)