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Application Granting Permission for Burial

Pursuant to the Certificate of Burial Right which Grantee rightfully holds, the Grantee hereby grants permission for the burial of

In the City of Orem Cemetery

The person signing this application represents and warrants to the City of Orem that he/she has the authority to grant this permission 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. By signing this application, the Grantee acknowledges that only one headstone may mark the burial lot, that no additional headstones or markers may be placed on the burial lot, and that the individual who has the right to the remains that are being interred is granted the authority to make all interment decisions including the selection of a headstone for the person being inferred.

Cremation Burial

Cremation Vault (If this is for a cremation fill this out)

Please note, Cremation vaults are not required. Cremains that are not buried in an approved vault cannot be recovered

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Date

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NOTE: A copy of the Certificate of Burial Right must be filed with this Application