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.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Date

Phone Number

Please transfer cemetery lot(s) from:

Section *

Block *

Lot *

Please transfer cemetery lot(s) to:

Section *

Block *

Lot *

Certificates included:

Yes

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.

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