Application Granting Permission for Burial

In the City of Orem Cemetery

Section *

Block Number *

Lot Number *

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)

Yes

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

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

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

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