[Insert name of cemetery]

[Insert address of cemetery]

 OWNERSHIP TRANSFER CERTIFICATE

DESCRIPTION OF INTERMENT RIGHTS, MERCHANDISE AND SERVICES

[Insert description of interment rights, merchandise and services to be transferred.]

OWNER INFORMATION & ATTESTATION

Name:              ____________________________________________________________

Address:          ____________________________________________________________

________________________________________________________________________

Name:              ____________________________________________________________

 

Address:          ____________________________________________________________

________________________________________________________________________

I/We, hereby attest that I/we are the owner(s) of the above-described interment rights, merchandise and services. I/We attest that no other person has any legal or equitable ownership interest therein. I/We relinquish all rights, interest and ownership therein and understand that this release and surrender is irrevocable.

Describe any necessary proof of ownership and any attached document(s) (such as the current certificate of ownership, if any, and/or a copy(ies) of any purchase agreements):

[Insert description]

I/We herby release and hold (Insert name of cemetery) and its employees, officers, affiliates and agents harmless and indemnify the cemetery against any and all damages, injuries, claims, causes of  action, demands, or liability of any kind whatsoever arising in whole or in part from this transfer of ownership.

ASSIGNMENT OF RIGHTS AND OWNERSHIP

I/We do hereby irrevocably give, assign and transfer any and all interest in the above-described interment rights, merchandise and services to the following individual(s):

Name(s):          ____________________________________________________________

Address(es):    ____________________________________________________________

________________________________________________________________________

TRANSFER OF OWNERSHIP BY CEMETERY

Recording Fee $ (Insert amount)

(Insert name of cemetery) agrees to transfer ownership, record the transaction and issue ownership documents for the above-described interment rights, merchandise and services to the following individual(s):

NAME:                       ______________________________________________________

ADDRESS:    ____________________________________________________________

________________________________________________________________________

PHONE NUMBER(S):          ________________________________________________

________________________________________________________________________

NAME:                       ______________________________________________________

ADDRESS:    ____________________________________________________________

________________________________________________________________________

PHONE NUMBER(S):          ________________________________________________

________________________________________________________________________

This is a legally binding document for the irrevocable release and transfer of the above-described interment rights, merchandise and services.

DATE OF TRANSFER:      ________________________________________________

OWNER’S NAME:                ________________________________________________

OWNER’S ADDRESS:         ________________________________________________

________________________________________________________________________

OWNER’S PHONE NUMBER(S):   __________________________________________

________________________________________________________________________

OWNER’S NAME:                ________________________________________________

OWNER’S ADDRESS:         ________________________________________________

________________________________________________________________________

OWNER’S PHONE NUMBER(S):   __________________________________________

________________________________________________________________________

[INSERT NAME OF CEMETERY]

BY:     __________________________________________________________________

            Signature and title of cemetery’s authorized individual

WITNESS the signature of owner(s) as of this ______ day of ______________, 20_____.

STATE OF:                 __________________________________

COUNTY OF:                        __________________________________

Sworn to before me this ________ Day of ___________, 20____.

_____________________________________________________

Notary Public

My Commission Expires:        _____________________________

ADDITIONAL INFORMATION

Some sales will not include all three types of items: interment rights, merchandise and services. The language should be modified appropriately or the description should specifically state that the transfer includes the sale of “interment rights only”, “merchandise only”, “merchandise and services only”, etc.

The cemetery should require receipt of the following prior to a transfer:

1.      The existing certificate of ownership/deed for any interment rights being transferred, a certified copy of any will bequesting interment rights, merchandise or services or a statement that none of the above are in existence.

 

2.      Proof of identity.

3.      A release statement signed by all possible heirs or proof that there are no other heirs, if applicable.

Sample provided by the Iowa Insurance Division, March 2007