I request that St. Mark’s Church issue a Columbarium Certificate and to assign a niche in the St. Mark’s Columbarium for interring the remains of the individual designated below.

New niche: $2000                                   Shared Niche: $3750**


Name _________________________________________

Please Print





Date of Birth: _______________


Date of Death:_______________


I have received and read a copy of the St. Mark’s Columbarium Policies and Procedures. I understand that this application is subject to approval of the Columbarium Committee; that a Columbarium Certificate will be issued when all fees have been paid in full; that all Columbarium Certificates are subject to the Policies and Procedures; that a Columbarium Certificate does not create, grant, or convey any property rights in any property of St. Mark’s; and that a Columbarium Certificate may not be assigned, transferred, or inherited except with the approval of the Columbarium Committee.


_________________________________, 20________.

Signed on




Approved by the Columbarium Committee on

__________, 20_______.




**Please note: The size of the urn may affect the sharing of a niche

v 2.9.2009
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