APPLICATION FOR A

COLUMBARIUM

CERTIFICATE

 

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

_____________________________________________

Address

_____________________________________________

 

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

____________________________________________

Applicant

 

Approved by the Columbarium Committee on

__________, 20_______.

 

By__________________________________

 

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

v 2.9.2009
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