AUTHORIZATION FOR USE OF GRAVE

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					                                              PLAINFIELD CHARTER TOWNSHIP
                                                       KENT COUNTY, MICHIGAN




                                       AUTHORIZATION FOR USE OF GRAVE


                                                                                                      Block
                             Plainfield Township Cemetery
                                                                                                      Lot
                             Oakwood Cemetery
                                                                                                      Grave(s)


OWNER(S)

Full Name:
Address:                                                       City:                               State:            Zip:

Telephone:                                                     E-mail:

I (we) are the holders of a Cemetery Lot Certificate which represents the right of internment and burial in and to the above
referenced grave(s) in the Plainfield Cemetery in the County of Kent, State of Michigan, subject however, to all ordinances,
rules and regulations now existing or which might hereafter be adopted by the Plainfield Charter Township Board, or its
successors or assigns.

I (we) desire to authorize the internment and burial of a third party in said grave without transferring the Cemetery Lot
Certificate to said person and do hereby authorize the human remains of the third party to be buried in the above referenced
grave. I (we) further acknowledge and agree that this authorization may not be revoked without the written consent of the
Township after a burial permit has been issued for said grave or human remains have been buried in said grave, whichever
occurs first. Any revocation of this authorization must be received by the Township Clerk to be effective.

Any subsequent transfer of the Cemetery Lot Certificate (including forfeiture of vacant graves) shall automatically revoke this
Authorization, unless a burial permit has been issued for said grave or human remains have been buried in said grave in which
case the authorization may not be revoked without the written consent of the Township.


THIRD PARTY(IES)
Full Name:                                                                       Date of Birth:                      Grave #:

Full Name:                                                                       Date of Birth:                      Grave #:

Full Name:                                                                       Date of Birth:                      Grave #:
Full Name:                                                                       Date of Birth:                      Grave #:

Full Name:                                                                       Date of Birth:                      Grave #:


Owner’s Signature                                                                                  Date

Owner’s Signature                                                                                  Date




                                         6161 Belmont Avenue • Belmont, Michigan 49306
                                             616-364-8466 Voice • 616-364-6537 Fax

				
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