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APPLICATION TO ERECT A CEMETERY MEMORIAL

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APPLICATION TO ERECT A CEMETERY MEMORIAL Powered By Docstoc
					                   APPLICATION TO ERECT A CEMETERY MEMORIAL

To: Town of Dalton, MA, Highway & Cemetery Dept..

Application is hereby made for permission to erect a memorial and for you to construct a foundation, if
necessary, on the area described on the reverse side of this application, and permit the monument
dealer who signs this application to furnish the memorial in accordance with the Rules and Regulations
of the Highway & Cemetery Dept. (referred to as the Dept.)

It is understood that all memorial work is subject to all the Rules and Regulations of the Dept. in any
way affecting monuments, markers, headstones or any other structures or memorials. Their
manufacture, location, care, erection, removal or in any other regard, subject to all other Rules and
Regulations of the Dept. now in force or hereafter adopted.

Should any memorial, in the opinion of the Dalton Cemetery Trustees (referred to as the Trustees)
become unsightly, dilapidated or dangerous to visitors, it is understood that the Dept. shall have the
right to remove the same at the expense of the lot holder or his or her heirs, after giving due notice in
writing to the last known address of the lot holder on file in the cemetery office.

The undersigned, who represents that he, she, or they, is or are the sole and exclusive holder or
holders of sepulture in the lot described herein hereby authorizes and request the Trustees to permit the
erection of the memorial as described on the reverse side of this application, and the construction of a
foundation, if necessary, and does hereby agree to all the terms, conditions and other provisions as set
forth on

________________________Address_________________________________ ZIP____________
(Signature of Lot Holder)

________________________Address__________________________________ ZIP ___________
(Signature of agent, Furnish authorization in writing)

In the event of this application being signed by an agent of the lot holder the agent agrees to inform the
lot holder of the provisions of this agreement and the Rules and Regulations the Dept. governing
memorial work.

(If the holder is deceased, heirship or right of interest must first be established by affidavit before this
application will be accepted, except in behalf of spouse or children.)




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                                                           MONUMENT DEALER AGREEMENT

I certify that I have been authorized by the person making this application to prepare a memorial for the
above described location and that the reverse side of this agreement contains the specifications and
detailed sketch of this memorial.

I certify that this memorial is made entirely of first-grade material and guaranteed by me to be free from
all flaws, defects and tool marks and that the workmanship on said memorial will be of the highest
standard.

I hereby agree to abide by the Rules and Regulations of the Dept., now in force or hereafter adopted, in
the erection of the memorial, and further agree that, if in the opinion of the Trustees should the
completed memorial not comply with said Rules and Regulations, it will, at the request of the Trustees,
be removed by me within three days of such request without cost to the Town of Dalton or the lot
holder.

The undersigned further agrees to hold the Town of Dalton free from any liability whatsoever for
damage to the memorial that may result from the installation of said memorial, before, during or after
the setting of said memorial.

I hereby agree to pay for any damage to lots, graves, walks, trees, shrubs, memorials, etc. during the
transportation and setting of this memorial. I hereby agree to indemnify, defend and save harmless the
Town of Dalton upon, or from, any and all claims, demands or alleged causes of action arising by
reason the erection of said memorial.

I hereby agree to pay the foundation charges of the Dept.
No memorial, once erected, may be removed from the cemetery without written permission of the
Trustees or of a court order.
No tools, equipment, structure, etc., required in the erection of the memorial may be left overnight in a
cemetery without written permission of the Dept.

Acceptance of this permit by the Dept. and the payment for foundation charges or other payments do
not constitute complete approval of this application.

Memorial
Dealer________________________Address__________________________________ZIP_________

Signature of Memorial Dealer or Agent_________________________________________

Date______________________________




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THIS APPLICATION IS ACCEPTED WITH THE CONDITION THAT THE MEMORIAL IS SUBJECT TO THE FINAL INSPECTION OF
THE TRUSTEES. SHOULD THIS MEMORIAL, IN THE JUDGEMENT OF THE TRUSTEES NOT COMPLY IN FULL WITH THE RULES
AND REGULATIONS OF THE DEPT., IT SHALL BE REMOVED FROM THE LOT BY THE MEMORIAL DEALER AT THE REQUEST OF
THE TRUSTEES WITHIN THREE DAY OF SUCH REQUEST.


                                                                    MEMORIAL SPECIFICATIONS

NAME OF DECEASED______________________________________

CEMETERY NAME____________________ SECTION NO. ____ LOT NO. ______ GRAVE NO. ___

MEMORIAL: BASE: l._____ w. _____h. _____Die Size l. ____w .____h._____
(Height above concrete foundation shall not exceed 36”)
                                                        Total Front Area__________ sq ft.

KIND OF MATERIAL: _____________________ Trade Name: ______________________ Color____________________

QUARRIER : __________________________________ Address _______________________________________

CARVING AND LETTERING: Specify method for:

    Family Name:__________________________________ Individual Name______________________________

      Inscriptions: ________________________________________                                         Ornamentation: __________________________________


TYPE OF FINISH: Front _____________ Back_____________ Top_________________ Ends________________
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                    SKETCH OF MEMORIAL SHOWING ALL DIMENSIONS, CARVINGS AND LETTERING,
                               INCLUDING FRONT, BACK , SIDE AND TOP OF DIE AND BASE:
            (Sketch should be drawn to scale. If space is inadequate, attach 8 ½ “ x 11” sheet containing scale drawing.)




Status of Approval of This Application:

         Approved by Burial Agent ___________________________________                                               Date___________________________

         Approved by Cemetery Trustees ______________________________                                               Date___________________________

                                                       ______________________________                                Date___________________________

                                                       ______________________________                                Date___________________________



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posted:7/5/2011
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