Illinois Cemetery Purchase Contract Template
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1XYZ Cemetery, 1234 Main Street, Anytown, Illinois
Phone (555) 555-5555
John Jones – Manager (optional)
CEMETERY PURCHASE CONTRACT
(STATEMENT OF SERVICES AND MERCHANDISE SELECTED)
Easement Rights selected: _______________ $ ______________ Each. $ ________________
Certificate of Ownership to: ______________________________________________________
Description: Lot: __________ Block: ___________ Section: ___________ Grave(s): ________
Interment Fee ( )/Inurnment Fee( )
$ ________________
_______________________________________________________
Name of the Deceased:
Date and time of service: __________________________________
Other:
___________________________________________
$ _________________
___________________________________________
$ _________________
Total Amount $ _________________
Cemetery Regulations require the use of a concrete or suitable permanent outer container for this
burial. (Optional statement)
Additional charges may be incurred for unexpected expenses. Unexpected expenses include but are
not limited to, overtime charges if the committal service is held at other than normal business hours
as designated by the management, for a service on Saturday, or for winter fees. (Optional statement)
The undersigned purchaser(s) hereby attest to the following:
1. I/we were given or offered for retention a copy of the cemetery’s general price list.______
Initial
2. I/we were given or offered for retention a copy of the Illinois Consumer’s Guide to Cemetery and
Final Disposition Purchases. ______
Initial
TERMS: Payment in full is due at the time of signing.
METHOD OF PAYMENT:
Cash ________________ Check Number ___________________Other ______________
I/we have read the above, accept and approve same, and jointly and severally promise to make full
payment therefor. Receipt of a copy of this contract is acknowledged.
__________________________________
Signature of purchaser (s)
__________________________________
_________________________________
Printed name of purchaser(s)
Signature of Cemetery Official
_____________________________________
___________________________________
Street Address
Title of Cemetery Official
_____________________________________
__________________________________
City
State
Zip Code
Date
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