Form Wv/cem-1 - Registration Application For Cemeteries (Page 2 of 2) in pdf

Form Wv/cem-1 - Registration Application For Cemeteries Page 2

Do you maintain a Mortuary in connection with your Cemetery?

___ Yes

___ No

Date Cemetery commenced business _____________________.

Please furnish your fiscal year end date ___________________.

Is Cemetery incorporated?

___ Yes

___ No

Is this Cemetery owned or operated by a:

___ county

___

municipal corporation

___ church

___

nonstock corporation not operated for profit

If so, does this cemetery do any of the following:

(a) Compensate any officer or director except for reimbursement of reasonable expenses incurred in the

performance of official duties?

___ Yes

___ No

(b) Sell or construct or directly or indirectly contract for the sale or construction of vaults or lawn or

mausoleum crypts?

___ Yes

___ No

defraying the direct expenses of maintaining the cemetery?

___ Yes

___ No

Is this cemetery a community cemetery not operated for profit that does not compensate any officer, owner or

director except for reimbursement of reasonable expenses incurred in the performance of official duties, and

uses the proceeds from the sale of the graves for the sole purpose of defraying the direct expenses of

maintaining its facilities?

___ Yes

___ No

Is this cemetery a family cemetery wherein lots or spaces are not offered for public sale?

___ Yes

___ No

Total acreage of cemetery _____________________.

Number of acres now developed so that burials can be made therein ______________________________.

Do you have a Preneed Sales Program:

___ Yes

___ No

Lots

___ Yes

___

Lawn Crypts

___ Yes

___ No

Vaults

___ Yes

___

Open/Closing of grave

___ Yes

___ No

Bronze

___ Yes

___

Memorials

___ Yes

___ No

Mausoleum Crypts

___ Yes

___

Marker Bases

___ Yes

___ No

Other (

)______________________________________________________________________________

please describe

Do you have an established trust fund(s) for the proceeds from sales of such preneed items or services?

___ Yes

___ No

If so, enter trustee(s) and furnish their address.

NAME

P.O. BOX/STREET ADDRESS, CITY, STATE, ZIP CODE

______________________________________________________________________________________________

Person completing this application please furnish name and telephone number:

____________________________________________________________ ________________________________

NAME

TELEPHONE

Form Wv/cem-1 - Registration Application For Cemeteries Page 2

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