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HomeMy WebLinkAboutBy-law No. 2016-057 BY-LAW NO. 2016-057 OF THE CORPORATION OF MUNICIPALITY OF BAYHAM BEING A BY-LAW TO ADOPT SCHEDULES 'A' — 'H' FOR THE MANAGEMENT, REGULATION & CONTROL OF CEMETERIES WHEREAS on June 7, 2016 By-Law 2015-116, being a By-Law for the Management, Regulation & Control of Cemeteries for the following cemetery licenses: 00513 00518 00524 00529 00534 00514 00519 00525 00530 00515 00520 00526 00531 00516 00522 00527 00532 00517 00523 00528 00533 was approved by the Bereavement Authority of Ontario; AND WHEREAS the Bereavement Authority of Ontario deems it necessary to remove all schedules as follows from the By-Law for the Management, Regulation & Control of Cemeteries: Schedule 'A' —Contract for Purchase of Interment Rights, Cemetery Supplies or Services; Schedule 'B' — Interment Rights Schedule 'C' — Interment Rights Resale Endorsement Schedule 'D'— Interment Permission Form Schedule 'E' — Interment Rights Transfer Form Schedule 'F' — Repurchase of Interment Rights Request Form Schedule 'G' — Columbarium Schedule 'H'—Cemetery Rates & Fees AND WHEREAS the Bereavement Authority of Ontario deems it necessary to enact a by- law to adopt Schedules"A"—"H"; NOW THEREFORE, THE COUNCIL OF THE CORPORATION OF THE MUNICIPALITY OF BAYHAM ENACTS AS FOLLOWS: THAT effective upon passage of By-Law 2016-057 Schedules 'A' — 'H' attached hereto and forming part of this by-law are hereby adopted and shall remain in effect until amended or rescinded; AND THAT this by-law shall come into full force and effect upon final passing. READ A FIRST, SECOND AND THIRD TIME AND FINALLY PASSED THIS 21st DAY OF JULY, 2015 MAY R ' � INAY ►z 4 tap silL ' 44'lltill eff- IP The Corporation of the Municipality of Bayham 9344 Plank Road, Box 160 Straffordville, ON NOJ 1Y0 Telephone: 519-866-5521 www.bavham.on.ca bavham(c�bavham.on.ca CONTRACT FOR PURCHASE OF INTERMENT RIGHTS, CEMETERY SUPPLIES OR SERVICES Schedule "A" to By-law 2016-057 Cemetery operator License # 3267732 2016 In Name and Address of Cemetery CONTRACT INFORMATION Contract Reference # Date of issue PURCHASER INFORMATION Name Address PC Telephone Email address Purchaser's relationship to the Recipient(s) RECIPIENT #1 INFORMATION RECIPIENT #2 INFORMATION Name Name Address Address Province Postal Code Province Postal Code Telephone Telephone Email Email This contract is between the Purchaser AND The Corporation of the Municipality of Bayham For cemetery Interment Rights, Supplies and/or Services for the recipient(s) as identified in this contract. To be made in DUPLICATE Schedule"A" to B/L 2016-057 -2 - The Purchaser (if different than the Recipient (s) represents being legally authorized or charged with the responsibility for the Recipient(s) cemetery Interment Rights and cemetery pre-paid supplies and services arrangements specified in this contract. This agreement will be enforceable to the benefit of and be binding upon the parties hereto and their respective heirs, heirs, executors, administrators, successors, and assigns. Interment Rights per regular lot may include no more than one full size traditional body interment, plus two (2) cremation interments, provided the first interment is in a vault. Alternatively, up to four (4) cremation interments only, may be made in a regular lot. No more than two (2) appropriately sized urns shall be placed in any single columbarium niche or in a designated 3' x 3' cremation lot. Cremation urns or containers may be used for burials in regular lots when used for cremation burials only. All cremated human remains interred in a regular 4'x10' lot on top of a full body casket in a vault shall be placed in a small flat six by six inch (6"x6") box type container with a depth of no more than four (4) inches to ensure at least two feet (2') of earth coverage over the cremation remains, at surrounding ground level. For each cremation interment on top of an existing body burial with a vault, permission forms must be completed, signed and on file with the Municipality, in advance. **The purchase price per regular lot, cremation lot or niche permits one interment only in the respective lot or niche. **Each additional interment in a regular lot, cremation lot or niche is subject to payment of an additional fee, as may be in place at time of such interment, and must be properly authorized in writing. ** Resale: Interment Rights may be resold to a third party, through the operator, subject to restrictions. The Purchaser agrees that in the event of resale of the said Internment Rights, this certificate shall be returned with the completed and signed Part 1 and Part 2 of the Interment Rights Resale Endorsement — Form "C", to the Cemetery Operator who, upon completion, approval and payment of any required fees, will issue a new certificate to the new Interment Rights holder. **( Examples of Care and Maintenance Fund contributions from purchase of interment rights: 1. The Purchase Price of$600.00 (six hundred dollars) per regular lot includes $300.00 to the Care and Maintenance Fund and allows one interment in the regular lot. 2. The purchase price of$300.00 (three hundred dollars) per cremation lot includes $150.00 to the Care and Maintenance Fund and allows one interment in the cremation lot.) 2016 Schedule "A" to B/L 2016-057 - 3 - 3. The Purchase Price of$1200.00 (twelve hundred dollars) per single columbarium niche includes $300.00 to the Care and Maintenance Fund and allows one interment in a single columbarium niche. Interment Rights to Regular/ Cremation Lot or Columbarium Niche purchased: Location & Details Block Section Plot# _ Row Grave(s): No. of graves(s) Dimensions per lot Area of square feet. OR: Columbarium Niche Unit 1 or 2 Side A or B # The number of Regular Lot(s) / Cremation Lot(s) or columbarium niche purchased: at ($600/ $300 or $1200) , each, equals , which includes ($ 150, $300 or$300)_ to the Care and Maintenance Fund. (Circle above as appropriate) Interment Rights Purchases: Amount HST Regular lot(s) Cremation lot(s) Columbarium Niche Services: Identification & marking of lot for burial Identification & marking of lot for marker placement Placement of up to four corner posts provided by interment rights holder Duplicate Interment Rights Certificate —Transfer Duplicate Interment Rights Certificate— Resale Endorsement Interment Permission Form No charge Municipal fee for opening & closing Cremation grave Municipal fee for opening & closing Columbarium Niche Fee for each additional interment in a regular or cremation lot or inurnment in a single columbarium niche (circle selection) Name plate & engraving plus cast shipping Extra copy of Cemetery By-law Booklet Purchase of two (2) or four(4) corner markers (circle choice) Ministry interment/inurnment fee N/C Other Sub-Totals Total Contract Price $ 2016 Schedule"A" to B/L 2016-057 -4 - TERMS & CONDITIONS OF CONTRACT 1. THE FOLLOWING TRUSTING PROVISIONS ARE IN EFFECT: Per each regular Lot: 40% of the Purchase price or$ 300, whichever is greater Per each cremation lot: 40% of the Purchase price or$150, whichever is greater. Per each columbarium niche: 40% of the Purchase price or$300, whichever is greater. 2. CONTRIBUTION TO CARE AND MAINTENANCE FOR MARKER INSTALLATION: Flat marker 173 square inches or more: $ 50. Upright monument up to 4 feet in height or width $100. Upright monument more than 4 feet in height or width $200. 3. A CONTRACT FOR THE PURCHASE OF INTERMENT RIGHTS INCLUDES: • In accordance with the cemetery By-law 2015-116, the following restrictions on the exercising of interment rights and documents required are under the Interment Heading. • If an interment rights holder desires to transfer an interment right, the rights holder shall give notice on the appropriate form Schedule "E" to the cemetery owner and return the original interment rights certificate. Upon full payment of all applicable fees, the cemetery owner shall issue a new interment rights certificate to the Transferee. • For Contract Cancellation within thirty days of purchase, refer to the By-law heading "Cancellation". • In accordance with By-law 2015-116, restrictions on the transfer of interment rights can be found under the Transfers, Repurchases & Third Party Sales heading. • The resale of interment rights after 30 days by the purchaser or interment rights holder, as applicable, to a third party is now permitted. Please refer to "Resales" under the Transfers, Repurchases & Third Party ReSale heading. NOTE: ALL THIRD PARTY RESALES OF INTERMENT RIGHTS SHALL BE CARRIED OUT THROUGH THE CEMETERY OPERATOR. 4. CANCELLATION OF CONTRACT • If the above Interment Rights have been paid for in full, have not been used, and the Interment Rights Certificate has not been issued, the Purchaser may, in writing to the owner, within thirty (30) days from the signing of the contract, cancel this contract and receive a full refund. • If the above Interment Rights have been paid for in full, have not been used, and the Interment Rights Certificate has been issued, the Interment Rights Holder(s) may, in writing to the owner, within thirty (30) days from the signing of the contract, cancel this contract and receive a full refund. • The Purchaser or Interment Rights Holder, as applicable, may in writing to the owner, within thirty (30) days from the signing of the contract, cancel pre-paid supplies and services, provided they are paid in full, and receive the refund. 2016 Schedule"A" to B/L 2016-057 -5 - 5. RESALE OF INTERMENT RIGHTS AFTER 30 DAY COOLING-OFF PERIOD & PRICE • Unless the interment rights have been exercised the Purchaser or Interment Rights Holder, as applicable, retains the right to re-sell the interment rights. • A Purchaser or an Interment Rights Holder cannot re-sell their Interment Rights for more than the current value on the cemetery price list. • The current cost for the cemetery operator to complete and provide a new Interment Rights Certificate upon resale is listed on the Cemetery Tariff/Fee Schedule. 6. SUBDIVISION OF INTERMENT RIGHTS • No Purchaser or Interment Rights Holder(s) may sub-divide and sell or transfer a portion of an Interment Rights. 7. MEMORIALIZATION • The purchase of a lot permits placement of a maximum of one (1) upright monument only on a traditional full body interment, plus up to two (2) cremations or on a lot with up to 4 cremations only, subject to approved by-laws. • Care and Maintenance Fund Contribution for Marker and Monument Installation: In accordance with the FBCSA and Ontario Regulation 30/11, the following contributions will be made to the Care and Maintenance Fund for every installation of a marker or monument: (a) In the case of a flat marker measuring less than 1,116.3 sq. cm. (173 sq. in.) $0.00 (b) In the case of a flat marker measuring over 1,116.3 sq. cm. (173 sq. in.) $50.00 (c) In the case of an upright monument measuring 1.22 m. (4 ft.) or less in height or length, including the base $100.00 (d) In case of an upright monument measuring more than 1.22m. (4 ft.) either in height or length, including the base $200.00. • Only the Memorial plaque included with the purchase of the Niche are permitted as found under the Columbarium heading. • Interment Rights Holder(s) request to remove memorialization: A marker, monument, or memorialization purchased and/or installed by anyone other than the Rights Holder(s) may be removed by the cemetery representative on the written request of the Rights Holder(s). 8. PAYMENT TERMS • Payment in full is required at time of purchase. Full payment must be made before any burial or memorialization can take place. An Interment Rights Certificate will not be issued until the Interment Right(s) and Care and Maintenance portions have been paid in full. An Interment Rights Certificate(s)will be issued within 14 days of full payment and signing of the contract by the operator. 9. CAUSES BEYOND THE CEMETERY OPERATOR'S CONTROL • The cemetery operator cannot be responsible if unable/prevented from carrying out this contract due to causes beyond its control. 2016 Schedule"A" to B/L 2016-057 -6 - Privacy Policy Personal Information: The Purchaser acknowledges and provides consent to permit the Corporation of the Municipality of Bayham to collect, use and disclose your personal information in accordance with the requirements under the FBCSA and Ontario Regulation 30/11 for information within the municipal owned cemeteries public register. The Purchaser also understands that the Corporation of the Municipality of Bayham does not rent or sell personal information to third party organizations. Consumer Information Guide and cemetery price list: By initialing below, the purchaser acknowledges receiving a copy of the Ontario Government's Consumer information Guide (where made available by the Registrar) and the cemetery price list at the time of entering into this contract. {_} I hereby acknowledge I have been offered and/or received a copy of the Ontario Government's Consumer Information Guide and the Cemetery Price List. I have reviewed the Contract's terms and conditions and hereby confirm that the Interment Rights, as specified in this contract are complete and correct. I direct the operator to proceed with the sale of the Interment Right(s), as identified in the contract in accordance with the cemetery by-laws which are now or at any time hereafter in force. } I hereby acknowledge I have received and reviewed a copy of the cemetery's by-laws. The Terms and Conditions set out in this contract expire within 30 days unless executed by the purchaser and the operator. The contract date set out below is the date on which this contract is accepted by the operator. { } I acknowledge having received a copy of this contract, and assume full responsibility for payment of the total contract amount to the operator in accordance with the contract's terms and conditions. It is agreed between the parties that this contract and the operation of the cemetery, including restrictions on Interment Rights, is subject to the Cemetery By-laws of the Municipality of Bayham and the Purchaser hereby acknowledges receipt of a copy of the current By-laws and that the "Terms & Conditions of Contract" above, have been read and understood. Total Contract Price $ (from page 3) Ordered by: Signature (Purchaser Name) Payment by cheque #: received on Accepted on behalf of the Operator by: Name Cemetery Operator/ Representative: Signature Contact: Email: Telephone #:_ 2016 MUNICIPALITY OF BAYHAM 1a 9344 Plank Road, Box 160 Straffordville, ON NOJ 1Y0 Telephone 519-866-5521 www.bayham.on.ca bayhamAbayham.on.ca Schedule "B" to B/L 2016-057 INTERMENT RIGHTS CERTIFICATE Certificate #: Operator License # 3267732 Pursuant to the Cemeteries Act and Regulations and all amendments thereto, BETWEEN: The Corporation of the Municipality of Bayham Cemetery Name and Address Here hereinafter called "The Cemetery Operator" AND: Interment Rights Holder, hereinafter called the "Purchaser" In consideration of the sum of Dollars ($ ), receipt of which is hereby acknowledged, and which included the sum of Dollars ($ ), for Care and Maintenance which is deposited with the Municipality of Bayham, the Cemetery Operator agrees to assign the Purchaser the Interment Rights as follows: Section: Block: Plot# Row: Grave(s)/Lot(s): Area of square feet. OR: Columbarium Niche Unit (1 or 2) Side (A or B) # Date of Purchase/Transfer or Third Party Resale (circle 1 only): Interment Rights per regular lot may include no more than one full size traditional body interment, plus two (2) cremation interments, provided the first interment is in a vault. All cremated human remains interred in a regular 4'x10' lot on top of a full body casket in a vault shall be placed in a small flat six by six inch (6"x6") box type container with a depth of no more than four (4) inches to ensure at least two feet (2') of earth coverage over the cremation remains, at surrounding ground level." Section 3.58 Alternatively, up to four (4) cremation interments only, may be made in a regular lot. A maximum of two (2) cremation burials are permitted in a 3' x 3' cremation lot or in a single columbarium niche. Cremation urns or containers may be used for burials in regular lots when used for cremation burials only and in designated 3'x3' cremation burial lots. 2016 Interment Rights Certificate-Schedule B to By-Law 2016-057 Page 2 of 2 For each cremation interment on top of an existing body burial with a vault, permission forms must be completed, signed and on file with the Municipality, in advance. No more than two (2) appropriately sized urns shall be placed in any single columbarium niche. The purchase price per regular lot, cremation lot or niche permits one interment only in the respective lot or niche. Each additional interment in a regular lot, cremation lot or niche is subject to payment of an additional fee, as may be in place at time of such interment, and must be properly authorized in writing. Resale: Interment Rights may be resold to a third party, through the operator, subject to restrictions. The Purchaser agrees that in the event of resale of the said Internment Rights, this certificate shall be returned with the completed and signed Part 1 and Part 2 of the Interment Rights Resale Endorsement — Form "C", to the Cemetery Operator who, upon completion, approval and payment of any required fees, will issue a new certificate to the new Interment Rights holder. The Purchaser, by signature below acknowledges acceptance of this indenture and confirms that the By-law(s) governing the operation of the cemetery have been received and read, and agrees to be guided by the said By-law(s) as well as the provisions of the Funeral, Burial and Cremation Services Act and Regulations thereto, as if these were included as part of this indenture. With respect to the erection or installation of markers, the Purchaser agrees to abide by the restrictions in the Cemetery by-law(s) regarding the erection or installation of monuments or markers. Signature of Purchaser: In WITNESS whereof the Cemetery Operator has affixed its signature by the hands of its proper signing officer this day of in the year Cemetery Operator Representative Name: Signature: To be made in DUPLICATE (Issue one certificate for each lot sold) 2016 Schedule "C" to B/L 2016-057 4,p,YHA4 MUNICIPALITY OF BAYHAM 9344 Plank Road, Box 160, Straffordville, ON NOJ 1Y0 Telephone 519-866-5521 Website: www.bayham.on.ca Email: bayham(c�bayham.on.ca INTERMENT RIGHTS RESALE ENDORSEMENT Regarding the Cemetery at (If there are more than one Interment Rights Holders, all living Rights Holders shall sign the endorsement certificate. All Third Party Purchaser's shall be listed in full on the endorsement certificate in order to register their names and addresses on the cemetery records.] Part 1 — Interments Rights Holder(s) Resale Endorsement I/we, the Interment Rights Holder(s) registered on the cemetery records, hereby wish to re-sell the Interment Rights to Section: Block: Plot# Row: Grave(s)/Lot(s): to a third party purchaser. I/we certify that the Interment Rights are being resold in accordance with the Funeral Burial and Cremation Services Act, 2002 (FBCSA) and Ontario Regulation 30/11, and the Cemetery By-law(s). I/we further certify that the resale is for an amount no greater than the value on the cemetery price list in effect, at the time this resale is completed. I/we hereby acknowledge and direct the above named Cemetery to resell the identified Interment Rights to the purchaser(s) listed below. Interment Rights Holders contact information: Name(s): Address: PC Telephone #: Email: Signed: & Interment Rights Holder(s) Part 2 — Acknowledgement of Purchaser(s) I/we the third party purchaser(s) acknowledge that we have received a current copy of the Cemetery By-laws from the Interment Rights Holder(s). I/we have reviewed the Cemetery By-laws as they may apply to the Interment Rights and hereby agree to abide by the Cemetery By-laws and certify that I/we meet all necessary qualifications and restrictions under those By-laws. I/we have been informed by the Interment Rights Holder(s) that the Interment Rights being resold contains lot(s), and that no lot(s) have been utilized and said lots remain available for future use. Third Party Purchaser's contact information: Name(s) Address: PC Telephone #: Email: Signed: & *Date received by Cemetery Representative: (Mandatory) 2016 Schedule "C" to B/L 2016-057 Parts 1 and 2 of this form must be completed by the interment rights holder(s) and returned to the Municipal Treasurer in order to proceed with Re-sale of interment rights to a third party, subject to restrictions in the cemetery by-law. The Resale Endorsement fee listed in the current Cemetery Fee Schedule will apply based on the date this form is received by the Cemetery Operator. Part 3 — Cemetery Representative Acknowledgement and Acceptance of the Resale Endorsement The Operator for the above named Cemetery hereby confirms that the cemetery records have been reviewed and that the above Interment Rights Holder(s) are registered on the cemetery records and have the authority to resell the Interment Rights to the Third Party Purchaser(s). It is also confirmed that no monies are owing by the Interment Rights Holder(s) to the above named Cemetery in respect of the Interment Rights. On behalf of the above named Cemetery, I hereby accept and confirm that the resale has been recorded on the cemetery records and have issued a new Interments Rights Certificate in the name(s) of the Third Party Purchaser(s), as applicable for each resold lot. I also confirm payment of the Interment Rights Resale Endorsement Fee of $ , plus HST of $ , has been received and paid in full by cheque # in the amount of Accepted on behalf of the Cemetery License# 3267732 Municipality of Bayham Treasurer: Date of Resale: APPLICATION OF RESALE ENDORSEMENT FEES Calculation of the applicable fee(s) for Interment Rights Resale Endorsement will be based on the date this form is received by the Cemetery Operator representative and the current approved fee on the received date. Based on the fee at time of 2016 By-law approval, the Resale Endorsement Fee Payable = $75.00 plus HST $9.75 = $ 84.75, for each new Interment Rights Certificate issued. Examples 1. In the case of four cremation burials to be placed in a regular lot, (or other combinations as applicable), up to four names may be included on the certificate. In this instance, one original would be created and retained by the Operator, certified photocopies would be provided to each of the four persons listed and the respective Cemetery Secretary-Treasurer, if/as applicable, upon full completion of the transaction. This would be considered as one new certificate being issued at a cost of$84.75. 2. A Third Party Resale that pertains to more than one lot, will require a separate interment rights certificate to be issued for each lot regardless of the number of proposed interments in each. Example: 4 resold lots = 4 fees /4 certificates at $84.75 each for a total fee cost of$336.00 2016 Schedule “D” to B/L 2016-057 2016 MUNICIPALITY OF BAYHAM 9344 Plank Road, Box 160, Straffordville, ON N0J 1Y0 Telephone 519-866-5521 Website: www.bayham.on.ca Email: bayham@bayham.on.ca INTERMENT PERMISSION FORM Regarding the _____________________Cemetery at _____________________________________ Section: ____________________ Block: ______________________ Plot # ____________________ Row: _______________Grave(s)/Lot(s): _________________ OR: Columbarium Niche Unit (1 or 2) Side (A or B) # ____________________ Certificate #(s) OR Other Document(s) _________________________________________________ (Perpetuity Receipt, Deed or other document acceptable to the Cemetery Operator) I/We ___________________________________________________________________________ of Address:__________________________________________________________ PC____________ Telephone: _____________________________ Email: ____________________________________ hereby authorize the burial of __________________________________ in the above noted lot/niche. I acknowledge the following interment requirements (B/L 2015-116, Sections # 3.44, 3.45, 3.46 & 3.47 & 3.58): 3.44 Subject to restrictions, no more than three interments may be made in a regular lot, it is recommended that the first interment be in a concrete vault, and the remaining two interments must be cremation burials for which proper authorization has been documented and approved by the cemetery representative. 3.45 Installation of a concrete vault for all casket type burials is strongly recommended. 3.46 A full body casket in a vault or cremation interment must be to a depth that will ensure at least two feet of earth coverage over the case at the surrounding ground level; 3..47 No more than four (4) cremation interments, if placement allows, shall be made in a regular lot. A maximum of two (2) cremation burials are permitted in a 3’ x 3’ cremation lot. 3.58 All cremated human remains interred in a regular 4’x10’ lot on top of a full body casket in a vault shall be placed in a small flat six by six inch (6”x6”) box type container with a depth of no more than four (4) inches to ensure at least two feet (2’) of earth coverage over the cremation remains, at surrounding ground level. ___________________________________ ________________________________________ Signature of Interment Rights Holder Signature of Interment Rights Holder {Both if Joint Rights Holders only} In WITNESS whereof the Cemetery Owner has affixed its signature by the hands of it’s proper signing officer this ______day of____________________in the year _____________. For Cemetery Operator: __________________________ (Print Name) Signature: _____________________________________ Schedule"E" to B/L 2016-057 MUNICIPALITY OF BAYHAM INNYHAL4,1 9344 Plank Road, Box 160, Straffordville, ON NOJ 1Y0 _44II -0 `` Telephone 519-866-5521 Website: www.bayham.on.ca Email: bayhamO.bayham.on.ca INTERMENT RIGHTS TRANSFER FORM Regarding the Cemetery at Section: Block: Plot# Row: Grave(s)/Lot(s): OR: Columbarium Niche Unit (1 or 2) Side (A or B) # Certificate#(s) or other documents dated (Perpetuity Receipt, Deed or other document acceptable to the Cemetery Operator) I/We of Address: Telephone: Email: hereby authorize the transfer of the above noted lot(s), made without consideration, as a gift to: Name Address Telephone: Email: Name Address Telephone: Email: I/We hereby relinquish all rights to the above lot(s) and submit the original copy of the Interment Rights Certificate and request that the Cemetery Operator issue a new certificate(s) in the above noted name(s). (One name per regular lot unless multiple cremation or a mix of burials are proposed, in which case, all names must be provided in writing.) In WITNESS whereof the Cemetery Operator has affixed its signature by the hands of it's proper signing officer this day of in the year Signature of Interment Rights Holder Signature of Interment Rights Holder (Both if Joint Rights Holders only) Transfer Fee: $35.00+$4.55 HST per certificate issued For Cemetery Operator: Name: (Print) Signature: Fee amount received: $ 2016 Schedule "F" to B/L 2016-057 MUNICIPALITY OF BAYHAM 9344 Plank Road, Box 160 Straffordville, Ontario NOJ 1Y0 Telephone 519-866-5521 Website: www.bayham.on.ca Email: bayhambayham.on.ca REPURCHASE OF INTERMENT RIGHTS REQUEST FORM Regarding the Cemetery at Section: Block: Plot# Row: Grave(s)/Lot(s): OR: Columbarium Niche Unit (1 or 2) Side (A or B) Certificate #(s) OR Other Document(s) (Perpetuity Receipt, Deed or other document acceptable to the Cemetery Operator) I/We of Address: Telephone: Email: hereby request the repurchase of the above noted lot(s) by the Cemetery Board, in the negotiable amount of$ I/We acknowledge that the Care & Maintenance portion is non-refundable and a negotiated repurchase, including relevant HST, apply only to the interment right portion of purchases made after May 1, 2014. I/We hereby submit the original copy of the Interment Rights Certificate(s) and upon receipt of the Repurchase Price, I/we hereby relinquish all rights to the above lot(s) (All rights holders must sign). Signed & Dated: Signature of Interment Rights Holder Signature of Interment Rights Holder Upon successful negotiation, the following is to be completed I/We hereby acknowledge receipt of the agreed repurchase amount of$ , paid by cheque # dated Signature of Interment Rights Holder Signature of Interment Rights Holder In WITNESS whereof the Cemetery Owner has affixed its signature by the hands of it's proper signing officer this day of in the year For Cemetery Operator: THIS FORM TO BE USED ONLY WHEN THE CEMETERY OPERATOR CHOOSES TO NEGOTIATE THE REPURCHASE OF INTERMENT RIGHTS. 2016 Unit 1 4000--i UNIT 1-SIDE'A' UNIT 1 SIDE 'B' i ii ii i ii ii 1-1A 131 1-2A 1-3A I 1 1-1B pi 1-2B pi 1-3B 1 11-4A 1-5A p, 1-6A j 1 1-48 pi 1-5B 0q 1-68 S ii ii ii I ! ; 56.000 1 iii 56.000 i 1 1-7A 10 1-8A 131 1-9A 1 1 1-7B }011-8B h 1-9B 1 11-10A 1-11A 1011-12A 1 I # 1-10B II 1-11B loi 1-12B 1 — 6.000— 54.750 '1 } FI 54.7 0 ,i Unit 2 4.000 UNIT 2-SIDE'A' 4.000—I UNIT 2-SIDE'B' i ii ii 2 1A 2 2A 2 3A 2-1B 2 26 'pi 2-3B I ! ! ! ! S 1 ! ! ! ! 2-5A � �26A S ii ii 2 4A1 2-4B pi 2-5B 2-6B 1 ! ! ! ! ii ii i 56.000 .1 56.000 12-7A H 2-8A H 2-9A 1 i I 12-713 612-8B H 2-9B 1 ii ii ii ii 1 I 2-10A � �2-11A � i2-12A 1 � � 2-128 I 2-106 IH,2-11B I ! ! ! ! ! ! !! L 1 6.000— 1 54.750 6.000— 1_. 54.750 11 Schedule H to By-Law 2016-057 Municipality of Bayham 9344 Plank Road, Box 160 Straffordville, ON N0J 1Y0 Tel: 519-866-5521 Email: bayham@bayham.on.ca Web: www.bayham.on.ca License # 3267732 Cemetery Price List Fee HST@13% Total Identification & Marking of lot for burial $ 50.00 $ 6.50 $ 56.50 Identification & Marking of lot for marker placement $ 35.00 $ 4.55 $ 39.55 Placement of up to 4 corner posts provided by interment rights holder $ 35.00 $ 4.55 $ 39.55 Interment Rights Certificate - Transfer $ 35.00 $ 4.55 $ 39.55 Interment Rights Certificate - Resale Endorsement $ 75.00 $ 9.75 $ 84.75 Interment Permission Form No charge Municipal Cremation fee for opening & closing grave $300.00 $ 39.00 $ 339.00 Regular Lot Purchase price of regular lot total (Interment Rights @ $300, C&M @ $300) Purchase price permits one interment in a lot. Purchase price permits the erection of a flat or upright marker, subject to approved by-laws. $600.00 $ 78.00 $ 678.00 Fee for each additional interment in any regular lot, subject to completion of authorizing documents. Two (2) cremation burials are permitted on top of a casket burial, provided the first interment is in a vault, and subject to completion of authorizing documents. Up to four (4) cremation burials only are permitted in a regular lot, subject to completion of authorizing documents. $300.00 $ 39.00 $ 339.00 Cremation Lot Fee HST@13% Total Purchase price of one cremation lot total (Interment rights @ $150, C&M @ $150) Purchase price permits one interment in a lot. Purchase price permits the erection of one flat marker Only, at a maximum size of 24” x 14”, or less, on a 12” diameter post hole filled with a minimum depth of Four feet of concrete, subject to approved by-laws. A maximum of two (2) cremation burials are permitted in a cremation lot, subject to completion of authorizing documents. A cremation lot is 3' x 3'. $300.00 $ 39.00 $ 339.00 Fee for each additional interment in any lot used for cremation purposes, subject to completion of authorizing documents $300.00 $ 39.00 $ 339.00 Columbarium Niche Fee HST@13% Total Purchase price of a single columbarium niche includes (Interment Rights @ 900 C&M @ 300) Purchase price permits one cremation inurnment in a single columbarium niche A maximum of two (2) cremation inurnments are permitted in a single columbarium niche, subject to completion of authorizing documents $1,200.00 156.00 $1,356.00 Niche Nameplate & Engraving Must be purchased as part of initial columbarium purchase price $300.00 $39.00 $339.00 Inurement – Open/Close $150.00 $19.50 $169.50 Fee for a second cremation inurnment in a single columbarium niche $300.00 $39.00 $339.00 General Extra copy of Cemetery By-law/Booklet $ 2.00 $ 0.26 $ 2.26 Purchase of 2 small corner posts $ 10.00 $ 1.30 $ 11.30