NOTICE OF BURIAL RIGHTS CONVEYANCE
I/We, as Grantor(s)/Seller(s) of the burial rights in and to the Plot described below, do
hereby convey, assign and warrant those rights of burial in and to said Plot free and clear of any
and all encumbrances as follows:
Reason for Transfer:_____________________________________________________________
is Notice of Burial Rights Conveyance must be completed and submitted by Grantor for
Board approval within 30 days from the Date of Conveyance to:
Rock Prairie Cemetery P.O. Box 45 Halltown, Missouri 65664
Printed or Typed Name of Grantee
Mailing Address
Phone Number:
Email Address:
Section, Lot & Plot
Date of Conveyance
Please check:
❑ Gift
❑!Sales Price:
$___________
Printed or Typed Name of Grantor
Mailing Address
Phone Number:
Email Address:
Signature of Grantee/Purchaser
Signature of Grantor/Seller
