APPLICATION FOR PRE-NEED GRANTOF RIGHT OF BURIAL www.boddington.wa.gov.au shire@boddington.wa.gov.au ph: (08) 9883 4999 fx: (08) 9883 8347

Name of Applicant:
Address:
Phone:	Email:
Cemetery:
Preferred Denomination/Section:
Allocated Grave Location:
Issue Date:	Amount Paid:	Receipt No:

I understand that I can transfer this Grant of Right of Burial only with Shire approval and upon payment of the set fee.

Signature of Applicant:__________________________________Date:_______________________________

Approved by

Authorised Officer:___________________________Date:_______________________________

Taxes & Levies

I acknowledge that any statutory increase or impositions of fees levied, except for those levied under the Cemeteries Act 1986 and amendments thereto, which are outside the direct control of the Shire of Boddington, after the date of this agreement and relating to the cremation, burial or conduct of funerals charged to and payable to my estate.

I will be responsible for the payment of all present and future taxes, duties, assessments and outgoings whatsoever including a goods and services, value added or similar broad based consumption tax, whether statutory or local or of any other description which may be assessed, charged or imposed on or in connection with the provision of the Service, and after the date of my death, my estate will be liable for the payment of any such taxes, duty charge, assessment and outgoing.

If I make a payment for future tax including a goods and services, value added or similar broad based consumption tax, in connection with the provision of the Service, and that tax is not eventually imposed, the Shire of Boddington will refund the value of any such payment to me or my estate.