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Thank you for your interest in Mimosa Cemetery. Could you please complete this form?
Name of the person to be placed in the burial plot:
Burial plot location (this information is noted on the purchase receipt):
Name of person requesting plot:
Funeral home name (if applicable):
I understand that the requestor will be responsible for the full cost of moving the remains to the appropriate plot if the original request is inaccurate.
Signature of requestor:
By typing my name above, I affirm that all data in this form is correct.
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