I certify that I, _______________________, am purchasing
(Purchaser's name)
___________________________________ interment spaces
(Number of spaces or niches)
or niches from _______________________________________________________
(Name of Cemetery Company selling the spaces or niches)
for the use of those whom I may designate without remuneration or compensation to me in any form. I understand that resale of interment spaces or niches is prohibited by N.J.S.A. 45:27-32.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.
____________________________
Purchaser's signature
N.J. Admin. Code Tit. 13, ch. 44J, subch. 14, app A
See: 38 N.J.R. 3746(a), 39 N.J.R. 1762(a).