( Grantee ) in and on the Following Described Cemetery Space(S)______Lot ______ Section______Of

(“Grantee”) in and on the following described cemetery Space(s)______Lot ______
Section______of the Forest Park Cemetery, 4000 Meriwether Road, Shreveport, Caddo Parish, Louisiana, as per plat of said section of said cemetery, of Caddo Parish, Louisiana (the “Interment Space”). The property rights acquired hereby by Grantee expressly do not include any interest in any minerals or mineral rights, Grantor owning, retaining and reserving unto itself all of the oil, gas and other minerals in any state, including liquid, gaseous and solid minerals, lying in and under the lands which constitute the Interment Space. Surface operations are not allowed on the Interment Space.

Any memorial for the Interment Space shall be permanently affixed to an underground concrete foundation by Grantor and is hereby declared by Grantee to be deemed a component part of the Interment Space.

It is expressly agreed and understood that this grant and assignment of perpetual Interment Rights is made subject to Grantor’s existing Rules and Regulations as well as such Rules and Regulations as Grantor may adopt in the future, which are all by reference made a part of this transaction and agreement, and Grantee’s acknowledgment of such fact and agreement thereto as to Grantee and Grantee’s heir, successors and assigns, is evidenced by Grantee affixing Grantee’s signature on the actual Purchase Agreement for the above described rights.

I understand and agree that at any time I or any of my heirs, successors or assigns desire to place any memorial on a lot, that inaddition to any cost of such memorial, and without regard to whether same is acquired through, or placed by Forest Park Cemetery or acquired throughor placed by a third party supplier, prior to any actual placement there will also be due Forest Park Cemetery’s then current memorial care fee, plus ForestPark Cemetery’s then current foundation fee or supervisory fee, as applicable. If the memorial is placed by Forest Park Cemetery, the then current foundation feewill be due; if the memorial is placed by a third party supplier, the supervisory fee will be due. I understand, and agree for myself, my heirs,and successors and assign that until such memorial care fee and foundation fee or supervisory fee, as applicable, is paid, Forest Park Cemetery may prevent theplacement of any memorial, or if nonetheless placed without such payment having been made, Forest Park Cemetery may remove the memorial.

Grantor binds and obligates itself, its successors and assigns, to set aside 15% of the consideration paid by Grantee, in trust, to be held in perpetuity as an Endowed Care Fund and agrees that is shall hereafter from income of this Fund and from the income of other funds heretofore created and to be hereafter created from 15% of the proceeds of all grants of interment rights which have been or may be made from time to time, all to provide for the endowed care of the cemetery.

It is agreed and understood however that Grantor shall not be bound to pay or deposit any additional part of the consideration paid by Grantee herein towards the endowed perpetual care of the cemetery, but may at its option add such additional funds as it desires.

The Interment Rights granted under this Certificate of Interment Rights and the above described Interment Space shall be used solely and exclusively for the purpose of human interment.

To have and to hold said Interment Rights in and to the above described Interment Space to said Grantee, his, hers, or their heirs, successors and assigns forever for the purpose so granted.

This grant and assignment of perpetual Interment Rights is made for the consideration of the sum of

ZERO AND ZERO CENTS($_0.00__)

Cash in hand paid, the receipt of which is hereby acknowledged.