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WE DO NOT ACCEPT THIS FORM BY FAX Date received in office Applicant Phone it *64e 700 N. Monroe Street Bay City, Michigan 48708 (989) 8924772 (888) 2733553 Fax (989) 8921713 CREMATION SOCIETY OF www.cremationsocietymidmi.com

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We are not responsible is a legal statement indicating that one party is not liable for certain actions or outcomes.

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