Roberts, Tom WCemetey Call Work Sheet
Date: / 3' / 0 9
Funeral Home/ Monument Company:
Contact Name:
Kiate, 1) " , ,j E
arol
Tel. #: 0 f 9 0 I_ Fax #:
Reason for-can:( ` / / 1 pp t)
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Deceased Name:
Block oL Lot
Q- .
Date of Birth: Date of Death -/-/
`f Space
Owner of Plot: T M?ti+s
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee - received on: -/-/.
Date of Burial: Time: am/pm
Disinterment:
The following authorization should be obtained prior to disinterment:
1.) A disinterment permit and burial/cremation transit permit
2.) Written authorization from the individual(s) who currently own the burial rights
for the plot; and
3.) Written authorization from the individual(s) who would be permitted to authorize burial
Monument Being Placed: (No Fee for Staking of Monument)
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Status of Block: 2 Lot: 4 as of 04/14/2009
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH
I FULL DUKES HELEN 9/3/1908 06 / 08 / 1914
2 FULL DUKES AMADA 3/7/1872 04/11/1938
5 FULL UNKNOWN 1/1/1901 01/01/1901
6 FULL BOLEY ELVIRA D 10/30/1853 04/11/1890
7 FULL WILLIAMS W H 2/19/1819 12 / 20 / 1908
8 FULL WILLIAMS ELIZABETH E 2/14/1825 04 / 04 / 1890
9 FULL ROBERTS HELEN W 9/16/1852 05/19/1941
10 FULL ROBERTS TOM 11/2/1857 02 / 03 / 1930
11 FULL ROBERTS ADIN H 11/7/1907 04 / 24 / 1966
12 FULL UNKNOWN 1/1/1901 01/01/1901
13 FULL UNKNOWN 1/1/1901 01/01/1901
14 FULL UNKNOWN 1/1/1901 01/01/1901
15 FULL BARNES HAROLD S 9/19/1895 05 / 25 / 1970
16 FULL BARNES ANNIE L 12/15/1899 06 / 15 / 1990
17 FULL COLLINS FRANCES E 2/29/1924 07 / 07 / 2000
18 URN DUPPER RICHARD 1/1/1901
18 URN DUPPER DOROTHY 1/1/1901
19 FULL DUPPER HAROLD W 10/25/1952 01 /02/ 1988
24 FULL LONDON FREIDA M 5/23/1923 08 / 14 / 2006
25 FULL SUMMERFORD MYRTLE 6/1/1902 01 / 03 / 1996
26 FULL LONDON LAURA A 1/1/1904 01/01/1936
27 FULL ROBERTS C E 1/1/1875 01/01/1943
28 FULL ROBERTS MARY A 1/1/1876 02 / 03 / 1964
29 FULL BARNES WILLIAM N 1/1/1871 01/01/1946
30 FULL BARNES EMMA S 1/1/1874 01/01/1943
31 INFANT BARNES INFANT 3/28/1907 03 / 28 / 1907
32 FULL BARNES MEPHARMA 11/21/1868 03 / 31 / 1890
33 FULL BARNES LAURA 11/28/1846 11/28/1903
34 FULL BARNES T J 1/12/1846 09 / 05 / 1877
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INTERMENTS:
SPACE BURIALTYPE
35 URN
35 URN
37 FULL
38 FULL
39 FULL
40 FULL
41 INFANT
42 INFANT
42 INFANT
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
2 FULL
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DECL DECF DECM BIRTH DEATH I:
BARNES DWIGHT W 10/7/1904 01 / 22 / 1985 2,
BARNES MARION N 12/10/1909 01 / 06 / 1996 1,
HARRIS RUPERT 10/10/1892 09 / 07 / 1972 91
HARRIS LONA BARNES 7/29/1898 02 / 28 / 2001 3.
BOLEY BYRON K 5/30/1889 07/17/1915 7.
SUMMERFORD LEON L 1/1/1901 05 / 31 / 1972 5,
ROBERTS IDA L 1/1/1899 01/01/1904 11
ROBERTS RENA C 1/1/1897 01/01/1897 1,
ROBERTS JOHN W 1/1/1896 01/01/1896 1,
DUKES
AMADA
04/11/1938 03 / 07 /
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