Jackson, George
•
Cemetery Call Work Sheet
Date: X3 /I -p
Funeral Home:
Contact Name: M1 l ?? c_.?
Tel. #•?
r
Monument Company:
Contact Name:
Tel. #:
Fax #: 7a"1 3a-? C3 $ a-C) Fax #:
RE: I??? ?-eJt --t,p ?.y e i ?4t
Deceased Name: +? DOD: DOB:
Owner of Property:
-
Block ?CP Lot 0-9 Space J-
_?-??-......?• ruu vsuriat• Urn Space:
($30.00 Staking Fee) - (One full burial and one•urn, or two urns)
Time: am/pm
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: V
(No Fee for Staking of Monument)
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F-11/18/2096 13:27 7273279520 PAGE 01
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Fax: 3X7 Si Fe=sbw& FL 33713
MA Pme: 1-3W-394-5429
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