Tota, LauraCemetery Call Work Sheet
late: 3 / aS/ Poll
Funeral Home/ Monument Company:
Contact Name: L awAa. -r°te- -
J, -iW a.:
Tel. #:
Reason for call:
,lf"o aehrm. or?
MAt.
Fax #:
Staking Request (Interment)
Affidavit (Burial Rights)
Monument (Marker) being placed
(No fee for staking of monument)
? C.Qe? w a'?er .
Other reason: W ? LQ ?k V i S Z
M.o r M i-a E X-Q cLP%r'l r
ldv'J,Q Jq-Zk-L -t' W-5 if
Interment: (One full burial and one um, or two urns per space)
40 ull Burial
Owner of Plot:
CQ cry ,--Y,
Urn Space bWx?-Js ;,,- ?k 1(.1)
Lof 5- -t .
Deceased Name:
Block Lot Space
Date of Birth: Date of Death
Date of Burial: Time: am/pm
$30.00 Staking Fee (Funeral Home) - received on:
Copy of permit faxed to Joe Taylor/P&R - Fax No. 6551 on:
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
is 3.) Written authorization from the individual(s) who would be permitted to authorize burial
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Status of Block: 16 Lot: 54 as of 03/25/2011
INTERMENTS:
SPACE BURIALTYPE
I URN
2 FULL
3 URN
4 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECL DECF DECM BIRTH DEATH INTERRED
SELTZER JOHN B 5/16/1943 02 / 06 / 1989 2/10/1989
MAGGIO ELEANOR 7/10/1929 11/19/2009 11/21/2009
MILLER CHARLES 7/20/1932 03 / 24 / 1986 4/12/1986
JOHNSON OSCAR 12/25/1915 08 / 27 / 1985 8/30/1985
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http://msb-crystal-ent/businessobjects/enterprise 11 /infoview/viewers/rpt/DHTMLV iewer.aspx?skin=skin... 3/25/2011