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Ayers, Steven Bn • Cemetery Call Work Sheet Date: 1-,)- /7-?/ CCP Contact Name: 0Q-1-e-R-zo vim: ?h? S l•? ynrr?s?,? o Tel. #6 Fax #: r? Reason for call: (2vVIa 40 ? ')-). Deceased Name: Date of Birth: 0 Block ?S- LoQ??.- Space 'D---- Date of Death Owner of Plot: ************************************************************************************************** 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) 11 .i 0 y I' V ?i u 4n_- 0 r: 0 C?, ?V) o -s ll?- a 31 32 S3 S4 "- 37 38 39 40 30 29 28 27 24 23 22 21 It 12 13 14 15 18 17 IB 19 20 10 9 0 7 8 S 4 ! 2 I 111 112 113 114 115 116 117 116 119 120 110 109 108 107 106 105 104 103 102 101 91 92 93 94 95 96 97 96 99 100 90 89 88 87 88 85 84 83 82 81 71 72 73 74 - 77 78 79 80 70, 69 68 67 64 63 62 61 SI S2 53 54 SS 56 57 58 59 60 SO 49 48 47 46 45 44 43 42 41 31 32 !3 34 33 36 37 X138 39 10 !O 29 26 27 26 23 24 '.23 22 21 11 12 15 14 15 16 17 18 19 20 10 9 8 7 6 S 4 3 2 1 567 568 569 370 571 15721573157415-M 576 566 15r.5113&4156315621561 560 559 558 557 547 S48 S49 SSO 553 354 555 556 540 541 542 543 f 540 539 538 537 527 528 529 530 331 532 1533153415351536 526 525 524 523 522 521 520 519 518 517 507 508 509 510 511 512 513 ry m 15061505150415031502 501 500 L=J?? 28 27 28 29 3Q9 32 33 S4 25 24 23 22 21 20 18 18 17 28 29 30 31 52 33 35 2T 26 24 A 10 II 13 9 8 7 6 3 4 96 73 72 49 48 2S 24 98 95 74 71 50 47 26 23 2- 199 194 175 70 SI 46 27 22 3 100 93 76 69 A2 45 28 21 4 101 92 77 68 (D 29 20 5 102 91 78 67 30 19 6 103 90 79 66 55 42 31 IB 7 1104 109 80 65 56 41 1 12 17 0 103 88 81 64 57 40 33 16 9 106 87 82 65 58 39 34 15 10 1107186 BS 62 59 38 33 11 II 83 84 61 60 37 38 13 SS 38 37 38 13 O 12 IJ 10 9 IB IS 14 8 7 6 3 2 1 24 23 22 19 IB 1 7 9 10 11 k 14 13 16 8 7 8 54 3 2 1 73 72 49 48 23 24 93 74 71 SO 47 26 23 2 91 75 70 51. 46 27 22 3 93 76 69 52'_ AS 28 21 4 92 77 68 29 20 S 91 78 67 !0 19 6 90 79 68 SS 42 31 IB 7 89 80 65 58 41 32 17 8 80 BI 64 57 40 53 16 • 67 82 63 5• 39 34 15 10 86 83 82 59 38 35 14 It 81 61 60 37 36 13 177 1T6 ISS 154 133 132 III 110 89 88 67 66 4S 44 23 22 I 178 1 1751 156 153 131 131 112 109 90 •7 66 65 46 43 24 21 2 179 174 157 152 135 I30 113 10. 91 86 69 64 47 42 25 20 3 11801 1731 158 ISI 136 129 114 107 92 85 70 63 48 41 26 19 4 N I81 172 159 I50 137 128. 113 106 93 84 71 62 49 40 27 18 . 182 171 160 149 136 127 116 105 94 ?) 83 72 61 SO 39 26 17 6 183 170 161 148 139 126 117 104 95 82 73 60 SI 30 29 16 7 125 118 103 96 81 74 59 52 37 30 IS • 166 l L! 1 _ 63 16 L 41 24 02 7 0 5 8 3 6 1 4 9 ly"I W ? Am41; K r79 176 1 571 54 35 T32 13 10 - -1 / i?/ ??1 •wn IWI !3 t?0 1 ? Y cr .,-o-, N!uP ?7.156 .55 '34 34 !! 26 23 16T. _ 6 6. 93 94 81 00 63 64 49 48 3S Wig B2 79 6 31 14 7 IT 97 82 3 031 46 35 - 96 91 84 77 66 61 32 _ 45 86 29- 2p 13 4 36 31 20 23 IB .. 4. ? 1? . 18 90 05 T6 69 60 SS ? 44 57 20 21 12 3 89 86 75 70 59 54 43 36 27 22 II 6 17 30 29 22 19 Ii 9 2 20 IS 87 74 TI 56 35 42 39 26 23 10 7 73 72 57. 56 41 1401 t 23 2{ 9 8 21 20 11 10 21 1{ 6 It 22 13 29 28 2S 22 13 IS T 6 19 Je F-l 21 21 ?-, F. 5 ` t0 17? 5 J 23 12 ?`0 30 21 16 I ? I ? 1 24 li 26 25 20 4 1L.Jf 10 22 13 W 10 S X 25 10 19 14 3 10 IS 2 23 14 11 2 G 26 9 17 16 9 I 24 I] 12 I I Ei ? ? 16 I 15 i 6 I 5 1 6 ? 1 5 11 6 5 E ? 2 9Q' 9 4 4 a ®s?.. -_ -_ I I B 3 18 I3 ? 3 0 S O 4111- 29 ? 6 7 9 19 12 ? 2 B 31 4 `4 ( 10 20 II ? 10 111444999/// 4 32 12 19 21 24 21 2B 29 3S -? <=. -13 _ _ IB _. 2 i] 26 27 30 ?3 1 67 N U a , A J 7 Ch D r D Cn Xn m m