Slater, Paula•
Cemetery Call Work Sheet
Date: 10 / 3-p/ m(,o
Funeral Home/ Monument Company:
Contact Name:
Tel. #:? ?`? r
Fax #: '53 ? `?
Reason for call:
•
Deceased Name: 5kcotui
Date of Birth: 19 / /
Date of Death
Block Lot ,e Space
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)
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