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Woodworth, Jim
Cemetery Call Work Sheet Date: Funeral Home: Monument Company: n?,,?,,?r r Contact Name 3?rYA C-L)po ?' - Contac Name: Tel. #C?3 ( ?)-4-)-G-7 Tel. #: Fax #: Fax #: RE: ?rr.e.? S C??c? 'r'?'? ( ci 4 5 4 Deceased Name: Owner of Property: Block Lot Space DOB: C-a. In n ` ?,r,,,c?a j 'T". H..0 Interment: Full Burial: ($30.00 Staking Fee) - (One full burial and one urn, or two urns) Date of Burial: Disinterment: Time: am/pm Urn Space: The following authorization should be obtained prior to disinterment: I .) A disinterment permit and burial/cremation transit permit 2.) Written authorization from the individual(s) who currently own the burial rights for the plot; and 3.) Written authorization from the individual(s) who would be permitted to authorize burial Monument Being Placed: (No Fee for Staking of Monument) -to . to ei<? DOD: D C, t 07 1r . ANNETTE WELLER 19a?-2-3-77 t V/ 1(07 V/ >O.._,.. D. B. Williams'. 1894 - 1928 7 SALLY H. MOORE 11-2a-71 EFFIE THOMAS ,*9-14-1959 ' s JosA. R -.' Thomas S. 1?1-5t' 6-2-69 ?.? Phoebe Ii. Woodworth. 1876 1928 V1 Bertrand D. Woodworth 1872 - 194o Theresq' :h -man 1?d7-1952 . HerberT`Yeller 1900 - 1928 .M. IA. Moore 1863 - 1939 14:, Mrs Ft. Macneal ? l$go - 1928 I t:r ?? ? N J -? L r CEMETERY SEARCH NAMES AND NOTES REQUEST DECEASED NAME: BERTRAND D WOODWORTH BLOCK: 5 LOT: 7 SPACE: 2 BORN: 08 / 18 / 1872 DIED: 05 / 29 / 1940 INTERRED: 05 / 29 / 1940 BURIAL TYPE: FULL INTERMENT NOTES: NONE DECEASED NAME: ELMER S WOODWORTH BLOCK: 7 LOT: 26 SPACE: 2 BORN: 01 / 01 / 1861 DIED: 01 / 01 / 1943 INTERRED: 01 / 01 / 1943 BURIAL TYPE: FULL INTERMENT NOTES: NONE DECEASED NAME: JANE E WOODWORTH BLOCK: 7 LOT: 26 SPACE: 3 BORN: 01 / 01 / 1867 DIED: 01 / 01 / 1945 INTERRED: 01 / 01 / 1945 BURIAL TYPE: FULL INTERMENT NOTES: NONE DECEASED NAME: JENNIE L WOODWORTH BLOCK: 7 LOT: 26 SPACE: 4 BORN: 01 / 01 / 1865 DIED: 01 / 01 / 1936 INTERRED: 01 / 01 / 1936 BURIAL TYPE: FULL INTERMENT NOTES: NONE DECEASED NAME: PHOEBE M WOODWORTH BLOCK: 5 LOT: 7 SPACE: 3 BORN: 06 / 14 / 1876 DIED: 11 / 08 / 1928 INTERRED: 11 / 08 / 1928 BURIAL TYPE: FULL INTERMENT NOTES: NONE Page 1 of 1 == ? 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