Stewart, Ray & Marjorie •
Cemetery Call Work Sheet
Date: (° /
Funeral Home / Monument Company: C7 F k•ut.A.eint Co .
Contact Name: k'e-vi Cu�treU , ow r..e-A..
Tel. #: -1a-7- 9 't '- 155/ Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space — °'t 1,4‹.4 '
Other reason:
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Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: t `7 I.• S'tc00-r- p4.7 SfccJch�
Deceased Name: / 5104,..e_ - R‹y StetJGAt
(F )
Block la- Lot ( ( Space a ( 1)0(4.11-4- My-k ) ��,,h,;f x573
is/q/
Date of Birth: / / Date of Death / /
Noo
Date of Burial: 7 / a- / Time: 1.).:00 am pm Fn : r`j ar 4
S-te(4)
$30.00 Staking Fee (Funeral Home) — received on: / /
Copy of permit emailed to Mark Tokar, Marco Ortega/P&R on: / /
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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
N4 : 2(20,1e- 1a Lot ` ) Sp-c-ei3 3 4.-GQ 1,9
.
Revised 5/31/12 s� .. S- e.J4,n.� -_ fr RA7 GK 4r jbri e J1-14--)4A-t-
40/0
c. .
LaCosse, Judith
From: Ortega, Marco
Sent: Friday, June 29, 2012 8:00 AM
To: LaCosse, Judith
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie
Subject: RE: Cemetery Staking Request- Placement of a double marker
Good Morning,
Ray is in Yellow and Marjorie is in Pink.
From: LaCosse, Judith
Sent: Thursday, June 28, 2012 3:45 PM
To: Ortega, Marco
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie
Subject: Cemetery Staking Request- Placement of a double marker
Importance: High
Hi Marco,
We received a call this afternoon from Kevin Cantrell of Cycadia Monument Co.for a staking request for placement of a
double marker in Block 12,Lot 61,Space 1 and 2:
Ray Stewart is buried in Space 1 (Full burial)and Space 2 is vacant at this time, reserved for Marjorie Stewart (wife).
Staking is needed by this Monday,July 2nd at around 12:00 Noon.
Please advise me with the color of the flags being used so that we could notify the monument company.
Thanks for your help.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
1