Eastman, Roger Cemetery Call Work Sheet
Date: /0 / a't / I a-
Funeral Home / Monument Company:
Contact Name: R9 . €44M M.A.
Tel. #: (35a ) - 3s$- Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument) ^ /
Mr. C�l►r. tG/'MIK.K C Geit. d- WOCCQdC
Verifying Burial space -to 64 b�.�: �d� ,tom �r,ce. 3
Q•Qo,k 14.
Other reason: BL,AzeS Qoc :ef,,. 12�9iv� •. . (.•of
3
et-7 J 2��"Y,,.&v - M-f C ) /�
SPacc 3 - 0 *- : ��fri .i 4 4\. OQ S0". _ Sf eA. ot
f_eat
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Interment: (One full burial and one um, or two urns per space)
Full Burial Urn Space k (P40)
Owner of Plot: Mock ca,,.c 6reAks.40 f
spkG� L -44 M• a'toc-k (am)
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 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
Add sc.( Mr. M.ox ci fQ.ci:t 7 a.. .r.C C
Revised 5/31/12 �""'"`� �rOy1 4.2.4 ``� �-1 __ sp -.tet�
.
I Status of Block: 16 Lot: 14 as of 10/24/2012
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL MOCK SELMA 8/5/1903 03/02/1990 3/6/1990 1847
2 FULL MOCK BESSIE M 6/14/1912 02/19/1977 2/22/1977 1190
3 FULL EASTMAN BETTY J 12/6/1932 09/08/1984 9/11/1984 1579
4 FULL MARSHALL MAY 8/5/1935 02/04/1996 2/10/1996 2248
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
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