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Scott, Clifford• Cemetery Call Work Sheet Date: 3 / / Funeral Home / Monument Company: Contact Name:C-ark 'L Tel. #: Fax #: 1,--trskoi 1 Email: Reason for call: ** Staking Request — Interment $30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday) Full Burial Urn Burial (One full burial and one urn, or two urns per space) Owner of Piot: Deceased Name: CA, SC -4c3 -6E, Block P5". Lot 5 Space Date of Birth: / / Date of Death / / Date of Burial: / / Time: am/pm • ** • Monument (Marker) being placed - (No fee for staking of monument) For: Block Lot Space Date: / / Time: Affidavit (Burial Rights) Verifying Burial space Other reason: --Tv ci, wz . ?_ c Q5� G51� � lr-e-i -I-0 .,D=‘„o ^^-e IL Send email to P&R to stake the space Notify funeral home/monument company with color of the flags used to mark the space Staking fee received on: / / From: Copy of permit emailed to: Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in P&R on: / / ************************************************************************************************* Disinterment The following authorization should be obtained prior to disinterment: 1.) A disinterment permit and burial/cremation transit permit 2.) Written authorization from the individual(s) who currently own the burial rights for the plot; and 3.) Written authorization from the individual(s) who would be permitted to authorize burial ORLS/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20 Revised 4/21/2021 61 \ W 1gLz.I1'1 ' 11 11_11£1b21 6 92 01. 52 11 9 2 33 £ 11 PI t2 SI 22 K: [ 1 T r • 14 6 I I -to 1 I2 21 £2 21' 22 S 9 11 02 «I 9 P1 2 91 02 r .01 2 6 1 1I 61 U Os I2.$ It 91 22 11 21 01 61 91 L\ z I SI 91 \ £ I 9I 9 01 S 9 02 62 92 12 1 1 92 f L 21 61 22 £2 92 62 62 0£ L£ 9z K 92 l2 zf St. II 91 91 J pz 92 £2 9 SRN 3 Av £t1it SS 96 IL 9L1 X46 Q(11 I{"I11!C%1C!•, .hl S9/ ?)I L6/ . 86 spot 4t► )1 v 402 s 1 6 92 01 22 52 09 19 92 6S 29 9 t1 02 62 9t 59 2 61 0£ S£ It 96 LI t£ 21 221 St. VS SLS 91 6 L] 6 9 11 22 L2 92 £9 5 zl `12 sz LC •ii 9 t1 02 62 9t 59 2 61 0£ S£ It 96 LI t£ 21 221 St. VS SLS 91 6 L] 6 PI 12 92 22 _ 9S SL 09 • SI 02 12 ZS 62 91 19 1 91 62 92 16 09 CL 29 9 11 9Z 62 OS 19 21 t8 9 91 12 09 69 Z9 IL 99 9 61 92 19 99 £9 01 99 2 OZ 9Z 29 19 99 69 99 Z 1Z 92 2P 99 S9 99 19 ZZ £2 99 99 99 19 ee it 92 Lt 09 19 99� 11 4 91 St 92 69 29 2e 99 9 LI Z2 19 92 16[91[22 09(19f 99 1_2919 1 i 9 LI Z2 19 92 1 29 091 69 1 1 i 1 91 1 t I Z91 LS 991 64. 06 9 61 02 • 01191911 16 9 02 6Z 99 LL Z61 9 2 32 1 82 99 Z9 l 69 1 9126 Z2 L2 99•.19C0L181 96 921 L11 091 IL 1 9L196 I 9Z 99 69 21 tL 2 2 93 S 91 L 9 91 SI PI LI 91 2 61 2 919 11 101 6 2222 9 1 1 92 9 6 01 n 2i t<I PI SI 91 92]Lt 92 St 4.6 ¢ea eft( 9P, 11911 SZI1 1L91�291 •91 ►•1 201 611 921 191 96 £0 0,1 191 ,96 901 111 921 621 991 191 011 291 96 903 911 LZI 821 691 091 ILI 291 26 6111971 901 0121 1991 6211Z/11191 1091 1 26 14.01 1911 621 921 1 2/1 16 901 211 021 921 261 LSI 911 611 06 601 Z11 121 921 293 991 911 911 011 111 221 221 PSI 991 911 LL) l £1 92 4.t 09 19 99 99 II, 91 ,St et 6S 29 29 99 101 0 11} Ot0 29 29 19 901 `91 1 £t 09 L=[ 99 19 99{901) 9 11} Ot0 091irol 1201 1 ` 91 12 29I SSI 99I 6L 06 9 61 Ot0 29 [ Ze 191 11613011I 9 OZ 6Z 119 99 1L 26 101 JI 2ICZ ii 9.2 29 [ Ze 1 10011 12 1 22 1 12 1 9, IS 011 84. 96 66 2ICZ 2 2 PZ 1 1 221 991 611ZL1 ft 96696 I 2 2 9 S 9 J. 9 6 91 LI 91 21 21 11 01 61 OZ IZ L99 9Z S2 92 LZ 92 St 92 22 22 12 Ot 6Z 92 11 91 ,61 02 1Z ZZ t 2 92 S2 92 22 22 12[02 62 02 12 9Z sS IS SS 92 21 21 \ It it 19 Pr 65 0t 61 99 69. St os 69 94 Ss 06 2S If 99 Lt OS 29 99 6t .29 '26 96 6P 91 59 06. 19 96 96 11�.�1�1! -a , 1 . 1 I 1 2 13334s 3 39 I'g 3 12? 1 t2:13J 00S 109 20S £O9 90S SOS 906 21S 219 IIS OIS 606 90S LOS LIS 915 61S 029 122 ZZS 2ZS *ZS S 2S 922 92S 629 929 226 229 Its 029 629 92S 12S 122 926 6SS 099 f \ 299 P9 g92 990 966 SSS PSS £SS (\�J 099 698 992 19S 196 996 666 092 19S 292 299 99S 996 999 9LS SLS PLS 219 21S 119 016 692 99S L99 IP 2 2 9 6 9 1 9 6 01 Ei 02 61 91 LI 91 SI 91 21 Z1 11 IP 22 22 92 92 92 12 92 62 02 11Z 09 62 92 12 92 St 92 CC 22 It IP 29 29 PP Si 99 LP 99 69 OS 09 6S 9S 19 99 SS PS 26 ZS IS 19 29 29 99 98 L9 99 69 OL 09 6L 91 11 '— 11 21 Z1 I1 19 29 62 99 98 99 Le 9e 69 06 001 66 96 L6 96 26 96 26 26 16 101 201 £01 901' 901 901 101 901 601 011 021 611 911 111 911 S11 911 til 211 111 1 Z 2 9 5 9 1 9 6 01 OZ 61 91 LI 91 SI PI 21 21 11 12 2Z t2 920 LZ 9Z 62 02 09 62 9t I2 0 92 t£ 22 IS