DeCanioCemetery Call Work Sheet
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Contact Name: a 1d(G
Contact # or Email: (ytJ . " Co 77 51,0
7Re son for call:
** STAKING REQUEST for 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 Plot:
Deceased Name:
Verify Ownership/Burial Rights in cemetery program before confirming:
Block Lot Space
Date of Birth: / / Date of Death
Date of Burial:
** STAKING REQUEST for Monument to be placed _
No fee for staking of monument
Deceased Name:
• Block Lot Space
Verify Ownership/Burial Rights in cemetery program before confirming:
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** OTHER REASON: ` n o �^ D
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Sent email to P&R to flag the space / / T �)GA,_(1 Q1"Q �7 t h 4"b)
Notified funeral home/monument company with color of the flags used to ark a space(,-'�'aJ�
Stakingfee received(if applicable): / / From: Ftortic. NGY t Cis ( r
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Copy of burial permit emailed to: 65,,))--701 3 _� 7
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky 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
City Clerk/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 12/27/2023