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Andreson, Leigh
Cemetery Call Work Sheet ate: / / / � r' Contact Name: l._r<c I (?"-1 r ve v Funeral Home / Monument Company: Contact # or Email: Lit...PNTY-ZESENt Reason for call: A: ** 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: „D €-L-ce 1 Deceased Name: Verify Ownership/BurialcRights in cemetery program before confirming: Block 9 Lot `' 6 Space 4 e?" - Date of Birth: / / Date of Death / / Date of Burial: / / B: ** 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: ** OTHER REASON: 4. D w ca cD h s- - Get ***************************************************************************************************************************** Sent email to PSR to flag the space / / Notified funeral home/monument company with color of the flags used to mark the space Staking fee received (if applicable): / / From: Copy of burial permit emailed to: 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 26 27 28 29 30 31 32 33 25 24 23 22 21 20 19 16 17 28 29 30 31 32 33 34 35 56 27 26 25 24 48 21 20 19 IO 11 12 13 18 15 17 18 9 5 1 6 5 4 3 2 1 1196 73 72 49 48 25 24 1 98 95 74 71 50 47 26 2312 99 94 '75 70 51 46 27 22 3 100 93 76 69 52 45 26 21 4 104 92 17 68 102 91 79 67 29 20 5 30 19 6 Ib0390[79 1166 [55 k42 131 110 1 7 I 104 89 50 65 56 41 -32 17 8 105 66 81 64 57 40 33 16 9 106 87 82 63 58 39 34 15 10 1071 86 1 85 62 59 33 84 61 60 37 35 14111 36 13 X7711761155 110 169s\ 31 30 10 32 29 12 9 33 28 13 34 27 14 37 24 t5 6 16 5 17 4 39 23 18 3 39 22 19 2 40 21 20 111 112 113 114 115 116 „7 118 119 120 110 109 IO2 107 106 105 104 103 102 101 91 90 92 89 95 98 94 87 95 86 98 85 97 84 98 85 99 82 100 61 51 72 69 52 73 68 74 67 53 54 55 58 77 64 57 78 43 58 79 62 59 60 61 GO 50 49 48 47 46 45 44 43 42 41 31 30 32 29 33 28 34 27 35 36 37 36 39 26 25 24 23 22 40 21 10 12 9 15 8 14 7 15 6 16 5 17 4 16 3 19 20 2 1 567 566 547 540 568 569 565 564 543 541 549 542 570 563 550 571 562 572 561 573 560 574 575 559 558 553 554 543 540 539 527 528 529 530 531 532 533 534 555 539 558 537 535' 556 626 507 506 525 508 sos 524 309 504 523 510 503 522 511 502 521 512 504 520 5,3 500 519 548 517• SEE 314887 3 MYRTLE 1541133 1132118 178 175 155 453 154 131 112 109 90 179 174 157 152 135 130 113 108 91 150 173 158 151 136 129 114 107 181 172 159 150 137 128 145 108 92 93 35 • 0z.0. 1 TZ 38 37 38 16 45 14 m 12 IJ 1019 13 8 7 8 5 4 3 2 , f 24 23 22 28 49 48 17 9 10 11 O 14 15 18 8 7 6 5 4 3 2 1 IF l 72 49 93176 [ 25 { i 24 1 95 174 74 i 30 143 47 28 23 112 94 75 51 27122 i 3 1 93176 [ [8`52 148 45�25 21 4 92 77 66 52 29 20 5 91 T8 67 1 65 30 19 6 so 79 66 52 42 30 15 6 1 89 f 80 1 65 58� 41 1 32 17 6 86 1 91 64 57 40 ` 33 1 16 9 63 1 58 l 39 1 34 ] 15 1 10 (1;51571.66145144i231-221 T.\ 182 17t 160 149 138 127 146 105 94 67 68 65 46 43 24 21 2 66 59 64 47 42 25 20 3 86 X70 63 48 44 26 19 4 84 71 82 49 40 27 I8 5 83 72 61 60 9 28 17 6 183 170 161 148 139 125 117 104 95 154 169 162 147 140 125 118 103 96 185 156 163 146 141 124 119 102 97 185 167 84 145 142 123 120 101 98 187 466 155 144 143 122 12t 100 99 4 82 73 60 51 38 29 15 7 91 74 59 52 37 30 15 6 35 114 �11 1 1561134 1,62 51 60 [3738 � 38 13 (1;51571.66145144i231-221 T.\ 182 17t 160 149 138 127 146 105 94 67 68 65 46 43 24 21 2 66 59 64 47 42 25 20 3 86 X70 63 48 44 26 19 4 84 71 82 49 40 27 I8 5 83 72 61 60 9 28 17 6 183 170 161 148 139 125 117 104 95 154 169 162 147 140 125 118 103 96 185 156 163 146 141 124 119 102 97 185 167 84 145 142 123 120 101 98 187 466 155 144 143 122 12t 100 99 4 82 73 60 51 38 29 15 7 91 74 59 52 37 30 15 6 80 75 68 53 38 31 14 9 79 76 57 54 35 32 3 10 76 77 56 55 34 33 12 11 AVENUE SEE SHEET 2 ViliM'H5isnl.