Switzer, Paula•
•
Date: v /X/ a3
-
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Cemetery Call Work Sheet
-k 1-+-210r
Contact Name:rTe 17. # -2(oS3 (PC I Fax #:
rErrat•
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 Plot:
Deceased Name: 3 SCIQke. i S —.. tA-5" ,
Block !ti Lot (fSpace cD—. CD. t- rns in -e.Z i S Seg.c—e) 4-0 Pel
Date of Birth: / / D t f D h / /
Date of Burial: / /
?
**
a e o eat
Time:
am/pm
Monument (Marker) being placed - (No fee for staking of monument)
wil( o 6aCk—
� 73i a/I
For: +t) 411L-1
Time:
Block Lot
Affidavit (Burial Rights)
Other reason:
Space
Date: /
Verifying Burial space
**************************************************************************************************
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