TR Dallas Monuments• Date: 7 / 19 / a3
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Cemetery Call Work Sheet
Funeral Home / Monument Company: '71---e—CA
Contact Name: ' Tel. #: Fax #:
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Email:
Reason -for call:
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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:
Block Lot Space
Date of Birth: / /
Date of Burial:
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/ /
Date of Death / /
Time: am/pm
onument (Marker) being placed - (No fee for staking of monument)
For: Pit,ii-c--, v c.-zik.,
Block r4 Lot ) Space j Date: / / Time:
Verifying Burial space
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Affidavit (Burial Rights)
Other reason:
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: / /
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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
ORLS/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 4/21/2021