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Cycadia Monument (2)• • • -7/(7as Cemetery Call Work Sheet Date: 7 /13-7 a3 Funeral Home / Monument Company: C-"1 C._, Contact Name: 1�.eiNj, ( Tel. #: Fax #: Email: 7,....fr1Q:) YvyiQ *l - j -P iO(i OI'l -iA-1`' - Reason for call: ** Staking Request - Interment $30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, S • ��egal Holiday) a Full Burial Urn Burial 6 ``,, � (One full burial and one urn, or two urns per space)" Owner of Plot: ' 6-7� �1 Deceased Name: cp G, Block Lot Space ()-S Date of Birth: / / Date of Burial: / / ** Date of Death Time: am/pm / onument (Marker) being placed - (No fee for staking of monument) For: Ma -VW— $` C..C-f Block Lot 9 Space i 3 t `� P Date: / / Time: Affidavit (Burial Rights) Other reason: Verifying Burial space Send email to P&R to stake the space Notify funeral home/monu • .mpany with color of the flags used to mark the space Staking fee rec . 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 51 52 53 54 55 56 57 58 50149 48 47 46 45 44 43 42 41 31 32 33 34 15 37 38 39 40 30 29 26 27 7 24 23 22 21 11 12 T13 93 14 15 16 17 18 19 20 ID 9 Jt 8 7 6 5 4 3 2 1 111 112 113 114 115 116 117 118 119 120 110 109 108 107 I06 105 104 103 102 101 91 92 93 94 95 96 97 98 99 100 90 89 88 87 86 85 84 83 82 SI 71 72 73 74 55 77 78 79 6,0 70 69 66 67 47 ' 64 63 62 61 51 52 53 34 55 56 57 58 59 60 50 49 48 47 ' 46 45 44 43 42 41 31 32 33 34 35 36 37 36 39 40i 30 29 28 27 26 25 24 23 22' 21 II 12 13 14 15 16 17 18 19 201 IO 9 6 7 6 5 4 3 2 567 568 569 510 571 572 573 574 575 576 566 565 564 563 562 561 560 559 558 557 547 548 549 550 531 553 554 555 556 54d 54,64544543 525 524 .D 540 539 538 537 527 528 529 530 531 532 533 534 535 536 526 525 524 523 522 521 520 519 518 517 507 508 509 510 511 512 513 506 505 504 503 502 501 500 a' '3. -1 j SEE SHEET 3 I(lr`RT�.F 95 94 81 30 65 64 49 96 93. 82 79 66 63 50 97 92 \ 98 II 83 78 67 62 84 77 68 61. 76 6) 73 72 96 75 51 146125 l 24 22 `96495 173 74 71 149 17226 50 47 23 1 2 94 75 51 46 27 22 3 (99 00`93 l +70 76 69 (82 45 I 28 21 . 4 101 83 77 68O 29 1 20 I 5 102 91 76 67 130 19 6 86 83 157 38 I 1103 10 89 166 SO 65 41 56 142 2 I? 8 86 83 62 157 38 16 , 133 14 111 1106 188 67 181 82 164 63 58 39 34, IS 0 86 83 62 58 38 35 14 111 I107f 63 34 31 60 37 30 13 j (77 176 155 154 133 132 III 110 178 175 156 153 134 131 112 109 90 179 174 157 152 135 130 113 108 91 180 173 158 151 136 129 114 107 92 181 172 159 150 137 128 115 106 93 182 171 160 149 138 127 116 105 94 183 170 161 148 139 126 117 104 95 184 169 162 147_ 1 88 168 1631146 12 140,3 118 103 96 141 124J119 102197 135 18 36 37 38 15 14. 13 v 12 1.1 10 19 I 5 7 6 5 4 3 2 I 24 23 22 _60 37 19 18 17 9 10 II a 14 15 IS 8 7 6 S 4 3 2 1 951174 73 72 49 48 25 71 50 47.1 26 24 I 23 2_ 92 91 77 78 29(205 I '130 6 81 140 83 16 I 59 18858 39 63 I 87 I82 164 34, 15 10 186 83 62 59 38 35 14 1111 86 $4 61 _60 37 36 13 i (138 67 66 45 44 23 2 111 87 68 65 46 43 24 21 2 86 69 64 47 42 25 20 3 85 70 63 48 41 26 19 4 94 71 62 49 40 27 18 5 93 72 61 50 39 28 17 6 82 73 60 51 38 29 16 7 SI 174 59 52 37 30 IS 8 80 175 58 53 3.1 31 14 9 79b;11' f 14% 71; /144; 1� Not Eta I j Am i f r7 9 1 7 6 197 I /341,01 tot, �� 17S 7: 49 33 32 17 47 34 31 I6 57, 54 L35 132 13 IO 56 I S5 34 133 12 11 AVE NUE 51 46 52 Q 45 N 35 30 19 14 3 36 29 20 3 4 60 J 63 44 37 28 21 57 36 12 6 43 38j27 22 11 _ 6 42 39 26 23 10 7 41 40 25 24 9 8 34 33 J 26 I. 23 J 16 J IS.. 1. 35 2 27 36 31 29 rFFi 28 23 22 13 12 7 6 14 • 3 2 14 7 8 4 3 24 17 I 14 23 18 22 It 12 21 20 II 19 J. 7 20 n 21 16 22 15 8 6 Ki 5 22 13 12 r—1 I i I I 9 II 4 I I I I 24 I u 23 14 II 3 H 2 0 24 13 16 IS 17 14 18 19 13 12 12 7 8 12 19 22 23 9 10 25 26 F I 5 1E1 4 S 3 c 2 8 28 A 29 27 23 10 26 9 27(:)A . I 28 I 27 29 1.6 30 J 31 4 32 3 33 2 30 1 34 C U 7 1 G r r v-r IMV>iSfli H rn