Budget Cremation•
Date: 4 / t-"?, cz9
Funeral Home /C Monument Company:
Contact Name: Tel. #: Fax #:
Email: r7a3-
Cemetery Call Work Sheet
r-PaN-LcS44-
Reason- for call:
**
Staking Request – Interment
$30.00 staking fee (Weekdays) $50.00 staking�ngfee (Saturday, unay Legal Sunday & L I Holida
Full Burial Urn Burial Y
41.
(One full burial and one urn, or two urns per space)
Owner of Plot:
W 'Z ' P eaS%e_S
Deceased( Name: 'moa w 'Pjk,SL ems../
Block 14 Lot 5 4Space _4—. t
Date of Birth: / / Date of Death /
Date of Burial: / / Time:
•
/
am/pm
_ Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space Date: /_
Affidavit (Burial Rights) Verifying Burial space
Other reason:
/ Time:
*************************************************************************************************
Send email to P&R to stake the space
Notify funeral home/monument company with color of the flags used to mark the space
T-4- i S ((Nara ! O W f $14 4
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