Jordan, RitaCemetery Call Work Sheet
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Contact Name: 1
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Funeral Home / Monument Company:
Contact # or Email: -2 X? 44a a O
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 1O(.b
(One full burial and one urn, or two urns per space) 7A/3/
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Owner of Plot: '' aa 9 // a
Deceased Name: .11-4 4 _ 5'0 Y (QC -.----N
Verify Ownership/Burial Rights in cemetery program before confirming:
Block Lot S ace Q
Date of Birth: 1 . 31 Date of Death l / (o /
Date of Burial lieli/ J r
**,**************************************************************************************************
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:
C: ** OTHER REASON:
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Sent email to P&R to flag the space / / 7
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Notified funeral home/monument company with color of the flags used to mark the space
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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