Keysor, NancyCemetery Call Work Sheet
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Funeral Home / Monument Company:
Contact # or Email: (o`J L CI (4 45- 3g S�—• 'Fh`^-ko, M N )
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
(One full burial and one urn, or two urns per space)
Owner of Plot:
Deceased Name:
Verify Ownership/Burial Rights in cemetery program before confirming: _
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / /
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 / /
Notified funeral home/monument company with color of the flags used to mark the space
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