Kearney, Cecil A•
•
0
Cemetery Call Work Sheet
Date: 6 / 11 / 09
Funeral Home/ Monument Company:
Contact Name: ?eq"-KQA,
Tel. #:
Reason for call: (,d'e,, ,P ?o ?e a hG?,r ?•,??? ?. ?. ,.ti ?? owe
?o?C ?. , ?n?.?? ?,?."?un`.t .#? °.V?•.? w. o ??.?f ha ti.?n Z ?1 `.`,`]???P ? ?? ? c?..Q-Q
a K,-0K--V j Co. ctv.aC IW { l?. GN.? l/Q U'J- 4 C ? (kt t r.
I ?i K „n, w?, ?I?,( M.O YL t.l /h,2 WL C?p . W ? Q,Q
Fax #:
I
Deceased Name: Ce-cl A. k'e?•?n "A /c
Date of Birth:
Block a Lot a 3 Space IS
Owner of Plot:
Interment:
Full Burial
Date of Death /
(-,-r-A44
?- C r u &%.R w, o4 L.
(One full burial and one urn, or two urns per space)
Urn Space
$30.00 Staking Fee - received on: -/-/
Date of Burial: Time: am/pm
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
Monument Being Placed: (No Fee for Staking of Monument)