Holloway, Marsha Lynn Berry•
Cemetery Call Work Sheet
Date: ?/ 1-1 / SOS
Funeral Home/ Monument Company:
Contact Name: ?-ASA Vh01(0
Tel. #: moo' Uj?? " 0^0 Fax #: ?
Reason for call: MS
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Deceased Name: ?'k' ??? C-?•
Date of Birth: Date of Death /
Block Lot Space
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Owner of Plot:
Interment: (One full burial and one urn, or two urns per space)
Full Burial 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)
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