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Coulston, Doris' Date: 3 g % 0 Cemetery Call Work Sheet / Funeral Home/ Monument Company: ?a--,.,? Contact Name: r1o SS 0 Block ? Lot cJ--? Space Y Tel. #:o?- ?'CD-7CD Fax #: Reason for call: Deceased Name: o ?-?p,?jp,r i S C Date of Birth: Date of Death /?/ a-?o© S Owner of Plot: Interment: (One full burial and one urn, or two urns per space) Full Burial Urn Space V $30.00 Staking Fee received on: Date of Burial: d--? Time: I I 'O(D am/pm Disinterment: ?`" ``? The following authorization should be obtained prior to disinterment: 1.) A disinterment permit and burial/cremation transit permit 9'r 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) cv-e Ob-\/ CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE • BLOCK : 8 LOT: 57 DECEASED NAME: LEMMORE W SAKES BLOCK: 8 LOT: 57 SPACE: 1 BURIALTYPE: FULL BORN: 01 / 08 / 1875 DIED: 09 / 07 / 1956 INTERRED: 09 / 13 / 1956 INTERMENT NOTES: DECEASED NAME: ELLA E SAKES BLOCK: 8 LOT: 57 SPACE: 2 BURIALTYPE: FULL BORN: 12/18/1891 DIED: 04 / 22 / 1981 INTERRED: 04 / 25 / 1981 INTERMENT NOTES: BORN ??/??/1891 DECEASED NAME: GROVER C BLANTON BLOCK: 8 LOT: 57 SPACE: 3 BURIALTYPE: FULL BORN: 01 / 01 / 1887 DIED: 08 / 21 / 1957 INTERRED: 08 / 21 / 1957 INTERMENT NOTES: DECEASED NAME: DONALD COULSTON BLOCK: 8 LOT: 57 SPACE: 3 BURIALTYPE: URN BORN: 08 / 24 / 1919 DIED: 12 / 09 / 1993 INTERRED: 07 / 08 / 1994 INTERMENT NOTES: AFFADAVIT IN DEED FILE BLANTON/COULSTON DECEASED NAME: OMAY F BLANTON BLOCK: 8 LOT: 57 SPACE: 4 BURIALTYPE: FULL • BORN: 10 / 24 / 1895 DIED: 10 / 27 / 1985 INTERRED: 10 / 28 / 1985 INTERMENT NOTES: DECEASED NAME: DORIS COULSTON BLOCK: 8 LOT: 57 SPACE: 4 BURIALTYPE: URN BORN: 08 / 24 / 1919 DIED: INTERRED: INTERMENT NOTES: CREAMATED REMAINS - AFFADAVIT IN DEED FILE BLANTON/COULSTON ****END OF BLOCK : 8 LOT: 57 **** • Page 59 of 98 i r Cemetery Call Work Sheet Date: /.' Ac?- Funeral Home: r'C'?-:,S -17C U2 Contact Name: Tel. #: 5-L a " ,) v Fax #: I°D- ? RE Monument Company: Contact Name: Tel. #: Fax #: CQ--Q (? L)r 5 C°.?1 S-1 Deceased Name: DOD: S DOB: r2 /11-9 /JG >-,Zl- Owner of Property: -b'En- - S ($30.00 Stak' Feel _ (One full burial and one urn, or two urns) Date of Burial: Time: am/pm Block R Lot Space `4 Interment: Full Burial: Urn Space: 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) ?? xv 4 TUSKAWA L-LA m m OA N w N f m M on N - MI I N in MI N M N w N - t0 - cm N - N N N O ? STREET In it) n M o it. N , m - n ?> so in in a _. ? 1 N in g h: m' in fo 9 p w. " ? O ' - OtJ" @O 4D - M ? Op M m 'M ? M m - - ? . OD ? f Mf- N ® N ? -pO -.N A 01 OO tv ow pNj N v im :, - - - O - - 6+ N w ® w n of z O 0 . O - N M M M vA ? " M M Q h h h ? n ?fi LL L. L Q i Oft !!T; OA ? ` i q , . " ?F fix >n ? L f:fi O i Nf, a' N1 O M O a » a . a ,ii r?. h ^ `T N f0 N , fl M , ! e m a - 0 y t n rax ,,P a: t 10 11?(/1 ;N ® a u ' W 01 .' . 01. KP OI • ? OOi . ;rr. a ° cv O d F= , a p O ra O O ? sss 1 af L -j L- ;f