Cornwell, RodneyCemetery Call Work Sheet
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Date: g / 13 / 4010
Funeral Horne / Monument Company:
Contact Name: l,wisa
Tel. #: Fax ,2k, sq 3 13 o ? -,k, o , c oh
Reason for call: QoCCZO-I cm?- Iq n o JK-9-y C?r.• c.Q? Z 4.
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Deceased Name: Padmet (2or r Oe-U
Date of Birth: /
Block I 'I Lot 4 -7a- Space O
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Date of Death
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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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