McCall, Minnie B•
Date: / a° / ao (°
Tel. #: v, a w,cc6 (s ?1,0o . cOVV,
Reason for call: 1wvi.Ilj Sate Irt
Cemetery Call Work Sheet
Funeral Home / Monument Company:
Contact Name: 51M-ea Mc Cla
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Ce ¢ e?,?, ?? 2 -emu,. ?:,?.y b i cam,
Deceased Name: M1hh./ e R . Mc Cc--U-
Date of Birth: i / is Date of Death I a 1---\.-3 / (o G
• Block la' Lot 9 5 Space F,-,U)
Owner of Plot: C. Nlc C?QQ
**************************************************************************************************
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
0 Monument Being Placed: (No Fee for Staking of Monument)
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