Williams, Cedric•
Cemetery Call Work Sheet
Date: 3 / Q- /
Funeral Home/ Monument Company: N o a cb a Wonu l w:L OD
Contact Name: CCU I n Nt rfteAL
Tel. #: 196' tE551 Fax #:
Reason for call:
00 (Z J,) 1, appo)
Deceased Name: ?? 1L 1 u j _
Date of Birth: 11 /21/ 161-14-Date of Death 10 / Z / 16j&I b
is
Block -JU Lot Space 9,
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) ?V-?
WU*M
N?Y? VA-
-1(1\0-?
e, ?pf, .
CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
• BLOCK : 16 LOT: 12
DECEASED NAME: INEZ ELLIS
BLOCK: 16 LOT: 12 SPACE: 1 BURIALTYPE: FULL
BORN: 02 / 06 / 1914 DIED: 10 / 29 / 1996 INTERRED: 11 / 02 / 1996
INTERMENT NOTES:
DECEASED NAME: CEDRIC WILLIAMS
BLOCK: 16 LOT: 12 SPACE: 2 BURIALTYPE: FULL
BORN: 11 / 27 / 1974 DIED: 10 / 02 / 1996 INTERRED: 10 / 10 / 1996
INTERMENT NOTES:
DECEASED NAME: OLA SAMS
BLOCK: 16 LOT: 12 SPACE: 3 BURIALTYPE: FULL
BORN: 02 / 07 / 1924 DIED: 08 / 10 / 1996 INTERRED: 08 / 17 / 1996
INTERMENT NOTES:
DECEASED NAME: FELTON RHONE
BLOCK: 16 LOT: 12 SPACE: 4 BURIALTYPE: FULL
BORN: DIED: 07 / 31 / 1996 INTERRED: 08 / 05 / 1996
INTERMENT NOTES:
Larkin to call in b/date
****END OF BLOCK : 16 LOT: 12 ****
is
•
Page 11 of 49