Miller, Abraham
Date: -7 /t?j / K
Cemetery Call Work Sheet
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Funeral Home / Monument Company:' OLI.V'l s
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Contact Name:
Tel. #: % " 50V Fax #:
Reason for call:
Deceased Name:
Date of Birth: Date of Death 7 00 / ® lS
• Block -& Lot 0 q Space
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: -7 Time: 11 do - a /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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CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
• BLOCK : 16 LOT: 29
DECEASED NAME: GEORGE JACKSON
BLOCK: 16 LOT: 29 SPACE: 1 BURIALTYPE: FULL
BORN: 05/18/1914 DIED: 02 / 12 / 1997 INTERRED: 02 / 22 / 1997
INTERMENT NOTES:
DECEASED NAME: REGINALD T HARVEY
BLOCK: 16 LOT: 29 SPACE: 2 BURIALTYPE: FULL
BORN: 07 / 22 / 1956 DIED: 02 / 27 / 1997 INTERRED: 03 / 08 / 1997
INTERMENT NOTES:
****END OF BLOCK : 16 LOT: 29 ****
•
•
Page 25 of 49
YOUNGS FUNERAL HOME INC
Z 1005 Howard St
O Clearwater, FL 33756
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