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Falzoni, Peter Cemetery Call Work Sheet Date:/ ?51 Funeral Home / Monument Company: ThT16 Contact Name: Tel. #: -A&L ? Fax #: Reason for call: Deceased Name: Is ll , jam es a? Date of Birth: A Date of Death • Block 16 Lot qOl Space 5 Owner of Plot: ************************************************************************************************** Interment: (One full burial and one urn, or two urns per space) Full Burial Urn Space dl p8 $30.00 Staking Fee - received on: -7 U) V_ tf Irl-71© 2 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) o? F aU?