Haviland, Edward Clark
Cemetery Call Work Sheet
Date: 1(-, / 0
Funeral Home/ Monument Company: R.L&1,011aas ? ,?oN.S Futiem- Oyvv f?7
Contact Name: S)(,N
Tel. #: 1A'I A I P-11 Fax #:
Reason for call: _ S40C10(1 Re crest'
Deceased Name: Cd Wart l e l° k- 1A 0 W Jk t?d
Date of Birth: -3-/ -A/-" Date of Death A-/A/-JA
• Block A- Lot I q'I Space
Owner of Plot: Jc?n?t C? H1 61 k0d
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: 3 Time: 11.'L) am/
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)
0
CEMETERY SEARCH NAMES AND NOTES REQUEST
0-OUND AS CURRENT OWNER OF BLOCK: 7 LOT: 147 SPACE: 3
OWNER 1: JANET C HAVILAND
SPACE TYPE:
COMMENTS:
None
DECEASED NAME: BARBARA HAVILAND
BLOCK: 7 LOT: 147 SPACE: 3
BORN: DIED: INTERRED: BURIAL TYPE: FULL
INTERMENT NOTES:
AFFIDAVIT RE INTERMENT RIGHTS IN DEED FILE
DECEASED NAME: EDGAR C HAVILAND
BLOCK: 7 LOT: 147 SPACE: 3
BORN: DIED: INTERRED: BURIAL TYPE: FULL
INTERMENT NOTES:
AFFIDAVIT RE INTERMENT RIGHTS IN DEED FILE
ECEASED NAME: EDGAR E HAVILAND
BLOCK: 7 LOT: 147 SPACE: 1
BORN: 01 / 24 / 1885 DIED: 11 / 20 / 1940 INTERRED: 11 / 20 / 1940 BURIAL TYPE: FULL
INTERMENT NOTES:
NONE
DECEASED NAME: HAROLD J HAVILAND
BLOCK: 5 LOT: 15 SPACE: 8
BORN: 04 / 27 / 1914 DIED: 08 / 27 / 1990 INTERRED: 08 / 30 / 1990 BURIAL TYPE: FULL
INTERMENT NOTES:
NONE
DECEASED NAME: WILHEMINA HAVILAND
BLOCK: 7 LOT: 147 SPACE: 4
BORN: 02 / 15 / 1920 DIED: 03 / 10 / 1958 INTERRED: 03 / 11 / 1958 BURIAL TYPE: FULL
INTERMENT NOTES:
NONE
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