Clancy, Steven John
Cemetery Call Work Sheet
Date: I / (+
Funeral Home/ Monument Company: I?
Contact Name: ` (At j,,f-e Jwv, I? .t?n ?n
Tel. #: Fax 4'9 Le Reason for call: hntt (1
Deceased Name: ST-C veN JGHN 6t-ftNC`j
Date of Birth: L( / cA / ASS Date of Death
• Block Lot Ig Space Orl
Owner of Plot:
Interment:
0
Full Burial
ru
(One fu// burial and one urn, or two urns per space)
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)
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CEMETERY SEARCH NAMES AND NOTES REQUEST
DECEASED NAME: JOHN DOE
WOCK: A LOT: 18 SPACE: 2
BORN: 01 / 01 / 1901 DIED: 03 / 06 / 1981 INTERRED: 03 / 06 / 1981 BURIAL TYPE: FULL
INTERMENT NOTES:
UNKNOWN-COUNTY SPACE
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