Park, Anne G Varnum. r f
Date: -I l e( 05
Cemetery Call Work Sheet
Funeral Homer - Monument Company:
Contact Name: C'Wl -ntl/ Contact Name:
Tel. #: 54p2 - -.C09 Tel. #:
Fax #:
Fax #:
RE: Rc j l l ?-x ?vfa( -nud f ar-e Monj-i d / SP,ry? ml( ?
he id T s - 41mP 6- l ).
Deceased Name: AmmF, b. %"k, P ?&;( DOD: 1 v5 DOB: 2 .2 2
Owner of Property: I ur, xNc " rKK
Block 15Z Lot40 Space A-
Interment: Full Burial: ? Urn Space:
($30.00 Staking Fee) - (One full burial and one urn, or two urns)
Date of Burial: ?Z'1., OS Time: TPA 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)
S:/.ilacosse/Cemetery Call Work Sheet.doc 0
r
6/8/04
CEMETERY SEARCH NAMES AND NOTES REQUEST
DECEASED NAME: JAMES E VARNUM
BLOCK: 15 LOT: 40 SPACE: 3
BORN: 01 / 01 / 1924 DIED: 11 / 21 / 1978 INTERRED: 11 / 21 / 1978 BURIAL TYPE: FULL
INTERMENT NOTES:
NONE
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CEMETERY SEARCH NAMES AND NOTES REQUEST
FOUND AS CURRENT OWNER OF BLOCK: 15 LOT: 40 SPACE: 4
OWNER 1: ANNE G VARNUM PARK
SPACE TYPE: FULL
COMMENTS:
None
FOUND AS CURRENT OWNER OF BLOCK: 15 LOT: 40 SPACE: 3
OWNER 1: ANNE G VARNUM PARK
SPACE TYPE: FULL
COMMENTS:
None
Page 1 of 1