Haller, James Edward
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Date: 9- / /
Cemetery Call Work Sheet
Funeral Home/ Monument Company:
Contact Name:
r?-? ?-
Tel. #: ACf(40 Fax #: tea- ?? ?j ?,?
Reason for call:
OQA Q?Z .?? ?S?
Deceased Name:
Date of Birth /??/ 19 ?g Date of Death 9 12(0 / jq-, t
Block O L( Lot 514(9 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: 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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