Lopez, Laura E
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Cemetery Call Work Sheet `?ZeQ
Date:
Funeral Home:
Contact Name• Tc?r c: -
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Monument Company:
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Contact Name:
Tel. #:
Fax #: g`l "z> &i ?4 Fax #:
RE:
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Deceased Name: `'t DOD: DOB:
Owner of Property: It `' M "1"2-Block Lot y Space ? [
Interment: Full Burial: Urn Space:
($30.00 Staking Fee) - (One full burial and one urn, or two urns)
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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BURIAL PERMIT
CLEARWATER CARETAKER
CLEARWATER. FL
Permission is hereby granted for burial of:
Name of Deceased: LAURA E LOPEZ
PERMIT # 2562
March 07, 2006
Burial Type: URN
Owner of Property: MANUEL LOPEZ & LAURA E LOPEZ
Block : 15 Lot: 18 Space: 3 Date of Birth: July 20, 1921
Date of Death: November 10, 2005 Date of Burial: January 30, 2006
Funeral Home Director: PERCY @ ANNETTE BURIAL VAULTS
Time: 1211 :00 Staking Fee: 30.00 Date Paid: February 28, 2006
Clearwater Cemetery
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