Ineson, Jeanne Cemetery Call Work Sheet
° ao P7 II
Date: / /
Funeral Home / Monument Company:
Contact Name: jeavin.e =■^-e-e aN^'
Tel. #: 561- Lf3C- la- - 1 Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
✓ Verifying Burial space .
Ot eason: {us��n5 IA-c.ti : {,-yerf,�,--(" 2heSah
2 I u r Q ;Lox l 4tiG J wG?�. Ce bt, e
■10 L12- S vn 4).Q-e- (t q l o)
lI oak 5) Lof 35 � Sp- - urn
Interment: (One full burial and one urn, or two urns per space) AL e42 AA Mt
Ce•,. C. — 614 3)
Full Burial Urn Space
/, 19‘..c-e-. 3 flt r o t.�Z I°-
Owner of Plot: N�'ko
Deceased Name:
A Ia- a
Block Lot Space w'^iei` : Gum W` �`"
Date of Birth: / / Date of Death / /
Date of Burial: / / Time: am/pm
$30.00 Staking Fee (Funeral Home) — received on: / /
Copy of permit faxed to Joe Taylor/P&R — Fax No. 6551 on: / /
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
�SpI e lCc l authorize burial
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'°64�e6t-tn Twek W 1A ,Lahn 'S{f Revised 6/29/11 .26 b � 3 -�,✓ � o q.6 i
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