Dobson, Gladys L Moore
0 Cemetery Call Work Sheet
Date: / 1S/ OO
Funeral Home / Monument Company: klc-ss cast ell
Contact Name:
Tel. #: t5b a, ' Pow
Fax #:
Reason for call:
Deceased Name: (2-910 g, bobm-K-
Date of Birth: 2 / 2I/ P06 Date of Death aCO2
. Block Lot C?o Space
-4--
Owner of Plot: ?,U-owe ?JIL?J`
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space O
$30.00 Staking Fee - received on:
Date of Burial: /?/ ?g Time: 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)
Vol
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Q N
`
CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
BLOCK : 2 LOT: 30
DECEASED NAME: GLADYS M DOBSON
BLOCK: 2 LOT: 30 SPACE: 4 BURIALTYPE: FULL
BORN: 02 / 24 / 1909 DIED: INTERRED:
INTERMENT NOTES:
****END OF BLOCK : 2 LOT: 30 ****
Page 59 of 60
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Mpss Feaster Funeral Home(4673) Gelco Check Number 1 2 5 5 5 5 4 2 01 2 5 5 5 5 4 2 7
693 South Belcher Road
Clearwater FL 34624 USE. ?U ISSUE DAtL
cretorssn 8/18/2008
PAY TO THE NOT VALID AFTER SIX rc) MONTHS FROM ISSUE DATE
ORDER OF City of Clearwater
• - ?' backs
100 South Myrtle Avenue # 210
Post Office Box 4748
Clearwater, FL 33758
Thirty Dollars And No Cents*************************************************1 $* * * 3 0 0 0
r PAYABLE THROUGH
Frat PREMIER Bank
' SiOUX FALLS, SE)
NOT VALID FOR OVER $5,01DO NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
Paul MacLaren
78-858
this insMNT01t• tlo aiaas' confirms that tNs nsirument has been drawn m axordance with the aut"issued by Gelco Information Network, Inc. If any
914 By
stat?herein be untrue, we, the aforossigned, agree to pay the drawer upon demand the amount of ft mstrument and all expenses and damages ansing from such nusstatemem.
1180 L 25555L, 2711' 1:09 L408 585I: 2500000655118
SIGNER Paul MacLarenUSERID cretorssn
0125555427
DESCRIPTION
City of Clearwater
100 South Myrtle Avenue # 210
Post Office Box 4748
Clearwater, FL 33758
DATE LOCATION NUMBER GLCODES CONTRACT NUMBER NAME/DESCRIPTION AMOUNT
8/18/200 4673 8405-0 467301000760 Staking Fee for G. Dobson $********30.00
Cemetery Call Work Sheet
Date: I I / / ? / a 1
Funeral Home/ Monument Company:
Contact Name:
Tel. #: 8 6 - /SE I Fax #: 7a--l - 0 8 S 4,
Reason for call: for a-? k-t e ¢I 1 j!?JA k-CA-- &'%„
Noy. x151 ./?/rl 13QoGk a Lv7. 30 : ,p
Deceased Name: tAo o re -t4p,,., E`'eT
Date of Birth: l?oq Date of Death 0 l 1`F l Og
Block a Lot 3 ° Space It
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)
R)
ore. k nrX WnQ (.`.;4j ?o 4 4.kt
cntza • ADSej Mr. ec??tr,-JU I V
ATTN: Kevin Cantrell (cD- Cycadia Monument Co.
Fax: 727-785-0856
This fax includes a map of the Clearwater Municipal Cemetery.
Deceased: Gladys L. Moore Dobson
Gravesite: Block 2 / Lot 30 / Space 4
Gravesite has been flagged with orange flags by our Parks and
Recreation Dept.
Placement of marker to take place Saturday, November 21 st.
No fee for Staking area!
Please contact me with any questions.
Thank you,
Judith LaCosse
Staff Assistant
Official Records & Legislative Services
727-562-4093
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