Glackin, Jessie Griffin & Lloyd Aubrey Griffin
i
Date: a' / /If / 40 l (
Cemetery Call Work Sheet
Funeral 'Horne / Monument Company:
Contact Name:
Tel. #: -7 a?- -7 a` - Fax #:
148 Rc e,-t AJe. , 3 3-) 6
Reason for call: PtA . Ns. kt,, ?ro t?c? LQo y,?Q A,-4rcy Grp {fiv dL,,tifd
klyf- L"'- j /c, it ti Spy ? /S h Lw l ?° ??Gj/ ??otin, Lt wti g . 6r; ,( 4;'i
?
wL'rtiS bkAAA .4,K_ ,yba??. ,Qt? Cvrre???? ?{ -F?11cut{' f? MS. ??riF?
h_
Deceased Name: e e11 Ate.(,-v ?-f 1 l
Date of Birth: Date of Death
Block 1 Lot a• Space
• Owner of Plot: f-C? ?• ?r' ??
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)
n
LJ
?JS?p?OFjy?'- CITY OF CLEARWATER
POST OFFICE BOX 4748 CLEARWATER FLORIDA 33758-4748
?..? : ?; CITY HALL, 1 12 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4090 FAx (727) 562-4086
OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
February 15, 2011
Ms. Jessie Griffin Glackin
808 Regent Ave.
Clearwater, FL 33764
Re: City of Clearwater Municipal Cemetery
Block 1, Lot 2, Spaces 13, 14 and 15
Dear Ms. Glackin:
Enclosed please find the corrected Affidavit granting interment rights to the
above City of Clearwater cemetery spaces for you and your brother.
Please review this document with your brother for any errors or omissions. If
you agree with this document, have it signed and notarized by the appropriate
individuals.
You may return the completed Affidavit to my attention at your earliest
convenience. We then will update our records to reflect this information.
If you have any questions, please give me a call at 727-562-4093.
Sincerely,
" Q --
udith 4/-'?
aCosse
Staff Assistant
Enclosure
"EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER"
AFFIDAVIT
STATE OF FLORIDA
COUNTY OF PINELLAS
We, Jessie Griffin Glackin and Lloyd Aubrey Griffin, the undersigned, do hereby attest
that we are the descendants of Lloyd Griffin, our father, who is buried in Block 1, Lot 2, Space 6.
Lloyd Griffin was the owner of Block 1, Lot 2, Spaces 5, 6, 7, 8, 13, 14, 15 and 16 in the
Clearwater Municipal Cemetery. Lillian B. Griffin, our mother, is buried in space 7. Mildred I.
Griffin, our sister, is buried in space 8 and an infant named Barnes, our cousin, is buried in space
16. Spaces 5, 13, 14 and 15 remain vacant.
Please take this affidavit as your authority to note the right to property described below when the
need arises. We understand that the maximum capacity of a space is two burials provided at
least one person is cremated.
Block 1, Lot 2, Space 15: Lloyd Aubrey Griffin
Block 1, Lot 2, Spaces 13 or 14: Jessie Griffin Glackin
We agree to release, indemnify and hold the City of Clearwater harmless from liability in the event
of any claim arising from the use of the above described property as stated above.
SIGNATURE
Jessie Griffin Glackin
ADDRESS/PHONE
Lloyd Aubrey Griffin
SWORN TO and subscribed before me this day
Jessie Griffin Glackin who produced identification in the form of -
and who did/did not take an oath.
Notary Public
My commission expires:
SWORN TO and subscribed before me this day of 2011 by
Lloyd Aubrey Griffin who produced identification in the form of
and who did/did not take an oath.
Notary Public
of , 2011 by
My commission expires:
Cemetery Call Work Sheet
8rn? ••
Date: 3 / 33 / oq ?(o?d ?,, prey lTr? f?i?
Funeral Home/ Monument Company: o g FU i e Lie
Contact Name: Ja c Gr i f f;^ lr? '33-7(-Y
Tel. #: -f If 1- 3x89
Fax #:
Reason for call:
Deceased Name:
Date of Birth: Date of Death
13, ?? 1 S7 1
Block Lot a Space- 8'
Owner of Plot: L(bx 4 Gr i ffi o-, $ Lois)
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
I?lw;,P? ?? f Pa v ? "? f° M 5 6 6f. 4\ efc .
' /?8/0I
Ate ?,e
?1`
(A-. o . Y-
<a
1
OFFICIAI. RECORDS MID
LEGISLATIVE SERVICES
March 25, 2009
C ITY OF C LEARWATER
POST OFFICE BOX 4748, CLEARWATER, FLORIDA 33758-4748
CITY HAIL, 112 SOUTH OSCEOIA AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4090 FAX (727) 562-4086
Ms. Jessie Griffin Glackin
808 Regent Ave.
Clearwater, FL 33764
Re: City of Clearwater Municipal Cemetery
Block 1, Lot 2, Spaces 7, 13 and 14
Dear Ms. Glackin:
Enclosed please find the Affidavit granting interment rights to the above City
of Clearwater cemetery spaces for you and your brother.
Please review this document with your brother for any errors or omissions. If
you agree with this document, have it signed and notarized by the appropriate
individuals.
You may return the completed Affidavit to my attention at your earliest
convenience. We then will update our records to reflect this information.
If you have any questions, please give me a call at 727-562-4093.
Sincerely,
Judith LaCosse
Staff Assistant
Enclosure
FRANK HIARARD, MAYOR
GEORGE N. CRETEKOS, COUNCILMEMBER JOIIN DORAN, COUNCILMEMHER
PAUL F. GIBSON, COUNCILMEMBER ® CARLEN A. PETERSEN, COUNCILMEMRER
"EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER"
AFFIDAVIT
STATE OF FLORIDA
COUNTY OF PINELLAS
We, Jessie Griffin Glackin and Lloyd Aubrey Griffin, the undersigned, do hereby attest
that we are the descendants of Lloyd Griffin, our father, who is buried in Block 1, Lot 2, Space 6.
Lloyd Griffin was the owner of Block 1, Lot 2, Spaces 5, 6, 7, 8, 13, 14, 15 and 16 in the
Clearwater Municipal Cemetery. Lillian B. Griffin, our mother, is buried in space 7. Mildred I.
Griffin, our sister, is buried in space 8 and an infant named Barnes, our cousin, is buried in space
16. Spaces 5, 13, 14 and 15 remain vacant.
Please take this affidavit as your authority to note the right to property described below when the
need arises. We understand that the maximum capacity of a space is two burials provided at
least one person is cremated.
Block 1, Lot 2, Space 7: Lloyd Aubrey Griffin
Block 1, Lot 2, Spaces 13 or 14: Jessie Griffin Glackin
We agree to release, indemnify and hold the City of Clearwater harmless from liability in the event
of any claim arising from the use of the above described property as stated above.
SIGNATURE
/Jessie Griffin GI in
ADDRESS/PHONE
7z 7- q- 41 -3C'9S'
33 1 % YS /? tom' 1? r: 2 W.4 fZ -0i Lloy ubrey Griffin
71)-311,Y )??o
SWORN TO and subscribed before me this o215t da%?? 200 by
Jessie Griffin Glackin who produced identific in the form ofu
and who did/did not take an oath. 17 j
WC-STATE OF FLORIDA
Not r} ?ubli Debra E, Lemere
°? Commission r DD406665
V Expires: APR. 28, 2009
Bonded Thru Atlantic Bonding Co., Inc.
My commission expires:
SWORN TO and subscribed before me this "?6 Clof , 200 by
Lloyd Aubrey Griffin who produced identificatio ' the form ofl OF FLORIDA
and who did/did not take an oath. zebra E. Lemere
Commission ,06 DD406665
xpires: 28, 2009
Notary P bli Bonded Th .'-'.`ionding Co., Inc.
, v 9
My commission expires:
{ 1
CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
BLOCK : 1 LOT: 2
DECEASED NAME: INFANT ANDERSON
BLOCK: 1 LOT: 2 SPACE: 4 BURIALTYPE: INFANT
BORN: 01 / 01 / 1901 DIED: 01 / 01 / 1901 INTERRED: 01 / 01 / 1901
INTERMENT NOTES:
DECEASED NAME: LLOYD GRIFFIN
BLOCK: 1 LOT: 2 ! BURIALTYPE: FULL
BORN: 05 / 04 / 1892 DIED: 12/08/1991 INTERRED: 12/11/1991
INTERMENT NOTES:
DECEASED NAME: LILLIAN GRIFFIN
BLOCK: 1 LOT: 2 7 BURIALTYPE: FULL
BORN: 03 / 08 / 1899 DIED: 12 / 05 / 1968 INTERRED: 12 / 07 / 1968
INTERMENT NOTES:
MIDDLE NAME: BARNES
DECEASED NAME: MILDRED GRIFFIN
BLOCK: 1 LOT: 2 "'81' BURIALTYPE: FULL
BORN: 09 / 23 / 1923 DIED: 03 / 15 / 1925 INTERRED: 04 / 01 / 1925
INTERMENT NOTES:
DECEASED NAME: INFANT BARNES
BLOCK: 1 LOT: 2 BURIALTYPE: INFANT
BORN: 01 / 01 / 1901 DI U1 / 01 7 1901 INTERRED: 07 / 01 / 1953
INTERMENT NOTES:
****END OF BLOCK : 1 LOT: 2 ****
La
(I ?_ (v
( V6,z?
Page 4 of 43
AFFIDAVIT
STATE OF FLORIDA
COUNTY OF PINELLAS
We, Jessie Griffin Glackin and Lloyd Aubrey Griffin, the undersigned, do hereby attest
that we are the descendants of Lloyd Griffin, our father, who is buried in Block 1, Lot 2, Space 6.
Lloyd Griffin was the owner of Block 1, Lot 2, Spaces 5, 6, 7, 8, 13, 14, 15 and 16 in the
Clearwater Municipal Cemetery. Lillian B. Griffin, our mother, is buried in space 7. Mildred I.
Griffin, our sister, is buried in space 8 and an infant named Barnes, our cousin, is buried in space
16. Spaces 5, 13, 14 and 15 remain vacant.
Please take this affidavit as your authority to note the right to property described below when the
need arises. We understand that the maximum capacity of a space is two burials provided at
least one person is cremated.
Block 1, Lot 2, Space X. Lloyd Aubrey Griffin
Block 1, Lot 2, Spaces 13 or 14: Jessie Griffin Glackin
We agree to release, indemnify and hold the City of Clearwater harmless from liability in the event
of any claim arising from the use of the above described property as stated above.
SIGNATURE
,;Jessie Griffin GI ` in
ADDRESS/PHONE '7z7- q-4-1- 3o 9"Y
Lloyji ubrey Griffin
3-3 j 6,
/I T
C) -'7 11, lk
SWORN TO and subscribed before me this oZ? day of ?(`, 'I;_6 200f by
/c2t?c Q lye ,C/C'
Jessie Griffin Glackin who produced identific in the form of
and who did/did not take an oath. - , /^)
My commission expires:
` Q SWORN TO and subscribed before me this da -of
Lloyd Aubrey Griffin who produced identification ' the form of lG
and who did/did not take an oath. ?i
Notary P blir"
My commission expires:
?UI;LICrSTAa OF FLO-KiD,x
y > ? Debra E, Lernere
P, • Corirrission ?D0406665
Expires; A-PR, 28, 2009
iiended Chru i tl u Bonding Co., Inv.
, 200 by
M -4' t% 1,:-OF FL0R1D
bra E, Lernere
_j l_Li •sioc ? DI)406b5
t l>>1. :" 2s, 20oc
is di?-ig Co., Ine,
Cemetery Tracking System
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Block: 1 Lot: 2
Profile Summary
Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on
the second grid to view the interment details of that individual.
EAST SIDE OF MYRTLE AVENUE
Space Owrier Last Owner First Qwner Middle Max Interred Total Assigned Interred
11 ANDERSON JOHN W 0 0 0 View Assigned
12 ANDERSON JOHN W 0 0 0 View Assigned
13 GRIFFIN LLOYD 0 0 0 View Assigned
14 GRIFFIN LLOYD V 0 0 0 View Assigned
`15 GRIFFIN LLOYD V 0 0 0 View Assigned
16 GRIFFIN L V 1 1 1 View Assigned
IL
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Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
I second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on
the second grid to view the interment details of that individual.
EAST SIDE OF MYRTLE AVENUE
Space Owner Last Owner First Owner Middle Max Interred Total Assigned Interred
1 ANDERSON JOHN W 0 0 0 View Assigned
2 ANDERSON JOHN W 0 0 0 View Assigned
3 ANDERSON JOHN W 0 0 0 View Assigned
4 ANDERSON JOHN W 1 1 1 View Assigned
5 GRIFFIN LLOYD V 0 0 0 View Assigned
6 GRIFFIN LLOYD 1 1 1 View Assigned
7 GRIFFIN LLOYD V 1 1 1 View Assigned
8 GRIFFIN LLOYD V 1 1 1 View Assigned
9 ANDERSON JOHN W 0 0 0 View Assigned
10 ANDERSON JOHN W 0 0 0 View Assigned
12
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Block: 1 Lot: 2 Space: 7
Rights Granted: 1--1 Interment Processed: ? 771
Burial Type:
First Name:
Date of Birth:
Interment Date
Interment Director:
Staking Fee $
Interment Notes:
FULL Owner of Space? YES
LILLIAN MI: F71-ast Name: GRIFFIN
03/08/1899 Date of Death: 12/05/1968
12/07/1968 Time of Service: ;
MOSS LAKESIDE
Permit:
668
IV Date Paid:
MIDDLE NAME: BARNES
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Block: 1 Lot: 2 Space: 6
Rights Granted: 12/10/1991 Interment Processed: 12/10/1991
Burial Type: FULL Owner of Space? YES
First Name: LLOYD MI: E7 Last Name: GRIFFIN
Date of Birth: 05/04/1892 Date of Death: 12/08/1991
Interment Date: 12/11/1991 Time of Service:
Moss
Interment Director: Permit: 2039
Staking Fee $ 0 Date Paid:
Interment Notes:
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Block: 1 Lot: 2 Space: 8
Rights Granted: r? Interment Processed: ?
Burial Type: FULL Owner of Space?
First Name: MILDRED MI: Last Name: GRIFFIN
Date of Birth: 09/23/1923 Date of Death: 03/15/1925
Interment Date: 04/01/1925 Time of Service: ;
Interment Director: Permit:
Staking Fee $ lV Date Paid:
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Transaction Block: 1 Lot: 2 Spac e: 16
Rights Granted: I? Interment Processed: I?
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Burial Type: INFANT Owner of Space? NO
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First Name:
INFANT
MI: Last Name:
BARNES
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Permit Date of Birth: 01/01/1901 Date of Death: 01/01/1901
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Interment Date: 07/01/1953
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