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Burke, Betty W Cemetery Call Work Sheet 01-*11 - Date: lhgjo Funeral Home: _?i1,h(.it'l5 G'-bbl ko 6t jj Monument Company: ick(1,U, 11fioi?,YIei 4 Contact Name: i?et l Contact Name: Tel. #: (AP7 - f?C150 Tel. #: Fax #: Fax #: RE: IM1CE???1t?Tf 1?1CN?11Y -Iyl-(?Vy Sr?? t`???i?zvLk_ (tqj3)6>"7' C? E? - (?13) "L - 7a ? Q? ,r? `:? n ' rn i 11 (alCau C( I?1 ?f ?(X1ce C' bin-ci6,C. Il1tbafj l? t Abl ulal Twu VU 1,11 faLc ??lL ' toy- i4i,IC4 Deceased Name: t? Y? Ul i? it DOD: -21'4 icy DOB: ° Z Z3 Owner of Property: 0-It 1t-0 Block 'D Lot 3C Interment: ?/ Full Burial: ($30.00 Staking Fee) - (One full burial and one urn, or two urns) Date of Burial: 11 ( fto 0.kx _) Time: am/pm Disinterment: Urn Space: 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) S:/Jlacosse/Cemetery Call Work Sheet.doc Space I )-- 6/8/04 Alfaro, Rosemarie From: Alfaro, Rosemarie Sent: Wednesday, August 11, 2004 10:37 AM To: King, JoEllyn; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie Subject: RE: Cemetery Issue - Re: Betty Burke fyi - Apparently the remains of Mr. Grundy (urn) were found in Space 12 during the interment service. They have placed Betty Burke's remain in the same space. This information will have to be corrected as well as the future burial note. Rosemarie -----Original Message----- From: King, JoEllyn Sent: Wednesday, August 11, 2004 6:51 AM To: Alfaro, Rosemarie; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie Subject: RE: Cemetery Issue - Re: Betty Burke It is taken care of and marked with purple flags. -----Original Message----- From: Alfaro, Rosemarie Sent: Monday, August 02, 2004 10:28 AM To: King, JoEllyn; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie Subject: Cemetery Issue - Re: Betty Burke Jo Ellyn: Request for staking - the interment will take place on Wednesday, August 11; to be staked Aug. 10 Betty W. Burke Block 5, Lot 30, Space 12 Located in the Grundy plot: between Ada Mae Davis (space 13) and Giralda K. White (space 11); Myrtle McMichael Loesher is adjacent to the empty lot (space 5) Thank you. Rosemarie Alfaro, Rosemarie From: Alfaro, Rosemarie Sent: Friday, July 30, 2004 10:57 AM To: Norman, Lois; LaCosse, Judith; Chase, Susan; Kaushal, Mona; Reehling, Dottie Subject: Cemetery Issue Re: Interment of Betty W Burke (urn space) Block 5, Lot 30, Space 12 Spoke with Brenda Burke today - the family is not sure if the memorial service and interment will take place at the same time. She will be calling later this afternoon with a definitive answer. Could possibly take place on August 6th. I have not contacted Jo Ellyn yet - waiting for confirmation. Norman, Lois From: Norman, Lois Sent: Tuesday, May 04, 2004 3:02 PM To: Norman, Lois Subject: Future burial - urn - Betty Burke Brenda Burke, daughter of Betty Burke has been calling to set up a future interment of an urn. Betty Burke is the daughter of H. Grundy (owns Block 5, Lot 30, Spaces 12, 13, 14 and 15). The cemetery pending file in the vault has a copy of the death certificate of Herbert Grundy and a US Naval Servie Coast Guard Notice of Separation showing Betty Grundy; then a Veterans Affairs statement for Betty Winifred Burke, connecting her identification as Betty Grundy. Space 14 will be for placement of an urn for Betty Winifred Burke. Mrs. Burke's son has terminal cancer and will be one urn (additional) in Space 14 at some future time. The interment for Betty Burke has not yet been done. -/b q 1 W J 7 W D Z W Q W J } LL 0 W ? U] c, O J L m ? R r O O N O O i r O r - N O O a I ?N+ LL ? i ? r o cv ca o o ! Z W z U Q U Q U Q ? O 0 = 2 2 2 W Z co 60 co W z W Z J J Lt 0 CC 0 CC 0 CC 0 O O o o O : ? ? J J J z W W W Z Z 2 2 2 } } } } W U U U Z Z W W ? Z ? Z ? Z ? Z C) L) U Z Z = = CC CC Cr CC w A Lo Lo M1 co 47 O N C 2 qE L.[) r Ul I U as Q1 O cr} cn ?J 4? V v a In m i 4 v a v 41 O O 0 7 ?v a? v 0 a Q 0 g x 0 c M U1 NOTICE OF SEPARATION FRO: HE U. S. NAVAL SERVICE - COAST G RD NAVCG•$58 IAev, 9-44) 1, MAMA ILAGrI IFIIIIST) (MIDDLEI a, RATE OR HANK A. RAY GRADE d. C. G. SERVICE NO MV= Basic we I Accrue. Y6. OR) 4 41005-10ot D- PERMANENT ADDRESS FOR MAILING ?VRPOSEB s. RACE 7. erx S. DATE OF BIRTH 1968 s. Drew Street Gleazwatex TIAL• W. t. 6/87/28 ?. ADDRESS FROM W141CH DISCHAACEE WILL SEEK WORK (IF DIFFERENT FNOM ITEM &St 10. MARRIED 11. NO DF DEPENDENT9 12. U. S. CITIZEN YEB I is. NO as 1te®t y RECORD OF COAST GUARD SERVICE BEIICCTIV6 12 AirISTERED IA, M014E?ADD?REE6Y AT TIME OR ENTRY INTO SERVICE 1` It. LOCAL HOARD NO., COUNTY AND STATE 9DATAa ?I YES I w0 I I'!?9!! Dr" St.. 1f.0G? * ?) /? Vi*ft1Wat6rp P146 I r ?P r r r le, RLACE Or SNTAV INTO SERVICE Tampa, na. I MO. DAY YR. e 9 43 17. PLACE OF SEPARATION FROM SERVICE 0a try s.. 8el'"Mah, ma. MO. DAY YR. l? 8 4d IS. CHARACTER OF DISCHAROE l! Donamb IR. LENGTH OP FOREION AND/OR SEA HERVIC[ WORLD WAR II r. - 11wr FYFARA MONTHS DAYS 120. SERVICE SCHOOLS ATTENDED COUAAES WEEKS 21. OFF DUTY EDUCATIONA L COU RCES CLASH HOURS AA?M ?T ?? yy?? ?? iblr ?. EMPLOYMENT AND NON-SERVICE EDUCATIONAL DATA Al. LAST EMPLOYER 1ERORE ENTRY INTO SERVICE (GIVE FIRM NAME AND ADOPIESA) I DATE LEFT 312. USUAL CIVILIAN OCCUPATION ID.O.T. TITLE AND SIIIKO OESCRIPTION) I ae. JOB FIELD PRICFENENCK IS. JOB AID DESIREDt ae, LOCALITT PREFERENCE.(GI`VE OKNERAI AIIIEA) YEN I 'O (G '•4. 27. aNTER NUMBER OF YHAPS COMPLETED 20. MAJOR COURSE OR FIELD NON-HERVICE I GRANMAP SCHOOL I MIGI,L ECM OOL I OLLHOH EDUCATION ?w" am x0sle• UCA s 20. VOCATIONAL OA TRADE COURSES (INDICATE NATURE AND LENOTM Or COURSES) ae&rMt®r malwa; 0"89, 01641eater, 71s. Hlydoses tra3aftag. SO. PREFERENCE 000 ADDITIONAL EDUCATIONAL TRAINING FftgU*B%.N mdaitl*M], ed=aLi*"X trQ4rj4Z&. al. REMARKS RMAC&NA tars 0"" a Rotor Utitled to wean Al-aeriomn A Va. Campaign M15Vano aW VlatOxy Modal, Entitled to diacbarge tmfts the Ooeat Ord Point Obrstes, 1 aerllfy (hUt all Informcdon on this form perIo4nlnq to the Navol Service of the above named Individual Is In accordance with \ the rccorde of the V. S. Coact Guard and that a copy of this term has been delivered to him in person. ISIONATURR o? DISCHARGING OPrICEA) 1 J9?AD_ Lt-119) 1 (TYPE NAME A O RANK OF 0I0CMAAa1N(i OFrICEA) OS, SIONATLRE OR 6 A JLs PATE *=4y' 4 11vatimber. 110 Y'Ot: COJ}LSYI a1JASD HrJ1LDQUARTIDS ? ? APR-28-2004 08:16 AM SPEC.S'v'CS.MANHATTAN 813 8396201 P.04 -- 4' OFFICE of VITAL STATISTICS "I CERTIFIED COPY --.......?...?..?,..,? _', R r ar I 'wf? dr+° i.14 1r'rr?!"'?? k 9--"04--001155 CERTIFICATE OF DEATH r3?1 ?;I .PL F?L B No FLORIDA , EDIZNT'SNAME",' f FIRST m Batt MIDDLE LAST y W. Burke Fema?. DATE OF DEATH IMoMth, Do$ yber) a, SOCIAL SECURITY NUMBER Sit. pG sa E ael Birthday, Sb. UNDER 1'V AR V * tr February 4, 2 ly 8 0 Months Hoursl : i; w a` r 264-40-2291 Days r d; DATE OF BIRTH (Monlh Day, 1wr) 7. BIRTHPLACE (Clly and Stare or Foreign CoLntry) A, WAS 0 ClEEN WER.t r. ) `'June 27, 1923' Clearwater Florida ` A McISFoa tiitiY0 pa, PLACE OF DEATH (Check envy one: see fnsUUclient on uhor srtla) Bb, INSIDE CITY LIMITS? (Wr it Ay) P 1-11-f ER/Ou'petlent DOA 0 F Nursing Homo _ Ruxidonco Other S ecl 4'.' ,in . , Xe g YW y,. ?? hu m^,+;. h a 9c. FACILITY NAME (It /W Inetiluk1h, 0V street end number) 9d. CITY, )OWN, OR LOCATION OF DEATH ' a8;^on +i „ ?.qVµ It I , Tti h w4 Ieyie qv ,! `Kindred Hospital-Central Tampa Tampa ?1? h? l ,+ 0s.0E4E1 DE t6 USUAL; OCCUPATION 10b, KIND OF BUS14ESSANDUSTRY 11. MAR T ITAL STATUS -Married, 12. SURVIVING BPOU5 If F wrrA, ?t1vs Afq?1n 4r r Nov*r Msrrlod, Wldowad, r p a l mi tda Spy rH, , , pD1°trh?l i??, „kh, ?kI rA AfN, I1„Divor00d (SDeClfyj as rical Worker Medical Divorced RE5f?pt NCK?r1vl T{17 1 ,IQ?QUNIy 13c, ('1TY TOWN, OR LOCATION 13d. aTREETAND *MACh? pnµii IM1A N? ?AI?Yf? , ,",M?^'n.M'P a *.yy; W x a} MW 'hl ?{W oNYKm ) 'V ?'tYuiOb rpm '?r ?0 Y tla ,'?+N'?d' ?d A? r2 ,v r,I C2f 9 lCL$ 1 tb )11 i, ° F??lsborough aoll rL Tampa " solit?liwrha?l M, v13e"'INSIDE CITY 131,'ZIP;CCDE 16, WAS DECEDENT OF HISPANIC OR HAITIAN ORIGIN? 1B, RACE - Amerken Intllen, 1?:'de.r0ENM' LIMIT&7(1ax or Nq (Spee,ly No W Yes If )s sPecry, Hsmnn, Cuban. , ;EN?DUt2 real',rte. , ,a .? • X Black, White, etc. y$cify on , ?? ro PI?I Mexican, Puerto Rlcen, sic.) „r No Yes $pacify Yes 33611 Eleme"larylsaoondory College (1-4.0f S + )' specify White (o• tr, 4 1T, FATHER'S NAME (uI Mk Lesq 18, MOTHER'S NAME (Firer, M(ddlo, Mnldon Svrnarno). Herbert Grru ndy y . Mae Davis r : "'tiyfi 111C;INfORMANT 8 NAME (7ypaiPrMQ 10b, MAILING ADDRESS (Sliest and Number or Flyrel Hoyle Number" Clly of 76h l'5181e ,d°Ip Cope, ,` 'l, iichaol D. 'Burke r 4007 Knights Avenue, 'Tampa? Florida.-3361:*' ?0 201 METHOD OF DI-SPO$ITTON $fyloq ?m 206, PLACE OF D13POSInON (Npmo of ceme/eryl crmnalay, or 20o LOCATION City of Town, State n SutW. j(, Crematlon Other prtco)? v ?y? Ylbllayon' i OttwDr,(gj)) Romovelfrom Slalo Premiere Crematory Pn?i1Fa'y,?rb1°)"r` k{"JuW4?Y(^krr^;;I, 4L 9ICiNATU E F FUNEpAL SERVICE LICENSEE OR 21b, LICENSE NUMBER 21e. NAME AND A00RESS OF FACILITY Abb. A f b> r a n?e., l ") ;`rl i;>??RaON INa AS SUCH a 1 x ? ??'f t. ( l oendee) , d l I's p o su rh. 1• Cremation & Funeral SVe3X„°;nw ? 3611 12541 Ulmerton Road, tar Or A 33?1 na o the beet of my krwwtedge, d urrod sl I a tlm? dale end ptodg end due 23s. On the bosis of stteminallon and/or InvOAllomon; In Mjc;op{nio >q urre to tna uussUl as slated ?) ?n j\J at the time, date and place end duo itl'I 51 ha.o a ,efldrmen?y 8 nature and Title 11. L R v \ 166o gilt ¢ ' (Slgnaturo and Title ? jig 22C. DATE SIGNED (M , Day, ylj 22c. HOUR OF DEATH w 23b, DATE SIGNED (Ma, Day, Y4 2ao HOUR oW t)EMI, W 4 i 4:17 P M A, r nos ?(' 22d, NAME F ATTfiNO No PHYSICIAN 1F OTHER THAN CERTIFIER (Type or PrInQ tad, MEDICAL EXAMINER'S CASE a ? r . 24, NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, MEDICAL EXAMINER) (7ype or Print) 011?yinka Bankole, M.D., 4204B North MacDill Avenue, Suite 2,'''Tam a, Florifl8'3356 lu°w n 1; Sa?,,,S 1®Rr? B,?RAR ,61,?iNATuRE AND DATE 28b, L AL-REOIB RA 16NATUWE ?y+C [? TE'REOIBIJT?f?RED kr f?tuG e^. '", „7 xc x, ? r,? ;,1'rr LTZ?'?^q???;? 1 v'4 26rPAFfT L Enter the dlseAess, 1nlun4e, or cMhplicallons that caused the death, Do not enter the modo of dyklp, such ae cardl gl' or heart failure. List only one amuse on each line, plralory pnCal, shock Approtlmala 'Inlorval Between Onset anti c yIMMEOIATE CAUSE (Final, 4uye, 01?p p btseaeo br eondulbn V1ly, 4 ?S,, ialuhlnpIn death):::. `-3e' r' +q N d, :. 0111 ,„ R ka N? uM ? ,, nF rN r&s? -77, el n 1 1 1 AA A N 41 r, ( -C2-O er «. °' I t ` r,, W 1 d y nyl t z Clearwater City of Clearwater, Florida Official Records and Legislative Services Department Phone (727) 562-4090 Fax (727) 562-4086 FAX MESSAGE TO: Brenda Burke LOCATION: Tampa, FL FAX NO.: 813 839 6201 COMMENTS: See attached VA Form 40-1330 re Betty Winifred Burke marker request. Thank you for the other copies you supplied. FROM: Lois Norman, (727-562-4091) DATE: 4/28/2004 NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2 Fax From: Brenda Burke April 28, 2004 Attached: 1. Department of Veterans Affairs application for government headstone 2. Office of Vital Statistics-Certlficate of Death (Burke) 3. Notice of Separation-Coast Guard (Grundy) Regarding: Betty Winifred Burke (Formally Betty Winifred Grundy) Re: Burial plots originally purchased by Herbert and A. Mae (Davis) Grundy at Clearwater Cemetery Department of Veterans Affairs-type of headstone (upright granite) permitted in Clearwater Cemetery area owned by the Grundy family Fax to: City of Clearwater Attention: Lois Norman *** (Thank you Lois for all of your help.) Fax #: 727-562-4086 Kindly sign Department of Veterans Affairs application for government headstone, # 24 and fill in # 25 and 26 (# 27 if there are remarks) and return to: Brenda Burke 4007 Knights AV Tampa, FL 33611-1357 Phone 813-837-2535 or cell 813-892-5738 Form, approved, OMB No. 2800.0222 Resoondsnt Burden: 16 minutes IMPORTANT: Please read the General Information Sheet before completing this form. Type or ' print clearly all information except for signatures. Illegible printing could result in an incorrect QUEST 7 headstone ormarker or delivery, Blocks outlined In bold are optional Inscription items. Unless P'Irst time) REQUEST indicated otherwise all other blocks must be completed. MILITARY DISCHARGE REQUEST SECOND DOCUMENTS OR RELATED SERVICE INFORMATION IS REQUIRED, ? CORRECTED APPLICATION/REPLACEMENT 2. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (NO NICKNAMES OR TAMES PERMITTED) 3. CHECK BOX BELOW IF REMAINS ARE FIRST (Or InltlaJ) MIDDLE (Or Initial) LAST SUFFIX NOT BURIED AND EXPLAIN BLOCK 27 (e. g., [apt of sea, remains sc tered, etc.) W1 Nt 9, U P, Vve REMAINS NOT BURIED VETERAN'S SERVICE AND IDENTIFYING INFORMATION (Vgenumber#only, cg,, 05-154941) 4, VETERAN'S SOCIAL SECURITY NO. OR SERVICE NO, (failure to complete PERIODS OF ACTIVE MILITARY DUTY (For addirlonal space use Block 27) will delay pro-sing.) ^ n BA. DATE(S) ENTERED BB. DATE(S) SEPARATED ? I r ? ? .D- . MONTH DAY YEAR MONTH DAY YEAR BA. DATE OF BIRTH 150. DATE OF DEATH 0 09 43 f 0C J ' l< ` R YEAR U o ? YEA oc? ? I 7. HIQHEST RANK ATTAINED (No pay grades) 8, BRANCH OF SERVICE (Check bar(es) - must be consistent with rank (Bar 7)) D G(, ft55 M(,tSlCi AN TNtR MARIE OAST ARMY MEp?HANT OTHER D AIR RINE ?Spec[Jy) ORCE FOR ES IP F fC EN 15 /ZE$?aV6 U C A ffAA M LJ AR {J A B u 9. VALOR OR PURPLE HEART AWARD(S) (Documentation mull be p?arided) 10, WAR SERVICE (Check applicable boz(es)) BRONZE MEDAL OF DST SVC NAVY AIR FORCE SILVER STAR PURPLE OTHER WORLD PERSIAN OTHER HONOR CROSS CROSS CROSS STAR MEDAL HEART is ecjfy) WAR 11 KOREA VIETNAM GULF clJj) S Des V PH II 71KO VN 1 1. TYPE OF HEADSTONE OR MARKER REQUESTED (Check one) 12. DESIRED EMBLEM OF BELIEF WHEEL OF STAR OF FIAT FLAT UPRIGHT FLAT BRONZE UPRIGHT LATIN CROSS RIGHTEOUSNESS DAVID OTHER (Speei/y)(See reverse oJback copy BRONZE GRANITE "ARBLE MARBLE NICHE GRANITE NONE Chr/stlan) Buddhist) Judaism) or illustrated authorized emblems) ?B ?G U ?F ?2 V ? 01 ?02 03 13A. NAME AND MAILING ADDRESS (No., street, r.[ry. Stare, and 13B. DAYTIME•PHONE NO, OF PERSON TO CONTACT 1 e, ARE YOU: -121PViide) OF PERSON, TO CONTACT FOR ADDITIONAL.. - FOR-AD TIONAL INFO.R INFORMATION - NEXT OF•KI - N 1 FUNERAL V ETERANS 14. E-MAIL ADDRESS (Optional) ?DIRECTOR SERVICE OFFICER C EM ETERY p I v r -, 001 N 1 c OFF ICIAL 16. FAX NO. (Options!) ? OTHER (5pectf'y) ~ 135 CERTIFICATION- I certfty the headstone or marker will be installed in the cemetery listed In block 21 at no expense to the Government and all statements made are true and correct to the best of my knowledge, 17. SIGNATURE OF PERSON NA APP RS IN BLOCK 13A 18. DATE LJ 19. NAME AND DELIVERY ADDRESS OF BUSINESS (CONSIGNEE) THAT WILL 20. DAYTIME PHONE NO. 21. NAME AND ADDRESS OF CEMETERY WHERE ACCEPT PREPAID DELIVERY (No., Street, City, State and ZIP Code); P.O. BOX (Include Area Code) GRAVE IS LOCATED (No., Street, City, Slate and IS NOTACCEPTABLE ZIP Cade) CERTIFICATION: I a ee to accept prepaid deliver of the headstone or marker. 22. SIGNATURE OF PERSON REPRESENTING BUSINESS (CONSIGNEE) NAMED IN BLOCK 18 23, DATE CERTIFICATION: I certl the type of headstone or marker checked In block 11 is permitted In the cemeter named in block 21. 24. SIGNRY OR OTHER E ONSIBLE OFFICIAL 25. DAYTIME TELEPHONE NO. 2e. DATE (Include Area Corte) 7ZI- 66;(- cat 04 -3C$-A0o 27. REMARK ( ptlonnl Inscrlpllan space will nary /n ,s[¢e arrarding In the type of marker) 29. GRAVE IS! CURRENTLY MARKED ? i h i l (W t pr vate y purchased marker) NOT MARKED STATE VET AAN$' CEMETERY AND GRAVE LOCATION C"neterl Use Onl y) 29. ID CODE 30. SECTION N0. JAN 2003 IRS) 40-1330 APPLICATION FOR STANDARD GOVERNMENT HEADSTONE OR MARKER ? • :Clearwater City of Clearwater, Florida Official Records and Legislative Services Department Phone (727) 562-4090 Fax (727) 562-4086 FAX MESSAGE TO: Jillian LOCATION: Affordable Memorials FAX NO.: 823 1640 COMMENTS: See attached map for Clearwater Cemetery, Block 5, Lot 30, Space 12 (Bet . Burke). The headstone spot will be marked with white flags on East side of Cemetery. Please come in from the East gate on the East side, there is a large tree blocking the road on the East side. If you have any questions, please call. FROM: Lois Norman, (727-562-4091) DATE: 9/29/2004 NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2 SEE SHEET ?I AVENUE 25 I6 15 6 5 44 [371 281 21 12 5 43 3B 27 22 II 6 29 1 28 1 23 1 22 1 13 1 12 1 7 6 30 ?G 19 14 3 18 15 2 17 16 9 1 I 16 15 6 5 a ?O 17 14 7 4 ?I 8 3 9 2 IA I 12 1,9 L 13 18 PROSPECT AVEWE 24 17 14 7 4 18 17, 23 18 13 B 3 19 16 22 I :19:] 1,2 i 9 2 20 ? IS 21 20 I I 0 I 21-_. 14 19 18 6 K 22 13 J 20 17 B? 5 J 23 12 u F 2 16 ? 4 T a4 II 22 15 W 10 3 M 25 10 23 14 II 2 G 26 9 24 13 12 I F 27 U1 8 16 IS ? 5 E 28 7 17 14 7 4 D 29 6 18 13 ? 19 12 ? 3 C F-?O- 2 8 5 4 20 21 II 10 24 25 1 A j 289 .? 32 33 3 2 22 23 26 27 30 I 34 1 MYRTLE