Nichols, Mary ECemetery Call Work Sheet
Date: 7 / ? / %011
Funeral Home / Monument Company: GarAJ-h Sc.ov ctkw?
Contact Name: 'belbr-A.
Tel. #: -7 a,'7 -- 3 It - o /.-t- I Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
(3)
V Monument (Marker) being placed (No fee for staking of monument)
F
e V- Fr ? +k ?•+.•1Q
Verifying Burial space pace-a, eA . `f:o° F• .
Oj Garr E. IJ i Aol s (K44 r ae-A (rm
Other reason:
3
a 1?sG l? Moro.vtc- ) P ?khti)
Uoc a Lo -7 Sp• 3
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space R? ?cws
Owner of Plot:
Deceased Name: -PA- R
Block Lot Space
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 authorize burial
Revised 6/29/11
LaCosse, Judith
From: Taylor, Joe
Sent: Friday, July 08, 2011 9:33 AM
To: LaCosse, Judith
Subject: RE: Three Staking Requests - Monuments being placed
Yes, that is correct
From: LaCosse, Judith
Sent: Friday, July 08, 20119:31 AM
To: Taylor, Joe
Subject: FW: Three Staking Requests - Monuments being placed
Importance: High
Never mind Joe,
I did notice that you numbered them. So, I'm assuming that it goes in the same order as I had them in the email. 1 =
Nichols, etc.
Judith
From: LaCosse, Judith
Sent: Friday, July 08, 20119:29 AM
To: Taylor, Joe
Subject: RE: Three Staking Requests - Monuments being placed
Importance: High
Joe,
Can you tell me which color goes with what name. They will probably ask me.
Thanks,
Judith
From: Taylor, Joe
Sent: Friday, July 08, 20119:25 AM
To: LaCosse, Judith
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: RE: Three Staking Requests - Monuments being placed
I used different Colo (s for all three
1.Green - ?i??olS
2. Red - Mor4-ve_4- ?44#1 Sl?:t eo•c???.?se.n ?rkve??
3. Yellow _ b.e-w S
it
-36 1
4.
From: LaCosse, Judith
Sent: Thursday, July 07, 2011 12:48 PM
To: Taylor, Joe
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Three Staking Requests - Monuments being placed
Importance: High
Hi Joe,
We received a call this morning from Debra at Garden Sanctuary requesting the following 3 spaces to be staked for
placement of monuments:
1. Block 7, Lot 87, Space 3 - Deceased, Mary E. Nichols (Mary Beth) - Full
Other burials nearby: Space 1= Archer Nichols - Full
Space 2 = Elizabeth Nichols - Full
2. Block 2, Lot 7, Space 3 -Deceased, Joseph Moravec- Urn
Other burials nearby: Space 1= Samuel Coachman, Jr. & Anne Coachman - Infants
Space 2 = Samuel Coachman - Full
Space 4 = Evelyn Coachman - Urn & Solomon Coachman - Full
Block 7, Lot 141, Space 3 - Deceased, Ruth M. Dews - Full
Other burials nearby: Space 1= John Cheatham - Full
Space 2 = Peachie Cheatham - Full
They would like the staking to be completed by tomorrow, July 8th late afternoon at around 4:00 p.m. If possible they
would like to have the monuments placed before the weekend.
Please advise me on the color of the flags being used on these three spaces so that I could notify them.
Thanks for your help.
Judith LaCosse
Staff Asst.
Official Records & Legislative Services
727-562-4093
• Cemetery Call Work Sheet
Date: a.O I I
Funeral Home/ Monument Company: oS seQ.t.
Contact Name: SwJ.kt?ti
Tel. #: 5 G a - o? °
Reason for call: Firms .
Fax #: S6a - aa't3
,.,I-,--r•i P-e .
SG-L /-P
N ??? ?i( Q !X S w? M y SS ft? ?' J1Ft.tf R S ?? w ?4 hnr ?.Y? IX ?/ i n Q45!L .
Deceased Name: Marl ?. W CAO I S
Date of Birth: I;'- / 'I / ( `l / I Date of Death 3 / a / 1 I
• Block -7 Lot ? ? Space 3
Owner of Plot: Arcl. C. N i CL I S - Spain 1- `f
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
?J L
$30.00 Staking Fee - received on: 3 / JC7
t 1:
Date of Burial: 3 Time: Cjam/per` h ° ow)
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)
0
Crystal Reports Viewer Page 1 of 1
a N ? N 1 / 1 Main Report ( 100%
----------- - --- -
Status of Block: 7 Lot: 87 as of 03/04/2011
INTERMENTS:
SPACE BURIALTYPE
I FULL
2 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECL DECF DECM BIRTH DEATH INTERRED
NICHOLS ARCHER C 1/1/1885 08 / 09 / 1965 8/10/1965
NICHOLS ELIZABETH 1/1/1886 01/01/1944 1/1/1944
Page 1 of I
N ! ? M 1/1
http://msb-crystal-ent/businessobjects/enterprise l l /infoview/viewers/rpt/DHTMLViewer.aspx?skin=skin-... 3/4/2011
Cemetery Tracking System
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http://clearwater/Apps20/cemetery/viewlotprofile. aspx?b=7&1=87
Cemetery Tracking System - View Lot Profile
Block: 7 Lot: 87
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.
WEST SIDE OF MYRTLE AVENUE
............
Space Owner Last Owner First Owner Middle Max Interred Total Assigned Interred
1 NICHOLS ARCHER C 1 1 1 View Assigned
2 NICHOLS ARCHER C 1 1 1 View Assigned
3 NICHOLS ARCHER C 0 0 0 View Assigned
4 NICHOLS ARCHER C 0 0 0 View Assigned
1
[ Too of Page ]
3/4/2011
LaCosse, Judith
From: LaCosse, Judith
Sent: Monday, March 07, 2011 8:11 AM
To: Wells, Alexis
Cc: Tokar, Mark; Sprague, Nicole; Gilmore, Stephanie; Taylor, Joe
Subject: RE: Staking Request - Mary E. Nichols
Thank you. I will notify the funeral home.
Judith LaCosse
Staff Asst.
Official Records & Legislative Services
727-562-4093
From: Wells, Alexis
Sent: Monday, March 07, 20117:55 AM
To: LaCosse, Judith
Cc: Tokar, Mark; Sprague, Nicole; Gilmore, Stephanie; Taylor, Joe
Subject: RE: Staking Request - Mary E. Nichols
Judith;
The grave is marked with PINK flag
From: LaCosse, Judith
Sent: Friday, March 04, 20112:27 PM
To: Wells, Alexis
Cc: Tokar, Mark; Sprague, Nicole; Gilmore, Stephanie; Taylor, Joe
Subject: RE: Staking Request - Mary E. Nichols
Thank you !!
From: Wells, Alexis
Sent: Friday, March 04, 2011 1:40 PM
To: LaCosse, Judith
Cc: Tokar, Mark; Sprague, Nicole; Gilmore, Stephanie; Taylor, Joe
Subject: RE: Staking Request - Mary E. Nichols
Hi Judith;
Both Joe and Mark are out for the afternoon, but I am sure they will get it on Monday morning.
Alexis
From: LaCosse, Judith
Sent: Friday, March 04, 2011 12:39 PM
To: Taylor, Joe
Cc: Tokar, Mark; Wells, Alexis; Sprague, Nicole; Gilmore, Stephanie
Subject: Staking Request - Mary E. Nichols
Importance: High
Hi Joe,
We received a call this afternoon from Moss Feaster requesting a staking for a Full burial for:
Mary E. Nichols in Block 7, Lot 87, Space 3, who passed away on March 2"d . She's the daughter of cemetery plot
owner, Archer C. Nichols.
Other burials nearby in Blk 7, Lot 87:
Space 1= Archer C. Nichols - Full burial
Space 2 = Elizabeth Nichols - Full burial
Spaces 3 and 4 are vacant
Staking is needed for burial this coming Tuesday, March 8th at 11:00 a.m. They requested staking be done if possible,
anytime in the afternoon on Monday, March 7ch
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith LaCosse
Staff 'Ass1.
Official Records & Legislative Services
727-562-4093
March 7, 2011
Attn: Susan
Funeral Home: Moss Feaster
Fax: 727-562-2043
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Mary E. Nichols
Gravesite: Block 7, Lot 87, Space 3
Full Burial
Gravesite flagged with Pink flags.
Nearby Burials:
Space 1 = Archer C. Nichols - Full burial
Space 2 = Elizabeth Nichols - Full Burial
Space 3 & 4 = Vacant
Staking Fee: 30.00
Please make check payable to: City of Clearwater
Mail to: City of Clearwater
Official Records Dept. - 2"d Floor
112 S. Osceola Ave.
Clearwater, FL 33756
If you have any questions, please give me a call.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4093
North Carolina
Department of Health and Human Services
NC Vital Records BURIAL-TRANSIT PERMIT
Now Rannvor
County
Name of Deceased Date of Death (month; day, year)
Mary Elizabeth Nichols March 2, 2011
Place of Death (Name of Institution or Street Address) City County
New Hanover Regional Medical Center Wilmington New Hanover
Name and Address of Attending Physician
Dr. Charles Herring, 1960 S. 16th St., Wilmington, NC 26401
Destination (Name and Address)
Moss-Feaster F.H., 1320 Main Street, Dunedin, FT 11756
Name and Address of Funeral Home or Person Acting as such within G.S. 130A-113
Andrews Mortuary, 1617 Market Street, Wilmington. NC 98401
A Notification of Death having been filed, permission is hereby granted to Date Issued
remove the body from this state. March 4., 2011
Si u e of cal Registrar, uty Regist r or Address
/9-Registrar 2029 S. 17th Street
Wilmington, NC 28401
IMPORTANT INSTRUCTIONS ON BACK OF FORM.
DHHS 1184 (Revised 7/07) Funeral Director's Copy - White Local Registrar's Copy - Pink
Vital Records
Vendor No. Vendor 03/07/2011
3141615 CITY OF CLEARWATER 10226707
PAYMENT DETAILS
Staking Fee - Mary Nichols
THE FACE • CONTAINS A SIMULATED WATERMARK
Moss Feaster Funeral Nome and Crema Amegy Bank N.A.
1320 Main Street ss-i t zs 10226707
Dunedin, FL 34698 Porter, TX
1130
03/07/2011
PAY Thirty and 00/100 Dollars
mac nao mro uao
PAY TO THE
ORDER OF
***********$30.00
Memo: Mary Nichols
111 10 2 2 6 70 7110 I:LL11L0586I: 4444070?2110
CITY OF CLEARWATER
112 S OSCEOLA AVE
CLEARWATER, FL 33756