Lugo, Gilberto & Guadalupe
Cemeter y Call Work Sheet
Date: 3 / I / afl l I
Funeral no- ument Company:
Contact Name: 0`t. - 4-K, G ` f-Lt`t° Lll - up%4-Q-e
Tel. Fax
Reason for call: Kr. LG-?? Z4 -le-'
c W d- ti-i Q c e. vo w c i ?+. o lkeA. u ?CW d- M-e ce .
Deceased Name:
Date of Birth: Date of Death
Block IS Lot 3
Space" -03) IS
- ( A) Lafi log) - S 1
0W , /4
• Owner of Plot: I Mknta
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)
3/-7//l `ItL I t ID juViCw' g,7Vi .
CQ-11?ter7 prs-y'zo. ?`p?Qc?aoQ 7?e
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, March 03, 20114:08 PM
To: Dougall-Sides, Leslie
Cc: Official Records and Legislative Services
Subject: RE: A02-00153: RE: Cemetery Matter
Thanks for your quick reply.
Judith LaCosse
Staff Asst.
Official Records & Legislative Services
727-562-4193
From: Dougall-Sides, Leslie
Sent: Thursday, March 03, 20113:55 PM
To: LaCosse, Judith
Cc: Treuhaft, Linda
Subject: A02-00153: RE: Cemetery Matter
No, per the Rules it is not allowed.
The normal practice for cemeteries is to allow one burial and one urn in a regular adult burial space.
If more than one urn, additional urns go in a smaller urn space or columbarium.
The reasoning behind this is apparently not to take up "real estate" for urns, which are more appropriately put in a
smaller space or columbarium built for them.
From: LaCosse, Judith
Sent: Thursday, March 03, 20112:51 PM
To: Dougall-Sides, Leslie
Cc: Treuhaft, Linda
Subject: Cemetery Matter
Importance: High
Hi Leslie,
According to the Clearwater Cemetery Rules and Restrictions, two burials in one space shall be permitted provided one
person has been cremated or is a baby. Two urns should be allowed in one urn space.
<< File: Cemetery rules and restrictions.pdf >>
A citizen wants to know if three cremations are allowed in one adult space. Do you know if this is allowed and if there's
room?
Please advise.
Judith LaCosse
Staff Asst.
Official Records & Legislative Services
Cemetery'Tracking System
Page 1 of 1
? .T, NET Good Afternoon! Today is Tuesday, March 1, 2011 Home I Feedback
You are logged in as Judith.LaCosse
E3 Cemetery
G File
Transaction
View Lot Profile
B Reports
Print Burial
Permit
Search Names
and Notes
Search Old
Locations
Print/View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List
of Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Permits List by
Location
PRBurial
9 Maintenance
Control Data
Valid Locations
Security
Updated on Tuesday, January 06, 2009
Home I Feedback I Departments I Contacts I Forms
[ Previous Page ]
[ Too of Page ]
3/1/2011
http://clearwater/Apps20/cemetery/viewlotprofile.aspx?b=15 &1=109
Cemetery Tracking System - View Lot Profile
Block: 15 Lot: 109
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 WHITE, JR. FRANK 1 1 1 View Assigned
2 BELL CHRISTINE 1 1 1 View Assigned
3 LUGO GILBERTO U 0 0 0 View Assigned
4 LUGO GILBERTO 0 0 0 View Assigned.
E
1
B . 3
pP,6 --k I S y 1 C, S' S p
j(ytt44n-l I r? - J?"??'1 !
Cemetery' Tracking System
Good Morning! Today is Thursday, March 3, 2011
n Cemetery
o File
Transaction
View Lot Profile
O Reports
Print Burial
Permit
Search Names
and Notes
Search Old
Locations
Print/View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List
of Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Cemetery Tracking System - View Lot Profile
Block: 15 Lot: 108
Page 1 of 1
Home Feedback
You are logged in as Judith.LaCosse
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 MARTIN MARTHA 1 1 1 View Assigned
2 LARGO LARGO K 1 0 0 View Assigned
3 MENDEZ DELIA 3 2 2 View Assigned
4 MENDEZ DELIA 2 1 1 View Assigned
1
lz I/?
)Ua ??,
1 -? r c? i es -I ?-?a;-
?Vot t
1nZ ?,?.???
r1 /? l ? c
hG?-1 "tots
TK
3vf S,
?? +f IiL 1vtQ(h'r1 LIt", IaL (;{,xarI1
Permits List by
Location
PRBurial
17 Maintenance
Control Data
Valid Locations
Security
[ Previous Page ]
[ Trop of Page ]
http://clearwater/Apps20/cemetel,.. 3/3/2011
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, Gilberto Lugo, the undersigned, am the owner of cemetery property described as Block
15, Lot 109, Spaces 3 (B) and 4 (A) in the Clearwater Municipal Cemetery. My wife, Guadalupe
Lugo, and myself, Gilberto Lugo, will be buried in Space 4 (A). I do hereby grant interment rights
to my nephew, William T. Stoll IV, my niece, Linda R. Parmelee, and their mother, Inez M. Stoll as
described below:
Block 15, Lot 109, Space 3 (B): Linda R. Parmelee and Inez M. Stoll
Block 15, Lot 109, Space 4 (A): Gilberto and Guadalupe Lugo
Please take this affidavit as your authority to note the right to property described above.
Per the City of Clearwater Rules and Restrictions the maximum capacity of a space is two
burials provided at least one person is cremated or two cremated remains.
I also would like to mention that Block 15, Lot 108, Space 1 has a full burial of Marta
Martin, owner of this space. Ms. Martin was the sister of Inez M. Stoll, mother of William and
Robert Stoll and Linda Parmelee. One urn burial may also be placed in this space. I do hereby
grant interment rights to my nephew, William T. Stoll IV, as described below.
Block 15, Lot 108, Space 1 (D): William T. Stoll, IV
I, further 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 for the interment
rights requests made.
Gilberto Lugo, (Owner)'
(Address)
co ;7Z ? r A"-+ -? ° -?--
33? ?
tness
111A
Relationship to Witness
(Address) I$a S g? h ? fie,. S. ? ?kr.e 4^ 1 :F7L 3 ?e(, ?V
SWORN TO and subscribed before me this j day of MACXA 2011,
by Gilberto Lugo who produced identification in the form of F
and who did/did not take an oath.
(SEAL), Notary Public
;cARENa.VAUGHAN
i;(?MMISSI(3 # DD 91820103
SIRES: December 20,
°' NfidedThruNofaryPublcUnderMite? My commission expires.