Glisson, Dixie E
Cemetery Call Work Sheet
•
Date: Y / a I / 1'o
Funeral Home i Monument Company: SGZ 4?KKA4.e_P
64 (2^1 : So6w-t
Contact Name: J?u fAq:L?A
Tel. #: 5736_0` 9Y Fax #: S30 - 0 `f a 1
Reason for call:
•
Deceased Name: a)(Xic e. G ?iSsorw
Date of Birth: 8 / Z? / a5
Block Lot 13 Space `f
Date of Death
Wfe r ai"o-a. -F. ?Q,:ss?. - Sp. ??F)
Owner of Plot: biX ie
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space ?
$30.00 Staking Fee - received on: a-3/ t ° F>QA # a ` 117
9
Date of Burial: )-I) I° Time: 13° amp
Disinterment:
9 a
The following authorization should be obtained prior to disinterment: 9JQ
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)
IJ of ? f '0 Mr . MA e-r S .
Crystal Reports Viewer Page 1 of 1
up C5 -4 4 } ] 1 / 1 Main Report 's 100%
Status of Block: 16 Lot: 13 as of 09/27/2010
INTERMENTS:
SPACE BURIALTYPE
I FULL
2 FULL
4 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECL DECF DECM BIRTH DEATH INTERRED
SHAW CLYDE SR. 9/25/1914 02/11/1996 2/17/1996
WINDHAM JESSE 6/30/1917 06 / I6 / 1996 6/18/1996
GLISSON WANDA F 5/28/1930 08 / 16 / 1990 8/20/1990
Page 1 of 1
http://msb-crystal-ent/businessobjects/enterprise 11 /infoview/viewers/rpt/DHTMLV iewer.aspx?skin=skin... 9/27/2010
September 28, 2010
Attn: Jeff Myers
Funeral Home: SCI Funeral and National Cremation Society
Fax: 727-530-0421
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Dixie E. Glisson
Gravesite: Block 16, Lot 13, Space 4
Urn Space
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 1 = Clyde Shaw Sr. - full
Space 2 = Jesse Windham - full
Space 4 = Wanda F Glisson - full (wife of Dixie E. Glisson)
Staking Fee: 30.00 (Check 10018531 received 9/24)
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4093
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