Hancock, Harry•
Cemetery Call Work Sheet
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Funeral Home/ Monument Company:
Contact Name:
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Tel. #: aogo Fax #:
Reason for call: ?Cl,i(a
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Deceased Name:
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Date of Birth: - q Date of Death
• Block 0 Lot Space
Owner of Plot:
******************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial
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Date of Burial: A U Time: /pm
Disinterment: S?i ??to )
Urn Space
$30 00 StaLein Fee - received on• S- l 1(,4 / )-° l o
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)
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May 13, 2010
Attn: Paul
Funeral Home: Moss Feaster
Fax: 727-562-2073
(This fax includes a map of the Clearwater Municipal Cemetery)
Deceased: Harry Hancock
Gravesite: Block 2, Lot 11, Space 11
Full space
Gravesite flagged with ely low flags.
Nearby Burials:
Space 8 = John Taylor Jr
Space 9 = Marion Taylor
Space 15 = Warren J Taylor
Space 16 = Palmelia E Taylor
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
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4090
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Moss Feaster Funeral Home(4673) Gelco Check Number 13460346 01 34603469
693 South Belcher Road
Clearwater FL 34624 USED ID ISSUE DATE
wellsjh 5/12/2010
PAY TO THE NOT VALID AFTER SIX (6) MONTHS FROM ISSUE DATE
ORDER OF City of Clearwater
Details .
back e
112 s. Osceloa Avenue 8 U. ,I, on b,rk
Clearwater FL 33756
Thirty Dollars And No Cents*************************************************
rvUl VNLIU fVM VVGri i>?UVU rvV I MCUCCMNCLC AVM VPJH 61 UI?NWCH, pUIl1VMILCU 11CYMtJtrvIaIlVt
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
PAYABLE THROUGH 78.858 Paul MacLaren
First PREMIER Bank
SIOUX FALLS
SO 914 By signing this instrument, the aforesigned confirms that this instrument has been drawn in accordance with the authority issued by Gelco Information Network, Inc. II any
?
, statement herein be untrue, we, the a c resigned, agree to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement.
116 0 L 3460 346911@ 1: 9 140a Sa 5i: 2 5000006 S 511'
SIGNER Paul MacLaren USERID wellsjh
01.34603469
DESCRIPTION
City of Clearwater
112 s. Osceloa Avenue
Clearwater FL 33756
DATE LOCATION NUMBER GLCODES CONTRACT NUMBER NAME / DESCRIPTION AMOUNT
5/12/2010 4673 8405-0 467301001192 Hancock - Staking fee $********30.00
BURIAL PERMIT
CLEARWATER CARETAKER
CLEARWATER, FL
Permission is hereby granted for burial of:
Name of Deceased: HARRY HANCOCK
Owner of Property: TAYLOR &
Block : 2 Lot: 11
Date of Death: May 10, 2010
Funeral Home Director:
Time: :
Space: 11
PAUL/MOSS FEASTER
Staking Fee: 30.00
PERMIT # 2611
May 14, 2010
Burial Type: FULL
Date of Birth: September 6, 1924
Date of Burial: May 14, 2010
Date Paid: May 14, 2010
Clearwater Cemetery
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