Ceraolo, AidaCemetery Call Work Sheet
Date: l 1 ! / ao 1
Funeral Home/ Monument Company: 0< 5 Fe,,ste r
Contact Name: 4nnie. / cJ;0 S& -P-- AO-74-2
Tel. #: s? a - ao8o
Reason for call: Fax #: Sq 6 - 3(,30
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Deceased Name: A t ?a C e r Ao (a
Date of Birth: l a° l
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Interment: (One full bur p
wo urns per space)
Full Burial ? Urn Space
$30.00 Staking Fee - received on: (-xej
Date of Burial: ao (o
Time: 500
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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)
49
May 13, 2010
Attn: Annie
Funeral Home: Moss Feaster
Fax: 727-596-3630
(This fax includes a map of the Clearwater Municipal Cemetery)
Deceased: Aida Ceraolo
Gravesite: Block 5, Lot 5, Space 10
Full space
Gravesite flagged with ely low flags.
Nearby Burials:
Space 8 = John Glasgow
Space 9 = Thomas G. Ceraolo - (Husband of Aida Ceraolo)
Space 11 = (burial rights for Rosemarie O'Donnell)
Space 12 = Bessie Vinzant
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)
693 South Belcher Road
Clearwater FL 34624
PAY TO THE
ORDER OF City of Clearwater
112 s. Osceloa Avenue
Clearwater FL 33756
Gelco Check Number 13460352 01 34603523
USER ID ._ ISSUE DATE
wellsjh 5/12/2010
NOT VALID AFTER SIX (6) MONTHS FROM ISSUE DATE
5 revees
t 1 id.d.
Derails on back.
Thirty Dollars And No Cents*************************************************? $ ***30.00
N VALID FOR OVER $5,000 NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
PAYABLE THROUGH Paul MacLaren
First PREMIER Bank 78-858
SIOUX FALLS, SID 914 statement this instrument, the e (B red confirms that this instrument has been drawn accordance with the authority issued by Gelco damages Network, Inc. If any
statement herein be untrue, we, , the a foesigned, agree to pay the drawer upon demand the amount or this instrument and all expenses es and d damages es arising from such misstatement.
00l34GO 352ps 11.-091,Ll585i: 2 5000006 5 5
SIGNER Paul MacLaren USERID wellsjh
01 34603523
DESCRIPTION
City of Clearwater
112 s. Osceloa Avenue
Clearwater FL 33756
DATE LOCATION NUMBER GL CODES CONTRACT NUMBER NAME / DESCRIPTION AMOUNT
5/12/201 4673 8405-0 467301001191 Ceraolo - Staking Fee $********30.00
BURIAL PERMIT
CLEARWATER CARETAKER
CLEARWATER, FL
Permission is hereby granted for burial of:
Name of Deceased: AIDA CERAOLO
PERMIT # 2610
May 14, 2010
Burial Type: FULL
Owner of Property: AIDA CERAOLO &
Block : 5 Lot: 5 Space: 10
Date of Death: May 9, 2010
Date of Birth: September 20, 1918
Date of Burial: May 14, 2010
Funeral Home Director: CONTACT: ANNIE/MOSS FEASTER
Time: 17:00 Staking Fee: 30.00 Date Paid: May 14, 2010
Clearwater Cemetery
By`?.
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Cemetery Call Work Sheet
6
Sate: In / 3 I t 1 ` \V��
Funeral Home / Monument Com an (, e, 'ad IC, `��LI1
P Y� � � U-k�'l��i 1 � �V�,�xi,�1�� \ \\
Contact Name: k \I 111
Tel. #: Lt 1)7 15,) ( Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space \ ti`•
Other reason:
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Sull Burial Urn Space
Owner of Plot: A;(.1 l(.
Deceased Name: /\( dc( ("u(; IC
Block -) Lot Space 1�'
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