Alston, Juanita Na ?
Cemetery Call Work Sheet
•
Date: if '01-0 (0
Funeral Home/ Monument Company: ?°`A, 'A S '^ P
Contact Name:
Tel. #: `?`fa- a-3 Fe
Reason for call: -r?f??e e-
Fax#: if Ya-?308
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Deceased Name: 0 - A Q sty
Date of Birth: [? / a I / y3 Date of Death `f / 07 / aat a
• Block I`f Lot 30 $ Space 00 ( CoKV, 4.304, 303 3
Owner of Plot: AAJ t AQSf A kfbh
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space ?Q^ 4w c+ a b d"(
$30.00 Staking Fee - received on: `t / /`t /_a-olo C II??
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Date of Burial: 4 x010 Time: 11 a /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)
0
April 13, 2010
ATTN: Robert Young / Young Funeral Home
Fax: 727-442-8308
Deceased: Juanita N. Alston
Gravesite: Block 14 / Lot 305 / Space 00
Full Space
Gravesite flagged with Orange flags.
Nearby Burials:
Block 14, Lot 309, Space 00 - Richard Vincent
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
727-562-4093
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