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Dixon, Charlotte Cemetery Call Work Sheet Date: /1)/Jf/ a Funeral Home / Monument Company: s Contact Name: 5ttxe- +4(1)-" Tel. #: Fax #: - K. `c Reason for call: ( Ef Q JA IJQ? _ vd)-ut ?b !ia ?av,l qI Deceased Name: Oof Birth: _&/ q+ADate of Death Block Lot • s30 Space Owner of Plot: Interment: Full Burial Urn Space $30.00 Staking Fee - received on: Date of Burial: Time:( ******************************************************************** m 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: (One fu// burial and one urn, or two urns per space) (No Fee for Staking of Monument) (YAIQPD?? Sprague, Nicole 0 o rom: Tokar, Mark nt: Thursday, October 25, 2007 12:41 PM : Sprague, Nicole Subject: RE: Staking Request - DIXON Yellow flags were used. mark downtown team -----Original Message----- From: Sprague, Nicole Sent: Wednesday, October 24, 2007 12:21 PM To: Taylor, Joe Cc: Gilmore, Stephanie; Frith, Renee; Lewis, Eric; Tokar, Mark Subject: Staking Request - DIXON We've received a staking request for Charlotte Dixon. The service is scheduled for this Saturday, October 27, 2007. Ms. Dixon is a full burial located at Block 6, Lot 37, Space 4. Other burials in Block 6, Lot 37 are: Space 5: Roy Dempsey Space 6: Laura Dempsey Space 9: Allen Dixon Space 10: Rosa Dixon Please let me know the color of flags used. Thanks for your help. • Nicole Sprague City Clerk Specialist Office of Official Records & Legislative Services 562-4097 0 CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE • BLOCK : 6 LOT: 37 DECEASED NAME: ROY A DEMPSEY BLOCK: 6 LOT: 37 SPACE: 5 BURIALTYPE: FULL BORN: 01 / 18 / 1889 DIED: 03 / 21 / 1966 INTERRED: 03 / 22 / 1966 INTERMENT NOTES: SR.-NOT SURE OF OWNER FOR DBF INPUT 1/6/93 DECEASED NAME: LAURA M DEMPSEY BLOCK: 6 LOT: 37 SPACE: 6 BURIALTYPE: FULL BORN: 01 / 18 / 1891 DIED: 10 / 22 / 1962 INTERRED: 10 / 24 / 1962 INTERMENT NOTES: UNSURE OF OWNER FOR DBF INPUT 1/6/93 DECEASED NAME: ALLEN L DIXON 9 BURIALTYPE: FULL 37 SPACE 6 LOT BL K r,nn LOD : : : OC BORN: 06 / 03 / 1916 DIED: 08 / 25 / 1980 INTERRED: 08 / 28 / 1980 INTERMENT NOTES: DECEASED NAME: ROSA M DIXON BLOCK: 6 LOT: 37 SPACE: 10 BURIALTYPE: FUL L, BORN: 08 / 25 / 1921 DIED: 09 / 24 / 1992 INTERRED: 09 / 28 / 1992 INTERMENT NOTES: DECEASED NAME: GUY C LOVELL BLOCK: 6 LOT: 37 SPACE: 11 BURIALTYPE: FULL • BORN: 01 / 19 / 1906 DIED: 05 / 21 / 1970 INTERRED: 05 / 22 / 1970 INTERMENT NOTES: DECEASED NAME: FRANCES E LOVELL BLOCK: 6 LOT: 37 SPACE: 12 BURIALTYPE: FULL BORN: 11 / 04 / 1914 DIED: 04 / 18 / 1983 INTERRED: 04 / 22 / 1983 INTERMENT NOTES: ****END OF BLOCK : 6 LOT: 37 **** L_J Page 51 of 51 TARPON CHAPEL, INC. DBA DOBIES FUNERAL HOME 701 EAST TARPON AVENUE TARPON SPRINGS, FL 34689 (727) 942-0515 WHITNEY Whitney National Bank Pensacola, Florida 63-950-632 10559 10/25/2007 **30. m PAY TO THE ORDER OF City of Clearwater Thirty and 00/100************* City of Clearwater LMEMO L S a i y 8 AUTHORIZED SIGNATURE C. Dixon 271-2590-07 11'01055911' 11:06 3 209 50 51: 00330028L,30 ?Lsl 1! 6Y? fly- In Ict ?n RUen «e?? Rau ?o? ? ?x