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Walter, Dorothy "Dottie"Cemetery Call Work Sheet IL Date: 05- I:5-o ?) Funeral Home: q kOJE S Monument Company: Contact Name: Contact Name: Tel. #: -q<4 6-3053 Tel. #: Fax #• L+{3 -'Fax #: RE: CIO ek Lo-, Sp ins -tk&lIY t)eoV,Jr? )C,.IOL/L Gj(fCd_y?j v() dFr-A- Las Deceased Name: I Th ?d)-i-? DOD: DOB: "aV Owner of Property: iM Block S Lot &l Sp?e Interment• r r Full Burial: y ($30.00 Stakink' Fee - (One full burial and one urn, or two urns) Date o urial: G 5-17 Q? . Time:?a? Disinterment: Urn Space: -if 3-??rs?M S-?s 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\ Y (r May 15, 2006 Office of Official Records / Clearwater City Clearwater City Hall 112 South Osceola -2 "d Floor Clearwater, Florida To Whom It May Concern: Margaret Kay (Garner) Schroer and her brother John Thomas Garner III, the only surviving relatives with sole rights of entitlement to the properties located in the Clearwater Municipal Cemetery Block 5 - Lot 32 - Spaces 5,6,7,8 * do both agree in accordance that their mother Dorothy A. (Ahlgrim) Walter will be interred in the location of Block 5 - Lot 32 - Space 7 at the Clearwater Municipal Cemetery off the intersection of Lakeview and Myrtle streets. * Currently, Mr. Archie S. Ahlgrim and his mother Ida (a.k.a. Inda) Dove Ahlgrim are interred in spaces 5 and 6, respectively, in this Block 5 of Lot 32 in the Clearwater Municipal Cemetery. AdAa E?? "_1PNk -?__ 16, Z-06( M are Kay ( ) Sc oer Date hn omas Garner I Date WORK & SON KRAEER HOLDINGS, INC. 2301 DBA RHODES FUNERAL DIRECTORS, INC. 63-751/631 2600 Gandy Blvd BRANCH 51103 St Petersburg, FL 33702 e ' 11?j t pug to * 'Klj?h-j -4-Y in 8 Fea, e. , 11120 M WACHOVIA Wachovia Bank, N.A. wachWa.com _ N u u'DO 0 iii' l:0 6 3 L 7 5 042000 5 708 468 w I FLORIDA DEPARTMENT OF H ALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased Dorothy A. Walter of May 13, 2006 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Lake Leesburg Inst. Leesburg Regional Medical Center 3. Name of Medical Address Phone Number Certifier Larry Foster MD 802 E. Dixie Hwy (352) Medical Examiner Physician Leesburg, FL 34748 787-1324 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment Rhodes Funeral 800 E. Druid Rd. (727) Directors, Inc. Clearwater, FL 33756 2632 446-3055 5. Check a. r] The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ® Arnita was contacted on May 16 , 2006 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Foster will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He/she verified that Medical Examiner, will complete and sign the medical (cation of cause o death within 72 hours. 6. Funeral Director/ ignature-, F.E. No./Reg. No. Date Signed Direct Cisposer 5/16/06 B. v BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No.2170-842 © A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. No extension of time for filin the death certificate has been requested. Registrar or Date Date Certificate Subregistrar Signature X??27z` Issued: 5/16/06 Dye: 5/25/06 v C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. Method of Disposition: D. ®BURIAL FICREMATION Signature of Sexton or Person-in-Charge FISTORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Clearwater Municipal Cemetery Date of Disposition This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8197 (Obsoleles all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar ts,dr G P-r- w I Cemetery Call Work Sheet Date: !O l I /-On Funeral Home / Monument Company: __ ? v'? QL"bti (5110a" Contact Name: EAtA c!t r) wpyy Tel. #: Fax #: Reason for call: Deceased Name: _hipej:na }} K LoPrUT4Ef, Date of Birth: 'a/ja/.? Date of Death Block Lot5A Space Owner of Plot: U CL- Ain I ? jryy Interment: (One full burial and one urn, or two urns per space) Full Burial Urn Space $30.00 Staking Fee - received on: _/_/_ Date of Burial: Time: am/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) CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE • BLOCK : 5 LOT: 32 DECEASED NAME: NEWTON A HAMMON BLOCK: 5 LOT: 32 SPACE: 2 BURIALTYPE: FULL BORN: 01 / 01 / 1847 DIED: 01 / 01 / 1931 INTERRED: 01 / 01 / 1931 INTERMENT NOTES: DECEASED NAME: LEO B HAMMON BLOCK: 5 LOT: 32 SPACE: 3 BURIALTYPE: FULL BORN: 01 / 01 / 1869 DIED: 01 / 01 / 1948 INTERRED: 01 / 01 / 1948 INTERMENT NOTES: DECEASED NAME: ARCHIE S AHLGRIM BLOCK: 5 LOT: 32 SPACE: 5 BURIALTYPE: FULL BORN: 07 / 09 / 1906 DIED: 07/18/1931 INTERRED: 07/18/1931 INTERMENT NOTES: DECEASED NAME: INDA D AHLGRIM BLOCK: 5 LOT: 32 SPACE: 6 BURIALTYPE: FULL BORN: 01 / 01 / 1867 DIED: 12 / 22 / 1954 INTERRED: 12 / 22 / 1954 INTERMENT NOTES: DECEASED NAME: DOROTHY WALTER BLOCK: 5 LOT: 32 SPACE: 7 BURIALTYPE: FULL • BORN: 06 / 20 / 1928 DIED: 05 / 13 / 2006 INTERRED: 05 / 17 / 2006 INTERMENT NOTES: DECEASED NAME: JOHN MENNIE BLOCK: 5 LOT: 32 SPACE: 9 BURIALTYPE: FULL BORN: 01 / 01 / 1858 DIED: 01 / 01 / 1938 INTERRED: 01 / 01 / 1938 INTERMENT NOTES: DECEASED NAME: KATE MENNIE BLOCK: 5 LOT: 32 SPACE: 10 BURIALTYPE: FULL BORN: 01 / 01 / 1862 DIED: 01 / 01 / 1933 INTERRED: 01 / 01 / 1933 INTERMENT NOTES: DECEASED NAME: MELVILLE G HUNTER BLOCK: 5 LOT: 32 SPACE: 11 BURIALTYPE: FULL BORN: 01 / 01 / 1913 DIED: 01 / 01 / 1931 INTERRED: 01 / 01 / 1931 INTERMENT NOTES: DECEASED NAME: JAMES R SAWYER BLOCK: 5 LOT: 32 SPACE: 14 BURIALTYPE: FULL BORN: 12 / 19 / 1857 DIED: 01 / 05 / 1932 INTERRED: 01 / 05 / 1932 INTERMENT NOTES: r? ?J Page 57 of 64 Sprague, Nicole om: Taylor, Joe nt: Tuesday, October 30, 2007 9:17 AM o: Sprague, Nicole Cc: Gilmore, Stephanie; Frith, Renee; Lewis, Eric; Tokar, Mark Subject: RE: Monument Staking - WALTERS I used yellow flags. F-I L -----Original Message----- From: Sprague, Nicole Sent: Monday, October 29, 2007 3:49 PM To: Taylor, Joe Cc: Gilmore, Stephanie; Frith, Renee; Lewis, Eric; Tokar, Mark Subject: Monument Staking - WALTERS Hi Joe, We've received a staking request for Dorothy "Dottie" Walter who is interred in Block 5, Lot 32, Space 7. She is a full burial. The monument company will be placing a marker for her. Other burials in Block 5, Lot 32 are: Space 5: Archie S Ahlgrim Space 6: Inda D Ahlgrim Space 9: John Mennie Space 10: Kate Mennie Please let me know if you need any additional info. Thanks. Nicole Sprague City Clerk Specialist Office of Official Records & Legislative Services 562-4097 0