Capitanio, Mary• r
Cemetery Call Work Sheet
Oate: S/ 16 / ao f f
Funeral Home/ Monument Company:
Contact Name: ?hha-
Tel.#: 39a- 31-7- gfM
e_ ( a W h a. C e4_10 e_ COX . h e.t
Fax #:
X
Reason for call: Staking Request (Interment)
Affidavit (Burial Rights)
Monument (Marker) being placed IMarY C? if.s'
(No fee for staking of monument) b?oc c I5
? ?tiQ
Other reason: Ce w%. elf-V_X S c )
..?? I1 A n I'•
,?L, -pUs _f'at keA w, ow•., I`ll-_ rY 0?-h;-fiiP-w
Interment: (One full burial and one um, or two urns per space)
Dull Burial Urn Space
C7 W h4+ /l? 4ctA 3 ? ?
Owner of Plot: fie; (`Ile?^?3 Ate") C D) (A)
Deceased Name: 3 = Ly4, ?'.-,D `°r -(urti)
Block 5 Lot e Space
Date of Birth: Date of Death W? mow` S?8-QQ -(lArn )
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
t,
eE%rnA VrT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, the undersigned, Delia Mendez, owner of Space 4, Lot 108, Block 15, do hereby
Grant Right of Interment to:
Cemetery.
William Stoll V, in Space 4, Lot 108, Block 15 in Clearwater Municipal
I further agree to release, indemnify and hold the City of Clearwater harmless from
liability in the event of any claim arising from the use of the above described property for the
interment of William Stoll V.
SIGNATURE
Delia Mendez
RELATIONSH P
(Address)
Witness
(Address)
Witness
(Address)
The foregoing instrument was acknowledged before me this day of , 2001,
by Delia Mendez, who produced identification in the form of
and who did/did not take an oath.
Notary Public
ti Dottie Reehling
MY COMMISSION#CC849381 EXPIRES
September 30 2003
? ;; nanintarHanrnrnFarNn?10RaWAiNc.
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, Gilberto Lugo, the undersigned, am the owner of cemetery property described as Block
15, Lot 109, Spaces 3 (B) and 4 (A) in the Clearwater Municipal Cemetery. My wife, Guadalupe
Lugo, and myself, Gilberto Lugo, will be buried in Space 4 (A). 1 do hereby grant interment rights
to my nephew, William T. Stoll IV, my niece, Linda R. Parmelee, and their mother, Inez M. Stoll as
described below:
Block 15, Lot 109, Space 3 (B): Linda R. Parmelee and Inez M. Stoll
Block 15, Lot 109, Space 4 (A): Gilberto and Guadalupe Lugo
Please take this affidavit as your authority to note the right to property described above.
Per the City of Clearwater Rules and Restrictions the maximum capacity of a space is two
burials provided at least one person is cremated or two cremated remains.
I also would like to mention that Block 15, Lot 108, Space 1 has a full burial of Marta
Martin, owner of this space. Ms. Martin was the sister of Inez M. Stoll, mother of William and
Robert Stoll and Linda Parmelee. One urn burial may also be placed in this space. I do hereby
grant interment rights to my nephew, William T. Stoll IV, as described below-
Block 15, Lot 108, Space 1 (D): William T. Stoll, IV
I, further agree to release, indemnify and hold the City of Clearwater harmless from liability
in the event of any claim arising from the use of the above described property for the interment
rights requests made.
Gilberto Lugo, (Owner)
(Address
Co.
C A"*, --? O
33? ?
4C-'?
tness
111A
Relationship to Witness
(Address) ISa-5 A- hne l,y? ""' . S, ) TJk,.e It- i :r(- 3 `f(, `I V SWORN TO and subscribed before me this day of Ma^ 2011,
by Gilberto Lugo who produced identification in the form of F t_.
and who did/did not take an oath.
(SEAL)
KAREN B. vAU(iliAN
918710
,^nwaMISStDNNDD
vIRES: December 20, 2013
i onded Th. Ndar/ Wblw Underwnlers
Notary Public
My commission expires:
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INST # 91-150368
JUN 6, 1991 3:24PMr F'INE:LLAS COUNTY FLA.
CEMETERY DEED OFF . RE C , BK 75B9 PG 2186
THIS INDENTURE made this ?_3A,40- day of , 1991,
between the City of Clearwater, Florida, a municip corporation as Grantor and
Mary Capitanio,.whose mailing address is 1350 Milton Street, Clearwater 34616 of
the County of Pinellas, State of Florida, as Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of
$200.00, to it in hand paid by the said Grantee, the receipt whereof is hereby
acknowledged, has remised released and quit-claimed unto the said Grantee, and
her heirs forever, all the right, title and interest, which the said Grantor has
in and to the following described parcel of land, lying and being in Pinellas
County, State of Florida, to wit: Space C, Lot 108, Block 15, Clearwater
Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas
County, Florida.
This conveyance is subject to the condition that Grantee herein shall not
assign or convey said property without the written consent of the Grantor, and
to the further condition that said property shall be used only for cemetery
purposes as human burial sites and is subject to such other rules and regulations
the City of Clearwater may adopt pertaining to use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof
of the said Grantee and her heirs and assigns forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed
in its name by its Mayor Commissioner, by its City Manager, and to be attested
and its corporate seal affixed by the City Clerk on the day and year first above
written.
1?° R RD11111
ACCT` igned, Sealed and Delivered
he presence of u :
REC
FEES
MTF
PTG
P/C
Doc ? proved as to form and correctness:
INT
TOTAL
C \
M. A. Galb ith, Jr. City Attorney
V
State of Florida,
County of Pinellas:
CITY OF CLEARWATER FLORIDA
By clJ?lL
Michael J. Wright, i y Manager
Cou rsigne t: f7
Oita Garvey.; ,ayor_C nissioner
Attest
Cyn is ,Goudeav ,. Aty Clerk
Personally appeared before me Rita Garvey, Michael J. Wright, and Cynthia
E. Goudeau to me well known to be the persons who executed the foregoing
instrument of conveyance in the capacity of Mayor Commissioner, City Manager, and
City Clerk respectively, and they severally acknowledged that they executed said
instrument in their respective capacity by and on behalf of and as the free act
and deed of the City of Clearwater, Florida, for the uses and purposes therein
expressed.
Witnes y hand and official seal at Clearwater, Florida this the
c3_ day of / 1991.
Notar ublic State of Florida
This instrument was prepared by:
M. A. Galbraith, Jr., City Attorney
City of Clearwater, P. 0. Box 4748
Clearwater, Florida 34618
Documentary Tax Pd. #_-r.1 6 Intin?lble Tax Pd.
Karleen F. DeBlaker, Clerk, Pinellas County
By Deputy Clark
Notary pumic, State „i "C!"
My Commission EapaL: April 20,.1"3
bonded rh?u LoY Faio lomunaa Inu - .
IC ARL.E EN F. IIEBLAKERr CLERK
RECORD VERIFIED IIY:
Cemetery Tracking System
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http://clearwater/Apps20/cemetery/transactions. aspx?b=15&1=108&s=2 5/17/2011
LaCosse, Judith
From: annacap@cox.net
Sent: Tuesday, May 17, 2011 10:21 AM
To: LaCosse, Judith
Subject: [BULK] Re: Clearwater Municipal Cemetery - 1300 Myrtle Ave.
Importance: Low
Judith,
Thank you SO much for all of your help yesterday. I'm sorry I started to cry about my mom's
situation, though your compassion was very much appreciated.
I got to thinking about a possible solution to a lot not being available near my family,
though it would depend upon the willingness of the Largo family to consider it. You
mentioned someone by the name of Largo has that lot next to the ones purchased by Delia
Mendez. Is there any way you could check with that family to see if they would consider
selecting another lot and thereby freeing that one up to allow for family to be buried near
family? Unless there was a particular reason they had to have those lot(s), that may work
out. Of course, that would depend upon your willingness to check with the Largo family but I
hope you'd be willing to do that. The thought of my mom being in a lot by herself still
breaks my heart.
Please let me know either way.
Thanks again for all of your help yesterday. I know the calls and research took a lot of
your time.
We'll see you on Friday.
Sincerely,
Anna Astengo
---- Judith.LaCosse@myClearwater.com wrote:
Hello Anna,
Per our telephone conversation this morning, see attached documentation regarding Block 15,
Lots 108 and 109 in the Clearwater Municipal Cemetery.
Affidavits granting interment rights:
<<Affidavits-Mendez & Lugo.pdf >>
Burials in Block 15, Lot 108:
<<Block 15 Lot 108. pdf>>
Owner of Space 1 = Marta Martin, also buried here.
Owner of Spaces 3 & 4 = Delia Mendez
Block 15, Lot 109, Spaces 3 and 4 are vacant right now, but see affidavit signed by Gilberto
Lugo granting interment rights to these spaces. He's also granting interment rights to
William T. Stoll, IV in space 1 of Block 15, Lot 108 to be buried with Marta Martin.
1
I'm also attaching copies of the cemetery map showing Block 14, the next sheet shows the Lots
that have spaces available for sale, Lots 394 through 407. The cost of an urn space at the
moment is $125.00 per space, plus deed recording fees. I will find out the correct amount
and will let you know.
<<Block 14 - Urn Spaces.pdf >>
Hope this helps for now and if you have any questions, please give me a call or email me
back.
Best regards,
Judith LaCosse
Staff Asst.
Official Records & Legislative Services
727-562-4093
2
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