Dierken, MargaretCemetery Call Work Sheet
Date: ( a / ; [ 1 / a v l l
Funeral Home / Monument Company:
Contact Name: MIM 'bi er keti. , ??- fug b& ?-S N "As-l"
Tel. #
Reason call: _
e 5b- oil.
t
Fax #:
Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed
(No fee for staking of monument)
Other reason:
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Interment: (One full burial and one um, or two urns per space)
Full Burial
Urn Space
Owner of Plot: My? e ke?ti
Deceased Name:
Block 1-5 Lot I IS Space
Date of Birth:
Date of Burial:
a ?C-)
_ Date of Death
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
+S??o""
pCITY OF CLEARWATER
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
CITY HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4090 FAx (727) 562-4086
TER,?../sip
OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
June 21, 2011
Margaret Dierken
Grafton Oaks Nursing Center
405 Grafton Avenue, Room 307
Dayton, OH 45406-5202
Dear Ms. Dierken:
We received your letter dated June 15, 2011 regarding the Clearwater Municipal
Cemetery. In our files we have a copy of your deed which indicates that you own
Space 2 (C) of Block 15, Lot 115 in the Clearwater Municipal Cemetery. This
space is vacant. (See attached documents)
We also have a copy of another deed which indicates that Emilie Dierken owns
Spaces 3 (B) & 4 (A) of Block 15, Lot 115 in the Clearwater Municipal Cemetery.
Our records show that Walter F. Dierken (Urn burial) and William F. Dierken (Full
burial) are interred in Space 3 and Emilie L. Dierken (Full burial) is interred in
Space 4.
You mentioned in your letter that Rhodes Funeral Home in Clearwater will be
handling the urn burial. The interment process is for the funeral home to contact
our department so that we could notify our Parks and Recreation Dept. to stake
the area. We charge a fee for the staking of the area which the funeral home will
pay. The funeral director shall be responsible for the opening and closing of the
gravesite.
Please let me know if you need any additional information. My telephone
number is (727) 562-4093.
Sincerely,
itta it h LaCosse
ff Assistant
Enclosure(s)
Tqm. EMPLOYMENT AND AFFIN.MATIVE ACTION EMPLOM"
WE2195
Cli,cjlI CUUMIT CEMETERY DEED
SEF CZ 4 39 PH 193
THIS INDENTURE, Made this 12th day of S e_.p t e mb e r A. D., 1983 between the City of
Clearwater, Florida, a municipal corporation created and existing under the laws of the State of Florida, party of the first
part, and Margaret Dierken
whose mailing address is: 1417 Lime Street, Clearwater, Florida 33516
of the County of Pinellas State of Florid a party of the second part;
WITNESS E T H : That the said party of the first part, for and inconsideration of the sum of $ 200 . 00
to it in hand paid by the said party of the second part, the receipt
whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the said part Y of the second part,
and her heirs forever, all the right, title and interest, which the said party of the first part has in and to the following
described parcel of land, lying and being in Pinellas County, State of Florida to wit: Space C Lot 115
Block 15 Clearwater Cemetery, as recorded in Plat Book 6 0 _ Page 3 0 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 also subject to such other rules and regulations the City of Clearwater may adopt pertaining
to use of said described property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said part y . of the second
part her heirs and assigns forever.
IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, has caused these. presents to be executed M
a j
in its name by its Mayor Commissioner, by its City Manager, and to be attested and its corporate seat affiiced by its City
Clerk on this the day and year first above written. ze_ :J 0 X
3 0 3 t?
Signed, Sealed and Delivered I CITY F CLEARW R;j OR - C.
in the presence of. us:
By r ? C
_ City Manager.
Coun gned f,
Commissioner.
Approved as to form and correctness Attest:
. City Clerk.
' t_ • - _ . City Attorney .
State of Florida,
County of Pinellas:
Personally appeared before me Kathleen F. Kelly, Anthony L. Shoemaker
and Lucille Williams to me well known to be the persons who
executed the foregoing instrument of conveyance in the capacity of Mayor Commissioner, City Manager, 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, a municipal corporation, for the uses and
purposes therein expressed. :ittsi+u:,;r
Witness my hand and official seal at Clearwater, Florida, this the 19th "d$y of
Sp t? pmher A.D. 1983_•
(Seal) \ 1 u
This instrument was prepared by: t Y.p?tUlc sate of Florida.
Thomas A. Bustin C i t t o rn My Commission expires
City of Clearwater, P. 0. Box 4748 r? -O r ' Fl 'a Aotr.ry RSr,. at tugs
Clearwater, Florida 33518 40 Rec My Commis ion [x;ires Oct. 31, lY i3
41 DS
43 jilt
Tot
i
154
CEMETERY DEED
THIS INDENTURE, Made this 14tlgay of November A. D., 19 79 between the City of
Clearwater, Florida, a municipal corporation created and existing under the laws of the State of Florida, party of the first
part, and [?ili• lliarlaea
whose mailing address is: 1417 Line Street, Clearwater
of the County of Pinellas state of Itlosida part- of the second part;
W I T N E S S E T H : That the said party of the first part, for and in consideration of the sum of ; 1 i O _0 p
ihra• flnndrad forty flnllar1p it in band paid by the said part y of the second part, the receipt
whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the said part y of the second part,
and _h"heirs forever, all the right, title and interest, which the said party of the first part has in and to the following
described parcel of land, lying and being in Pinellas County, State of Florida to wit: Spaceg a >ttt Lot 7 15
Block 15 Clearwater Cemetery, as recorded in Plat Book 60 Page 29-34 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 also subject to such other rules and regulations the City of Clearwater may adopt pertaining
to use of said described property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said part _7 of the second
part T heirs and assigns forever.
IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, 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 its City
Clerk on this the day and year first above written.
Signed, Sealed and Delivered CITY OF CLEARWATER, FLORIDA
in the presence of us:
By /s/ Anthony L. Shoemaker
City Manager.
/s/ Dorothy M. Johannsen Countersigned:
/s/ Denise L. Cowdrick /a/ Charles Le Cher
Mayor Commissioner.
Approved as to form and correctness: Attest:
/a/ Thomas A. Bustin /s/ Lucille Williams
City Attorney City Clerk.
State of Florida,
County of Pinellas:
Personally appeared before me Charles LeCher, Anthony L. Shoemaker
and 111 Pi 11P W i 111 am s to me well known to be the persons who
executed the foregoing instrument of conveyance in the capacity of Mayor Commissioner, City Manager, 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, a municipal corporation, for the uses and
purposes therein expressed.
Witness my hand and official seal at Clearwater, Florida, this the 20th day of
November A.D. 19 79.
(Seal)
This instrument was prepared by:
Thomas A. Bustin, City Attorney
City of Clearwater, P. 0. Box 4748
Clearwater, Florida 33518
/s/ Cynthia E. Goudeau
Notary Public State of Florida.
My Commission expires
Plotary ?aElit, State of Florida at Larne
iY Commission Ezpims Oct. 31, 1983
Lemetery i racxmg 3y SLcii>
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dock: 15 Lot: 115
Profile Summary
:lick 'View Assigned' to view interment details. If more than one individual is interred in a space, a
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WFST SIDE OF MYRTLE AVENUE
ISpace Owner Last Owner First Owner Middle Max Interred Total Assigned Interred
1 MESQUITA KIMBERLY C 1 1 1 View Assigned_
2 DIERKEN MARGARET 1 0 0 View Assigned.
3 DIERKEN EMILIE 2 2 2 View Assigned
4 DIERKEN EMILIE 1 1 1 View Assigned.
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.°.a ? W i 1• H 1 _ / 1 Main Report 100%
CEMETERY SEARCH NAMES AND NOTES REQUEST
FOUND AS CURRENT OWNER OF BLOCK: 15 LOT: 115 SPACE: 4
OWNER 1: EMILIE DIERKEN
SPACE TYPE: FULL
COMMENTS
None
FOUND AS CURRENT OWNER OF BLOCK: 15 LOT: 115 SPACE: 3
OWNER 1: EMILIE DIERKEN
SPACE TYPE: FULL
COMMENTS:
None
FOUND AS CURRENT OWNER OF BLOCK: 15 LOT: 115 SPACE: 2
OWNER 1: MARGARET DIERKEN
SPACE TYPE: FULL
COMMENTS:
None
DECEASED NAME: EMILIE L DIERKEN
BLOCK: 15 LOT: 115 SPACE: 4
BORN: 01/01/1888 DIED: 03 / 23 / 1982 INTERRED: 03 / 26 / 1982 BURIAL TYPE: FULL
INTERMENT NOTES:
NONE
DECEASED NAME: WALTER F DIERKEN
BLOCK: 15 LOT: 115 SPACE: 3
BORN: 03/12/1917 DIED: 02 / 17 / 1986 INTERRED: 03 / 18 / 1986 BURIAL TYPE: URN
INTERMENT NOTES:
NONE
DECEASED NAME' WILLIAM F DIERKEN
BLOCK: 15 LOT: 115 SPACE: 3
BORN: 01 / 01 / 1888 DIED: 10 / 30 / 1979 INTERRED: 10 / 30 / 1979 BURIAL TYPE: FULL
INTERMENT NOTES:
NONF.
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Ms Margaret Dierken
Grafton Oaks Nursing Center
405 Grafton Avenue Room 307
Dayton, OH 45406-5202
18 76 ? Ae 'r, lam,! 9 s.
RECEIVED)
JUN 21 2011
A, RECORDS
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EGISLA SrZVCS DEPT