Fischer, Linda
*ate: 5 l It l 'Po I I
Cemetery Call Work Sheet
Funeral Home/ Monument Company:
0
Contact Name:
?,?
Tel. #: 616 - 53Lt- 5 9 87 Fax #: 5 j?'
Reason for call: Staking Request (Interment)
Affidavit (Burial Rights)
Monument (Marker) being placed
(No fee for staking of monument)
Other reason: . Y'S i n±e,r Ph ek. 4, Q? w ? .fie
LA. A C'
CJ ?. uw K o W V V L/Y .
Interment: (One full burial and one um, or two urns per space) se
R" s 6 7F9_,..,1e-1 _', R.
40 ull Burial Urn Space
Owner of Plot: pac,Q M. NW Sr.
Deceased Name: R ?y N, N ?A
Block 11t Lot Yas Space
Date of Birth:
Date of Burial:
Oa
la 3 0
Date of Death /
Time
PO, 7
??? uvu . 19 -7a-
/ "'^ff Sty U,-(',l>= o.
803 N . Tf
am/pm A de .
$30.00 Staking Fee (Funeral Home) - received on: Y-f (. - a 375'
0 a,-7)
Copy of permit faxed to Joe Taylor/P&R - Fax No. 6551 on: ` - 5b a? do?o
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
S4&kc ??` i S?h`ter wee ,
L,s
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, May 12, 2011 3:21 PM
To: Irandys.lady@gmail.com'
Subject: Amy N. Neff - Disinterment
Importance: High
Hello Ms. Fischer,
It was nice talking to you yesterday. As I mentioned over the phone a disinterment is handled by a funeral home. A
licensed funeral director is required to be present during a disinterment. The funeral home will call our dept. to request
the staking of the area. We then call our Parks and Recreation Dept. and someone will mark the space with colored
flags, this way the funeral director will know the location for the disinterment.
Hopefully, Paul at Moss Feaster Funeral Home in Clearwater (727-562-2070), was able to assist you regarding this
matter.
If you have any other questions or concerns, please give me a call.
Best regards,
Judith LaCosse
Sfqf f 'Assl.
Citv of Clearwater
Official Records & Legislative Services
727-562-4093
299
CEMETERY DEED
THIS INDENTURE, Made this ------- Sth----- day of __JAnUar-y---------------- A. D., 19-7a--
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 ___P2lL3__M. _Kef ,__JZ__________________________________
__--707_N. Ft._Hairrison_Ave._,_A_P ,- 2s----------C1!4#_W4Ltgk-----------------_, of the
County of ---- UDSUAS____________________, State of _ 1_Qr1d , part-y-_ 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
$__Zigtesa-do1IAr8 _L$15-001 ___________, to it in hand paid by the said part-f-_ of the
second part, the receipt whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the
said part_-_ of the second part, and__bifi _______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 __IAMAP-t _ Lot __42Q-_____ Block __1------- Clearwater Cemetery,
as recorded in Plat Book__6Q___ Page29--3Q Public Records of Pinellas County, Florida.
Co
.d,o o L_ This conveyance is subject to the condition that Grantee herein shall not assign or convey said property
d o a0wvithout the written consent of the Grantor, and to the further condition that said property shall be used
CJ Monly for cemetery purposes as human burial sites.
a c°
o TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said
part-y____- of the second part-----hie --------- heirs and assigns forever.
v Gl ax"i
Y
'J. - y
F v '" IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, has caused these presents
o to be executed in its name by its Mayor Commissioner, by its City Manager, and to be attested and its
Ems- ?4 v corporate seal affixed by its City Clerk on this the day and year first above written.
Signed, Sealed and Delivered
in the presence of us:
CITY OF CLEARWATER, FLORIDA
----/sl_ Kathry-n_fl__ Green_____------
/s/ Sue Lamkin
Approved as to form and correctness:
/_s /--Herbert M.-Brown
City Attorney
By -!.s/_lierr-p-tt_R._.Stierh-: m----
City Manager.
Countersigned:
/s/ H. Everett Hougen
--------------------------- -
Mayor Commissioner.
Attest:
____L_s_L_R. _Sz?_ Whitehead -----------
City Clerk.
State of Florida,
County of Pinellas:
Personally appeared before me, _ H. Everett Hougen, Merrett R. Stierheim
-------------------------
and ------ R.--G.-Whitehead
--------------------------------- 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 cor-
poration, for the uses and purposes therein expressed.
Witness my hand and official seal at Clearwater, Florida, this the- 9'th_____________________day of
____ January A. D. 19_7-2--.
(Seal) {?? ->}}?3t £'Notary Public State of Florida.
My Commission expires---