Nelson, Vivian G •
Cemetery Call Work Sheet
Date: (" / / (I
Funeral Home / Monument Company: AIVA c lbo∎!-f: -1-1-0 z.
Contact Name: Rovx
V13 - X33 - QS° --(1`4U^--)
Tel. #: $ 13 - 5'`f - / S3 Fax#: (g 13) 3 6- 5 '7 3 "3
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Reason for call: Staking Request (Interment/Disinterment) e 6/3 G(
Le. g T��1/P� R
Affidavit (Burial Rights) �� S .
Monument (Marker) being placed (No fee for staking of monument)
V Verifying Burial space
Other reason:
Interment: (One full burial and one um, or two urns per space)
Full Burial / Urn Space
Owner of Plot: G.
Deceased Name: U)v 0.4 C, N a_s s,fc,« J. .
Block 16 Lot I I Space a
Date of Birth: / 1-1 / 1 917 Date of Death 6 / 3° / ;)° 11
Date of Burial: 7 / s / a° 11 Time: 11.'2° .' pm
$30.00 Staking Fee (Funeral Home) - received on: 7 / Iq/ II PIA 4 1�h(
Copy of permit faxed to Joe Taylor/P&R - Fax No. 6551 on: -7 / /ci / lI
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
Yi - e w -(o 21,LS k � � t. wu �
Revised 6/29/11 �� � K f� b
CrystalReports Viewer Page 1 of 1
4'2 1 4 * 1 / 1 Main Report 1 100%
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I Status of Block: 16 Lot: 19 as of 06/30/2011
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED
1 FULL NELSON CHARLES M 9/15/1903 07/22/1991 7/25/1991
3 FULL PHILLIPS DOROTHY P 11/6/1912 01/06/1998 1/9/1998
4 FULL SWANSON PATRICIA W 9/1/1906 10/26/1990 10/30/1990
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
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http://msb-cry stal-ent/businessobjects/enterprise 11/infoview/viewers/rpt/DHTMLV iewer.aspx?skin=skin... 6/30/2011
July 1, 2011
Attn: Ron
Funeral Home: McDonalds Funeral Home
Fax: 813-936-5733
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Vivian G. Nelson
Gravesite: Block 16, Lot 19, Space 2
Full Space
Gravesite flagged with Pink flags.
Date of burial: Tuesday, July 5' at 11:00 a.m.
Nearby Burials:
Space 1 = Charles M Nelson — Full (Husband)
Space 3 = Dorothy P Phillips - Full
Space 4 = Patricia W Swanson - Full
Staking Fee: $30.00
Please make check payable to: City of Clearwater
Mail to: City of Clearwater
Official Records Dept. — 2nd Floor
112 S. Osceola Ave.
Clearwater, FL 33756
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4093
•
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II 12 13 14 IS 16 17 IB 19 20 106 87 82 63 58 39 34 15 10 87 82 63 58 39 34 15 10 N
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(I)540 541 542 543 540 539 538 537 179 174 157 152 135 130 113 108 91 86 69 64 47 42 25 20 3
527 528 529 530 531 532 533 534 535 538
180 173 158 151 136 129 114 107 92 85 70 63 48 41 26 19 4
I 526 525 524 523 522 521 520 519 518 517. 181 172 159 150 137 128 115 106 93v/-�` 84 71 62 49 40 27 IB 5
507 508 509 510 511 512 513 1--ml 182 171 160 149 138 127 116 105 94 83 72 61 50 39 28 17 6
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4
MYRTLE 1 AVENUE
1
SEE SHEET 2
LaCosse, Judith
From: LaCosse, Judith
Sent: Friday, July 01, 2011 10:37 AM
To: Tokar, Mark; Wells, Alexis
Cc: Gilmore, Stephanie
Subject: RE: Cemetery Staking Request
Thank you Mark...we appreciate it. I will notify the funeral home.
Have a Safe and Happy 4th of July...
Judith LaCosse
Staff Asst.
Official Records& Legislative Services
727-562-4093
From: Tokar, Mark
Sent: Friday, July 01, 2011 10:02 AM
To: LaCosse, Judith; Wells, Alexis
Subject: RE: Cemetery Staking Request
Pink flags.
From: LaCosse, Judith
Sent:Thursday, June 30, 2011 3:14 PM
To: Wells, Alexis
Cc: Tokar, Mark
Subject: RE: Cemetery Staking Request
Thank You !!
From: Wells, Alexis
Sent: Thursday, June 30, 2011 3:13 PM
To: LaCosse, Judith
Subject: RE: Cemetery Staking Request
Mark will take care of it tomorrow.
From: LaCosse, Judith
Sent: Thursday, June 30, 2011 3:12 PM
To: Wells, Alexis
Subject: FW: Cemetery Staking Request
Importance: High
Please advise!!
1
Thanks...
From: LaCosse, Judith
Sent:Thursday, June 30, 2011 3:10 PM
To: Taylor, Joe
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie
Subject: Cemetery Staking Request
Importance: High
Hi Joe,
We received a call this afternoon from Ron at McDonalds Funeral Home requesting a staking for a Full burial for:
Vivian G. Nelson in Block 16, Lot 19,Space 2. Ms. Nelson passed away this morning.
Other burials nearby in Blk 16, Lot 19:
Space 1=Charles M Nelson—Full burial (Husband)
Space 3= Dorothy P Phillips—Full burial
Space 4= Patricia Swanson—Full burial
Staking is needed by next Tuesday,July 5th for a(full)burial,scheduled at 11:00 a.m.
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith LaCosse
Staff Asst.
Official Records&Legislative Services
727-562-4093
2
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MACDONALD FUNERAL HOME AND CREMATION, INC.
PH 813-933-4950 836
10520 N FLORIDA AVE 63-t 377/631
TAMPA,FL 33612
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DATE 7 -- /f- c/0/7
TO THE ORDER OF !r/ t"- C1 L fi,IZ-Gr//V G lam' is � G 1`
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MERCANTILE BANK �_
arcantile8ank is a trade name of TD Bank,N.A. `~
FOR /////1/1 /Z fGfO/-I „ {,Lrj4lt G 4-- -;; --__ ..___.___ -____.,_.___ _ ____M'
u'0080 3 6ii' 1:0 6 3 L L 3 7 7 21: 7 600 L 7 4 6 7Oii'
•
4.:00A4v7 CITY OF CLEARWATER
POST OFFICE Box 4748,CLEARWATER,FLORIDA 33758-4748
C:71; CITY HALL, 112 SOUTH OSCEOLA AVENUE,CLEARWATER,FLORIDA 33756
,s� TELEPHONE(727) 562-4090 FAX(727) 562-4086
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OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
July 19, 2011
MacDonald Funeral Home
and Cremation, Inc.
10520 N. Florida Ave.
Tampa, FL 33612
To Whom It May Concern:
We received your Cemetery Staking Fee check #8036 in the amount of$30.00 for
the interment of Vivian G. Nelson.
Attached you will find receipt No. 444836.
Thank you,
With La osse
Staff Assistant
Att.
"EQUAL EmpLo LENT AND AFHRyIATD'E ACTION EMPLOYFR"