Stephens, Donald H Cemetery Call Work Sheet
Date: 1 / 07 / a°1a-
Funeral Home / Monument Company: o n
�. � ti { n--12
Contact Name: //rn 1J
Tel. #: gi3 - 9900 Fax #: S/3 - -7F3 .-3/cig'
Reason for call: ✓ Staking Request (Interment/Disinterment) - irk QQ �� r- ,
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space
Other reason:
Interment: (One full burial and one urn, or two urns per space)
Full Burial ✓ Urn Space
Owner of Plot: H .
hei I H . S le_tA ev.s
Deceased Name: --1%'°r• H Ste-r h e h 5
Block IS Lot /°S Space --D ( � ) ,y g
Date of Birth: / /3 / i q3 1 Date of Death / / 4 42/ (c).--
Date of Burial: a- / I / (9-O l a 6)e-S • Time: (;oo am/im
$30.00 Staking Fee (Funeral Home) — received on: 2 / / -0 (a-
M 4.-- ( /1114. 4.,60
Copy of permit fa cd to r/PgR — Fax No. 6551 on: - / -7 / 3°lam
**************************************************************************************************
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
Revised 6/29/11
Status of Block: 15 Lot: 105 as of 01/27/2012 II'
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
2 FULL STEPHENS,JR WILLIE B 5/1/1930 02/ 13/ 1996 2/19/1996 2250
3 FULL STEPHENS, SR WILLIE B 8/28/1900 07/31 /2001 8/7/2001 2481
4 URN STEPHENS LESLIE L 6/19/1933 02/11 /2001 3/6/2001 2473
4 FULL STEPHENS HATTIE M 1/1/1902 07/07/1975 7/7/1975 1088
I
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
1
Page 1 of 1
LaCosse, Judith
To: Tokar, Mark
Cc: Ortega, Marco
Subject: RE: Cemetery Staking- Full Burial
Thanks ! I will notify the funeral home.
From: Tokar, Mark
Sent: Monday, January 30, 2012 12:59 PM
To: LaCosse,Judith
Cc: Ortega, Marco
Subject: RE: Cemetery Staking - Full Burial
Green flags.
From: LaCosse, Judith
Sent: Friday, January 27, 2012 12:27 PM
To: Ortega, Marco
Cc: Tokar, Mark; Wells, Alexis
Subject: Cemetery Staking - Full Burial
Importance: High
Hi Marco,
We received a call this morning from Tim Whitfield from Whitfield Funeral Home requesting a staking for a Full burial
for:
Mr. Donald H.Stephens in Block 15.Lot 105,Space 1(Di. DOD 1/26/12.
(See attached status sheet regarding burials in this block and lot)
Staking is needed by next Wednesday,February 1st for a(full) burial.scheduled at 1:00 p.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 Assistant
Official Records and
Legislative Services Dept.
727-562-4093
1
January 30, 2012
Attn: Tim Whitfield
Funeral Home: Whitfield Funeral Home
Fax: 813-783-3198
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Mr. Donald H Stephens
Gravesite: Block 15, Lot 105, Space 1 (D)
Full Space
Gravesite flagged with Green flags.
Nearby Burials:
Space 2 = Willie B Stephens, Jr - Full
Space 3 = Willie B Stephens, Sr - Full
Space 4 = Leslie L Stephens — Urn
Space 4 = Hattie M Stephens - 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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24994
WHITFIELD FUNERAL HOME, INC.
5008 GALL BOULEVARD
ZEPHYRHILLS,FL 33542
(813)783-9900
63-751-631
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Wachovia Bank,a division of Wells Fargo Bank,N.A.
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