Lugo, Guadalupe Cemetery Call Work Sheet
Date: la / / ) -
Funeral Home/ Monument Company: cti a,ef)A- Spc'(el�
Contact Name: ,As Tel. #: S3 �' °99`1 Fax#: 530 - Ott4a I
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
(Send email to P&R)
Verifying Burial space
Other reason:
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space ✓
Owner of Plot: L4
Deceased Name: G 4dct Plat. Lae
Block 1-S- Lot 1°9 Space
Date of Birth: S / 3 / 19 as- Date of Death H / a S/ ao/d
Date of Burial: la / 0.I / a-° 1a, Time: 6:°O am pQA
f4- ILI-a5-
$30.00 Staking Fee (Funeral Home) - received on: l? / 7 / a-°1?-
Copy of permit emailed to Marco Ortega, cc: Mark Tokar/P&R on: 1 a- / 1° / 4°la--
**************************************************************************************************
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 10/31/12
•
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, December 06, 2012 10:11 AM
To: Ortega, Marco
Cc: Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: RE: Staking Request- Urn burial
Thanks. I will notify National Cremation Society.
From: Ortega, Marco
Sent:Thursday, December 06, 2012 10:04 AM
To: LaCosse, Judith
Cc: Ortega, Marco; Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Re: Staking Request- Urn burial
Flags are pink.
On Dec 5, 2012,at 11:56 AM, "LaCosse,Judith" <Judith.LaCosse @myClearwater.com>wrote:
We received a call from Lisa of National Cremation Society for a staking request for an Urn burial for:
Guadalupe Lugo in Block 15, Lot 109,Space 4
Owner: Gilberto Lugo
Other burials nearby in this Blk 15, Lot 109:
Space 1= Frank A White,Sr—(Full burial)
Space 2= Homer Dunbar-(Full burial)
Staking is needed for burial for Friday. December 215`at around 6:00 D.M.
Please advise as soon as you can the color of the flags being used so that we could notify National
Cremation Society.
Thanks for your help.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
1
December 6, 2012
Attn: Lisa
Funeral Home: National Cremation Society
Fax: 727-530-0421
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Guadalupe Lugo
Gravesite: Block 15, Lot 109, Space 4
Urn
Gravesite flagged with Pink flags.
Date of burial: 12/21/12 Time: 6:00 p.m.
Nearby Burials:
Space 1 = Frank A White, Sr—(Full burial)
Space 2 = Homer Dunbar— (Full burial)
Staking Fee: $30.00 (To be paid by Funeral Home or Family)
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
Staff Assistant
Official Records & Legislative Services
City of Clearwater
727-562-4093
Status of Block: 15 Lot: 109 as of 12/05/2012
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL WHITE,SR. FRANK A 1/28/1944 01/06/1996 1/13/1996 2244
2 FULL DUNBAR HOMER 7/30/1930 02/02/1994 2/12/1994 2142
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
44F 194
"4,■%? ,-,7N-Iti CITY OF CLEARWATER, FLORIDA
MISCELLANEOUS RECEIPT
Date C r i , 20 1 I-'
--tfrf rik, '
Received from (-n \\ L \ ' L
In payment of L \(A IL I t (k 'I C .(:-.1 ea-titt by-- 6 Lot
Amount received 1 ''t t kt k \ 1 \‘(t k'*--f• Dollars
Fund ( it Code A'-: C-_,E- 4
CITY OF CLEARWATER
$
ti t; 41\
Department Rece.ived By
GILBERTO LUGO 644
FearoDrwldr,1K E3pD6t4702 63-466/631
.1 21)11,--
1D!C... 1 DATE
,
IOARYDEr THE l-k< (,). . Oka )attr I $ 50 CO
-Thir-N Do\ors ob
2DOLLARS n Fpv%
1--
--.--‘ REGIONS S to'k)0■Ce., .viv
FOR • i0C1 41 . I EI --,d./ae-4-e -)-411'`' p,
1:063 L0466131: 0 L303E115680 0644
4