Sims, Andrew & Adam (Infants)Date: a- / a5/ 1'f
Funeral Home / Monument Company:
Contact Name:
Reason for call:
Cemetery Call Work Sheet
Cr e_et. 4.4 M o h,u.6....,e rfi Cz .
Tel. #: 1551 Fax #: ogs1
Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For: A...r.Irear k clam c
Block Ii' Lot aSa Space 00
Date: a- / d-g/ I L . 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
Owner of Plot:
Deceased Name:
Urn Space
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / / Time: am /pm
$30.00 Staking Fee (Funeral Home) — received on: / /
Copy of permit emailed to Marco Ortega, cc: Mark Tokar /P &R 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
Revised 10/31/12
LaCosse, Judith
From:
Sent:
To:
Cc:
Subject:
Ortega, Marco
Thursday, February 27, 2014 10:49 AM
LaCosse, Judith
Ortega, Marco; Tokar, Mark; Wells, Alexis; Vaughan, Karen
Re: Cemetery Staking for Placement of markers
On Feb 25, 2014, at 10:26 AM, "LaCosse, Judith" < Judith .LaCosse@myClearwater.com> wrote:
We received a call for cemetery staking requests from Kevin of Cycadia Monument Co. for placement of
flat markers for the following plots:
Andrew & Adam Sims (Infants) — Buried in Block 14, Lot 252, Space 00 (Please flag this space)
Other burials nearby:
Lot 251 = Richardson (infant)
Lot 253 = Joanne Whiting (infant)
Alena Sargeant - Block 9, Lot 29, Space 2 — (Please flag this space at foot of Alena's space)
(future interment of Peggy Tench)
Other burials nearby, Block 9, Lot 29:
Space 1 = Harry Sargeant
Space 3 = Walter Stonehouse
Space 4 = Lois Stonehouse
If possible Kevin would like to have the abov
Let me know the color of flags so that we cou
Thank You.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562 -4093
e spaces flagged by Friday, February 28th.
Id notify Kevin of Cycadia Monument Co.
1
February 27, 2014
Attn: Kevin Cantrell / Cycadia Monument Co.
Fax: 727 - 785 -0856
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Andrew & Adam Sims (infants)
Gravesite: Block 14, Lot 252, Space 00
Gravesite flagged with White flags
Nearby Burials:
Lot 251 = Richardson (infant)
Lot 253 = Joanne Whiting (infant)
Alena Sargeant — (Sally)
Gravesite: Block 9, Lot 29, Space 2
(flagged at the foot of this space for flat marker for Peggy Tench)
Gravesite flagged with Pink flags
Nearby Burials:
Space 1 = Harry Sargeant
Space 3 = Walter Stonehouse
Space 4 = Lois Stonehouse
Please contact me with any questions at 727 - 562 -4093.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater