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Franklin, Susette TCemetery Call Work Sheet Date: 7 / 8 / / `t Funeral Home / Monument Company: R cen FLA.wcn 1-to'~�Q Contact Name: Bo 6 ra Tel. #: q't4 -3055- Fax #: A 644 dr.µJ e . ca 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: G (Send email to P &R) ✓ -7A 04 - at;ped. /.3.A S ruK t QA C AA-1 AA-1 wu s ,(A 1c-coP n,c� Q41/1 Verifying Burial space Kt eM.a.f,(L t. Other reason: ******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Interment: (One full burial and one urn, or two urns per space) Full Burial Urn Space ✓ ' Owner of Plot: OA' Deceased Name: S ksc-H"c TLere s4. Fr „■k Q; sk.s iC M. Jerre'(” (c, Dwu49) ti44- Spa GC 4. Block % Lot to 9 Space `t Date of Birth: / `t / la Lt`f Date of Death g / a-° l3 Noah_ h. Date of Burial: 7 Time: am /pm $30.00 Staking Fee (Funeral Home) — received on: 7 / g / aa1.{ 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: LaCosse, Judith Sent: Thursday, July 10, 2014 9:03 AM To: Tokar, Mark Subject: RE: Cemetery Staking Request for Urn burial Thank you !! From: Tokar, Mark Sent: Thursday, July 10, 2014 8:51 AM To: LaCosse, Judith Subject: RE: Cemetery Staking Request for Urn burial Red flags From: LaCosse, Judith Sent: Tuesday, July 08, 2014 12:20 PM To: Tokar, Mark Cc: Wells, Alexis; Vaughan, Karen; Gilmore, Stephanie Subject: Cemetery Staking Request for Urn burial Importance: High Mark, We received a staking request from Bob Grant of Rhodes Funeral Home for an Urn burial for: Susette Theresa Franklin in Block L Lot 109, Space 4 There's already a full burial in this space (4) — Susie M. Jerrett (Hall), mother Other burial nearby: Space 1 = Mildred E Lutz — full burial Space 2 = Millard F Hall — full burial Space 3 = Mary N Hall — full burial Staking is needed for burial for Monday, July 21st at around Noon Please advise as soon as you can the color of the flags being used so that we could notify Rhodes Funeral Home. Thanks for your help. Judith LaCosse Staff Assistant Official Records and Legislative Services Dept. 727-562-4093 1 CURRENT OWNER: II INFORMATION REPORT FOR: BLOCK: 7 LOT: 109 SPACE: 4 1 OWNER 1: OWNER UNKNOWN SPACE TYPE: CURRENT SALES INFORMATION: None PREINTERMENT INFORMATION: II None INTERMENT INFORMATION: 1 DECEASED: SUSIE M JERRETT INTERRED: 4/4/1944 BIRTH: 4/15/1917 DIRECTOR: NOTES: None DEATH: 4/4/1944 OWNER 2: SUSIE MAY JERRETT, INTERRED RELATION to OWNER 1: RIGHTS: BURIALTYPE: FULL PROCESSED: PERMIT #: 0 Status of Block: 7 Lot: 109 as of 06/20/2014 INTERMENTS: SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED 1 FULL LUTZ MILDRED E 11/8/1923 07 / 11 / 1973 7/13/1973 2 FULL HALL MILLARD F 1/1/1885 10 / 20 / 1962 10/20/1962 3 FULL HALL MARY N 1/1/1895 04 / 06 / 1967 4/7/1967 4 FULL JERRETT SUSIE M 4/15/1917 04 / 04 / 1944 4/4/1944 DISINTERMENTS FROM SPACE: No Matching Records REINTERMENTS: No Matching Records Page 1 of 1 PERMIT 982 225 559 0 !JutlQox.com - xsparxyvuweotv.uet SearcMew RePelearttir MuhitipatfirEemettsty Fo... Inbox 52 Junk 66 Drafts 25 Sent Deleted 401 child su... Lacey mom pits Saved ssi- disa... 1 U6• 1 V1 1 Kenny s Place Move to Categories rillJudith.LaCosse @myClearwater.com (Judith.LaCc To: ksparky@webtv.net 1 attachment (250.7 KB) Outlook.com Block 7 Lot 109,pdf Hi Alicia, Per our telephone conversation, Susie M Jerrett is buried in Block 7, Lot 109, space 4 — full burial. See attached documentation. Order AT &T U- verse® Internet for $39 /mo for 12 mos w/ term & get HBO ® /HBOGO ®- see details Exclusive Offer: $300 Reward Card when you order U -verse TV + Internet $49 /mo -see details You mentioned that you would like to have your grandmother bur' , d in space 4 and this is allowed. (One full burial and b e urn i allowed in one space) '6,d`�" If you have any other questions, please give me a call. © 2014 Microsoft Terms Privacy & cookies Developers https:// snt148 .mail.live.com/default.aspx ?id= 64855 &rru = inbox 6/20/2014 u 3 lil`r71ifii vat f lfi =i r aVt THIS DOCUMENT HAS A LIGHT ROUND. ON TRUE ATE MA KED ' AP '':_.. HOLD TO LIGHT 0 VERIFY FLORIDA WATERMARK. OFFICE of VITAL STATISTICS AMENDED CERTIFICATION OF DEATH STATE FILE NUMBER: 2013116059 DATE ISSUED: September 25, 2013 DECEDENT INFORMATION STATE FILE DATE: August 26, 2013 NAME: SUSETTE THERESA FRANKLIN DATE OF DEATH: August 17, 2013 SEX: FEMALE SSN: 266 -68 -2633 AGE: 069 YEARS DATE OF BIRTH: April 4, 1944 BIRTHPLACE: CLEARWATER, FLORIDA, UNITED STATES PLACE OF DEATH: INPATIENT FACILITY NAME OR STREET ADDRESS: FLORIDA HOSPITAL ZEPHYRHILLS LOCATION OF DEATH: ZEPHYRHILLS, PASCO COUNTY SURVIVING SPOUSE, DECEDENT'S RESIDENCE AND HISTORY INFORMATION MARITAL STATUS: DIVORCED SPOUSE: NONE RESIDENCE: 5534 EUGENE AVENUE, ZEPHYRHILLS, FLORiDA 33542, UNITED STATES COUNTY: PASCO OCCUPATION, INDUSTRY: CERTIFIED NURSING ASSISTANT, MEDICAL RACE: X White Black or African American Asian Indian Chinese Filipino _Native Hawaiian Japanese Korean American Indian or Alaskan Native— Tribe: _Vietnamese Other Asian: Guamian or Chamorro Samoan _Other Pacific Isl: Other: _Unknown HISPANIC OR HAITIAN ORIGIN? NO, NOT OF HISPANIC /HAITIAN ORIGIN EDUCATION: HIGH SCHOOL GRADUATE OR GED EVER IN U.S. ARMED FORCES? NO PARENTS AND INFORMANT INFORMATION FATHER: MORRIS MC CANN JERRETT MOTHER: SUSIE MAE HALL INFORMANT: STEVE BROWN RELATIONSHIP TO DECEDENT: SON INFORMANTS ADDRESS: 5534 EUGENE AVENUE, ZEPHYRHILLS, FLORIDA 33542, UNITED STATES PLACE OF DISPOSITION AND FUNERAL FACILITY INFORMATION PLACE OF DISPOSITION: PALM STATE CREMATORY SERVICES CLEARWATER, FLORIDA METHOD OF DISPOSITION: CREMATION FUNERAL DIRECTOR /LICENSE NUMBER: CHERYL GOOLDIN, F046877 FUNERAL FACILITY: COASTAL CREMATIONS & FUNERAL CARE F074523 4201 GRAND BOULEVARD, NEW PORT RICHEY, FLORIDA 34652 CERTIFIER INFORMATION TYPE OF CERTIFIER: CERTIFYING PHYSICIAN MEDICAL EXAMINER CASE NUMBER: NOT APPLICABLE TIME OF DEATH (24 hr): 0300 CERTIFIER'S NAME: SURESH VEMURI CERTIFIER'S LICENSE NUMBER: ME107075 NAME OF ATTENDING PHYSICIAN (If other than Certifier): NOT APPLICABLE CAUSE OF DEATH AND INJURY INFORMATION PROBABLE MANNER OF DEATH: NATURAL CAUSE OF DEATH - PART I - and Approximate Interval: Onset to Death: a ACUTE ON CHRONIC RESPIRATORY FAILURE b SEPTIC SHOCK C d PART II - Other significant conditions contributing to death but not resulting in the underlying cause given in PART I: ATRIAL FIBRILLATION, PERITONITIS, DYSPHAGIA, G. TUBE PLACEMENT AUTOPSY PERFORMED? NO DATE OF SURGERY: REASON FOR SURGERY: AUTOPSY FINDINGS AVAILABLE TO COMPLETE CAUSE OF DEATH? DID TOBACCO USE CONTRIBUTE TO DEATH? PROBABLY IF FEMALE, WAS SHE PREGNANT WITHIN THE PAST YEAR? NO NOT PREGNANT WITHIN PAST YEAR DATE OF INJURY: NOT APPLICABLE TIME OF INJURY (24 hr) INJURY AT WORK? LOCATION OF INJURY: DESCRIBE HOW INJURY OCCURRED: PLACE OF INJURY: IF TRANSPORTATION INJURY, Status of Decedent: Type of Vehicle: DATE AMENDED: ANY CERTIFICATION ISSUED PRIOR TO THE AMENDED DATE MAY BE NULL AND VOID. ,State Registrar So _Y THE ABOVE SIGNATURE CERTIFIES THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD ON FILE IN THIS OFFICE. THIS DOCUMENT IS PRINTED OR PHOTOCOPIED ON SECURITY PAPER WITH WATERMARKS OF THE GREAT WARNING: SEAL OF THE STATE OF FLORIDA. DO NOT ACCEPT WITHOUT VERIFYING THE PRESENCE OF THE WATER- MARKS. THE DOCUMENT FACE CONTAINS A MULTICOLORED BACKGROUND, GOLD EMBOSSED SEAL, AND THERMOCHROMIC FL. THE BACK CONTAINS SPECIAL LINES WITH TEXT. THIS DOCUMENT WILL NOT PRODUCE A COLOR COPY. i II i i I I i i .,, r -, n r r DH FORM 1947 (11/11) rat atartltaritr1 REQ: 2014206426 'CERTIFICATION OF VITAL RECORDf` '':