Bennett, Willie RCemetery Call Work Sheet
Date: cl / L / OHO
Funeral Home / Monument Company: rnia'`' e F.
Contact Name: e °� Tel. #: 1X"7- 3 3° - ?6 l Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
✓ Monument (Marker) being placed (No fee for staking of monument)
For: OiUte P• „Be nne;
Block 15 Lot 6 ? Space if.
Date: / / Time:
(Send email to P &R) ✓ ����� I p 1
l 4 K dL a- & u, W, 1L f , n k f I�Gt-tf/�, 1 •
Verifying Burial space
Other reason:
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot:
Deceased Name:
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
Status of Block: 15 Lot: 68 as of 09/04/2014
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INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL CROSKEY DOSHIE 12 / 28 / 1992 1/2/1993 2084
2 FULL MCDOUGAL MICHAEL J 3/23/1954 12 / 21 / 1993 1/1/1994 2134
3 FULL YELDON SAMMY D 3/10/1928 10/29/1994 11/4/1994 2183
4 FULL BENNETT WILLIE R 3/21/1941 02 / 04 / 1994 2/12/1994 2143
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
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LaCosse, Judith
From: LaCosse, Judith
Sent: Friday, September 05, 2014 8:17 AM
To: Tokar, Mark
Subject: RE: Cemetery Staking Request - Placement of a marker
Thank you !! I will notify the funeral home.
From: Tokar, Mark
Sent: Friday, September 05, 2014 8:16 AM
To: LaCosse, Judith
Subject: RE: Cemetery Staking Request - Placement of a marker
Pink flags.
From: LaCosse, Judith
Sent: Thursday, September 04, 2014 8:54 AM
To: Tokar, Mark
Cc: Sarnoff, Cherise; Wells, Alexis; Vaughan, Karen
Subject: Cemetery Staking Request - Placement of a marker
Importance: High
This morning, I received another request from Ted from Carnegie Funeral Home, Tel. No. 727 - 330 -7661, for a staking for
placement of a marker.
Block 15, Lot 68, Space 4
Deceased, Willie R. Bennett - was interred back on 2/12/1994 in this plot (full burial).
Staking is needed by tomorrow, September 5th.
Please advise me with the color of the flags being used so that we could notify the funeral home.
Other burials nearby:
Space 1= Doshie Croskey — full burial
Space 2 = Michael J McDougal — full burial
Space 3 = Sammy D Yeldon — full burial
Thanks for your help.
Judith LaCosse
StaffAssistant
Official Records and
Legislative Services Dept.
727-562-4 093
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