Mendez, DeliaCemetery Call Work Sheet
Date: ' / 3o I'1-
Funeral Home / Monument Company: wA G±° red-e1 -rpu�Y
Contact Name:T. 3 • COl eh Tel. #: 13--?--35.- b9Y{SFax #: Sllbl_ ?- ‘5.-,
Reason for call: Staking Request (Interment/Disinterment)( • ��`��` °,-1jiot) • C -°m
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 V de_hy.ts
Owner of Plot: 3.5a - 3 17 — 7 /
Na)cf " ft,‘
Deceased Name: a_ Revv ._
Block I. Lot I°`4 Space or
Date of Birth: i / d- / /9' Date of Death (‘)` / a`f /
Date of Burial: I / 17 / 3O !6" Time: . . 30 am/
$30.00 Staking Fee (FuYieral Home) - received on: 3- /10 / 15
ckLek it I Y °L,
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /P &R on: / /
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******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Disinterment:
ic.�Q
Pet w,i- (`f `f `7
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 11/24/14
Status of Block: 15 Lot: 108 as of 01/06/2015
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL MARTIN MARTA 10/4/1916 03 / 17 / 1992 3/19/1992 2051
2 URN CAPITANIO MARY 5/27/1935 09 / 20 / 2011 10/1/2011 1413
3 URN GUZIOR LYDIA M 4/29/1924 04 / 05 / 2002 8/2/2002 2501
3 FULL MARTIN ERASMA 12/18/1903 09 / 11 / 1994 9/13/1994 2176
4 URN STOLL V WILLIAM 9/19/1980 08 / 04 / 2001 8/10/2001 2483
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
LaCosse, Judith
From: Tokar, Mark
Sent: Wednesday, January 07, 2015 1:44 PM
To: LaCosse, Judith
Subject: RE: Cemetery Staking request - Urn Burial
Yellow flags
From: LaCosse, Judith
Sent: Tuesday, January 06, 2015 10:53 AM
To: Tokar, Mark
Cc: Sarnoff, Cherise; Wells, Alexis; Vaughan, Karen
Subject: Cemetery Staking request - Urn Burial
Importance: High
Hello,
We received a call this morning from T.J. Cohen, Cremations of Greater Tampa Bay for a staking request for an urn
burial.
The deceased name is Delia Mendez. Please Stake Space 4 of Block 15, Lot 108.
The date of burial will be Saturday, January 17th but they would like the area to be staked by Friday, January 16th
Other burials nearby in this plot:
Space 1: Marta Martin —full burial
Space 2: Mary Capitanio — urn burial
Space 3: Lydia M Guzior— urn burial & Erasma Martin — full burial
Space 4: William Stoll V — urn burial
Please advise me of the color of flags being used so we can notify T.J. Cohen.
Thanks,
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727- 562 -4093
1
January 7, 2015
Attn:
Fax:
T.J. Cohen / Cremations of Greater Tampa Bay
813- 235 -0946
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Delia Mendez
Gravesite: Block 15, Lot 108, Space 4
Urn Space
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 1 = Marta Martin — (full burial)
Space 2 = Mary Capitanio — (full burial)
Space 3 = Lydia M Guzior — (urn burial)
Space 3 = Erasma Martin — (full burial)
Space 4 = William Stoll IV — (urn burial)
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
CREMATIONS OF GREATER TAMPA BAY INC.
4021 HENDERSON BLVD.
TAMPA, FL 33629
Pay to the r .
Order of
-
I
k The Bank of Tampa
TAMPA, FLORIDA 33601-0001
POST OFFICE BOX ONE
For
1406
63-868/631
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Date
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CLEARWATER CARETAKER
CLEARWATER, FL
BURIAL PERMIT
PERMIT # 1447
February 06, 2015
Permission is hereby granted for burial of:
Name of Deceased: DELIA MENDEZ Burial Type: URN
Owner of Property: DELIA MENDEZ &
Block : 15 Lot: 108
Space: 4 Date of Birth: July 28, 1920
Date of Death: December 24, 2014 Date of Burial: January 17, 2015
Funeral Home Director: T. J. COHEN / CREMATIONS OF GREATER TAMPA BAY INC
Time: 14 :30
Staking Fee: 30.00 Date Paid: February 6, 2015
Clearwater Cemetery
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