Henderson, Evelyn CCemetery Call Work Sheet
Date: 3 / 9 / .9-0 15
Funeral Home / Monument Company: S5 --e-
Contact Name: LA-h M Tel. #: S 6 "if' 7° Fax #: 7a'1- S G V-- °1 o 7.g
Reason for call: v. Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
3/0fis
(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
L4Q.4) ►t CrocA.A.7
veQ7h C. r. Sen•-,
Block % Lot 1X' Space a.
Date of Birth: ` / (P i'19 Date of Death 3 / ? / a- 7 IS
Date of Burial: 3 / 13 / I S Time:
10:90 pm
$30.00 Staking Fee (Funeral Home) - received on: 3 / 36. / °/S
PAtv,;rt 4- )& L4-c
(-lick -4r 111'
M° 5 S �e
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /P &R on: 3 136 / 0(S"
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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 11/24/14
`,` y J,,- - -�,� \
C I T Y O F C L E A R W A T E R
� (_) ., .
___44POST OFFICE BOX 4748
Department of the
City Clerk
(813) 462 -6684
May 18, 1995
Ms. Melody L. Long
Bonner, Hogan & Coleman, P.A.
P. 0. Box 1640
Clearwater, FL 34617
RE: ESTATE FOR EVELYN CROWLEY, deceased
Dear Melody:
CLEARWATER, FLORIDA 34618 -4748
This letter is to inform you of the status of the cemetery property which was conveyed to
EVELYN CROWLEY by Dr. R. F. Wyatt, and his wife, Edna F. Wyatt on Feburary 18, 1952.,
as per your phone request this morning.
The cemetery property is described as Lot Seventy -two (72), a four (4) space lot, and the
North one -half of Lot Eighty -three (83), which consist of two (2) spaces, Block Seven (7) in
the Clearwater Cemetery.
Our records indicate burials and burial rights (via handwritten notes in our lot book) in /to the
spaces as follows;
Block 7, Lot 72, Space 1
Block 7, Lot 72, Space 2
Block 7, Lot 72, Space 3
Block 7, Lot 72, Space 4
Block 7, N 1/2 83, Space 3
Block 7, N 1/2 83, Space 4
Block 7, N 1/2 83, Space 4
Call me if more information is needed.
Sincerely,
(i
Camille Motley, CRM
Central Records Specialist
cm
Reserve for Eveleyn Crowley Henderson'
Reserve for Eveleyn Crowley Henderson
Interment - Evelyn Crowley
Interment - Charlotte Ann Rawlry
Reserve for Dr. Charles Crowley
Interment (Urn) - Margaret Bour Crowley
Interment (Urn) - Charles Raymond Crowley
"Equal Employment and Affirmative Action Employer"
/ 1 Main Report N 100% u
Status of Block: 7 Lot: 72 as of 03/10/2015
INTERMENTS:
SPACE BURIALTYPE DECL
DECF
DECM BIRTH DEATH
INTERRED
1 FULL HENDERSON EVELYN C 01 / 01 / 1901
2 FULL HENDERSON EVELYN C 01 / 01 / 1901
3 FULL CROWLEY EVELYN 9/30/1908 03 / 03 / 1994 3/5/1994
4 FULL RAWLING CHARLOTTE A 1/1/1888 04/06/1961 4/6/1961
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
4 > 1 / 1
Page 1 of 1
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Updated on Wednesday, March 06, 2013
Home 1 Feedback 1 Departments 1 Contacts 1 Forms
Status of Block: 7 Lot: 83 as of 03/10/2015
INTERMENTS:
SPACE BURIALTYPE DECL
DECF DECM BIRTH DEATH INTERRED
PERMIT
1 FULL PHILLIPS JAMES S 1/1/1877 01 / 01 / 1943 1/1/1943 0
2 FULL PHILLIPS DEE U 4/14/1890 10 / 08 / 1982 10/11/1982 1484
3 FULL CROWLEY CHARLES 1/1/1901 0
4 URN CROWLEY MARGARET B 6/21/1919 04 / 26 / 1979 10/25/1982 1486
4 URN CROWLEY CHARLES R 9/6/1926 01 / 06 / 1989 9/7/1989 1819
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
LaCosse, Judith
From:
Sent:
To:
Subject:
Red flags.
Tokar, Mark
Wednesday, March 11, 2015 1:32 PM
LaCosse, Judith
RE: Cemetery Staking Request - Full Burial
From: LaCosse, Judith
Sent: Tuesday, March 10, 2015 8:36 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Importance: High
Staking request for full burial received from Dan Miller /Moss Feaster.
Name of deceased: Evelyn C. Henderson
Please Stake Space 2 of Block 7, Lot 72
The date of burial will be for Friday, March 13th at 10:00 a.m.
Other burials nearby in Block 7, Lot 72:
Space 1: Vacant
Space 2: Vacant
Space 3: Evelyn Crowley— (full)
Other burials nearby in Block 7, N % Lot 83:
Space 1: James S Phillips — (full)
Space 2: Dee U Phillips — (full)
Space 3: Dr. Charles Crowley — (full)
Space 4: Margaret B Crowley — (urn) & Charles R Crowley — (urn)
Please advise me of the color of flags being used so that I could notify the funeral home.
Thank you.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
March 11, 2015
Attn: Dan Miller
Funeral Home: Moss Feaster Funeral Home
Fax: 727 - 562 -2073
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Evelyn C. Henderson
Gravesite: Block 7, Lot 72, Space 2
Full Burial
Gravesite flagged with Red flags.
Nearby Burials:
Space 1 = vacant
Space 2 = vacant
Space 3 = Evelyn Crowley — (full burial)
Other burials in Block 7, N 1/2 Lot 83:
Space 1 = James S Phillips — (full burial)
Space 2 = Dee U Phillips — (full burial)
Space 3 = Dr. Charles Crowley — (full burial)
Space 4 = Margaret B Crowley & Charles R Crowley — (urn burials)
** 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
MOSS FEASTER FUNERAL HOME
' AND CREMATION SERVICES
693 SOUTH BELCHER ROAD
CLEAR WATER, FL 33764
(727)562 -2070
PAY TO THE
ORDER OF
City of Clearwater
- -- Thirty And 0 /100 --
MEMO Henderson 467301210148 Staking
BANK OF AMERICA
64-1278-611
3/23/2015
$
30.00
VOID AFTER 180 DAYS
c
DOLLARS z
AUTHORIZED SIGNATURE
01167300LLLL1II 1 :06LLL27881: 0033598 LOOS LH'
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
Comments
Henderson 467301210148 Staking fee
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
L# Comments
1 Henderson 467301210148 Staking fee
Total forHenderson 467301210148 Staking fee
)DELUXE CORP' 1 +800- 328 -0304 www.deluxeforms.com
1114
Amount
30.00
30.00
1114
Amount
30.00
30.00
125 DBC152 STXRXIO 07/14/2014 0409