Hornsby, IvyCemetery CaII Work Sheet
Date: 7 / / / aalS
Funeral Home / Monument Company: Moss Fe 4_51.
Contact Name: R -k CiNe5014, Tel. #:7a`7- Spa- 2-0-70 Fax #:
Reason for call: 1 Staking Request (Interment/Disinterment)
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:
GW��� '/-//
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: 1AVIM,ith, �. 44 orn 0., y-
Deceased Name: t-tarr\�by
Block 0- Lot 0-q Space
Date of Birth: (I / I�' / /911 Date of Death 1 / /3 / c;- °15
Date of Burial: +7 / i° / 3-O IS Time: /0.- v v �.!4 p
$30.00 Staking Fee (Funeral Home) - received on: 7 / /3 / Do IS i Ickg Fi vv:t kce
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /P &R on: / /
-/c
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, July 02, 2015 12:35 PM
To: Tokar, Mark
Cc: Vaughan, Karen
Subject: RE: Cemetery Staking Request - Urn Burial
Thank you. I will notify the funeral home.
Judith LaCosse
Staff
City of Clearwater
ORLS Dept.
727 -562 -4093
From: Tokar, Mark
Sent: Thursday, July 02, 2015 12:13 PM
To: LaCosse, Judith
Subject: RE: Cemetery Staking Request - Urn Burial
Yellow flags.
From: LaCosse, Judith
Sent: Wednesday, July 01, 2015 10:41 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Cemetery Staking Request - Urn Burial
Importance: High
We received a call this morning from Rick Chesler, Moss Feaster for a staking request for an urn burial.
The deceased name is Ivy Hornsby. Please Stake Space 1 of Block 12, Lot 29.
The date of burial will be for Friday, July 10th at 10:00 but they would like the area to be staked by Thursday, July 9th.
Other burials nearby in this plot:
Space 2: William B Hornsby Sr - (full burial)
Space 3: William B Hornsby, II - (full burial)
Space 4: Frank Smith - (full burial)
Please advise me of the color of flags being used so we can notify the funeral home.
Thanks,
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
1
July 2, 2015
Attn: Rick Chesler
Funeral Home: Moss Feaster Funeral Home
Fax: 727 - 562 -2073
Deceased: Ivy Hornsby
Gravesite: Block 12, Lot 29, Space 1
Urn Burial
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 2 = William B Hornsby Sr — (full)
Space 3 = William B Hornsby, II — (full)
Space 4 = Frank Smith — (full)
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727 - 562 -4093
1114673001173111 1061111 27881: 003359810051n'
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
Comniatits
l'Icrnsby 467301210015 Staking Fee
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MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
intrituocie t. 32e-0304 www4eluxeforms,
RECEIVED
JUL 1 3 2015
FINANCE DEPARTMEN1
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1173
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At ht,h0
`Clearwater
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......../..........................„...................-
City of Clearwater, Florida
Official Records and
Legislative Services Department
Phone (727) 562 -4090
Fax (727) 562 -4086
FAX MESSAGE
TO: Rick Chesler
LOCATION: Moss Feaster
FAX: 727 -562 -2073
COMMENTS: Attached is a copy of the Clearwater Municipal
Cemetery map (sheet 2 of 3). The burial space
reserved for Ivy Hornsby is Space 1 of Block 12,
Lot 29. I have also attached a document showing
other interments in this block & lot.
Give me a call when you're ready to have the area
staked.
Thank You ! !
FROM: Judith LaCosse, (727 -562 -4093)
DATE: 3/19/2015
NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 3
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PROSPECT AVENUE
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Status of Block: 12 Lot: 29 as of 03/19/2015
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL HORNSBY IVY 1/1/1901
2 FULL HORNSBY SR WILLIAM B 4/17/1921 11 / 28 / 1991 12/3/1991 2038
3 FULL HORNSBY, II WILLIAM B 10/11/1946 08 / 20 / 1959 8/24/1959 14
4 FULL SMITH FRANK 3/25/1909 09 / 09 / 1992 9/12/1992 2072
0
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
4 FULL SMITH FRANK 09 / 09 / 1992 03 / 25 / 1909 09 / 12 / 1992 09 / 10 / 1992 02072
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