Worline, NellieCemetery Call Work Sheet
Date: / H /° 11O
Funeral Home / Monument Company: C 7 c `k- 4( i u 14,L e Pl-t CD
Contact Name: •C' Vi vx Tel. #: S12 -- /5-5-1 Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
c (.(604_ t4o: -k .Ae�rt
IV Monument (Marker) being placed (No fee for staking of monument) (;_ a2k)
For: 1� aka. 1,v o r ►� k 411. LOP r 11.%in..2. L-c cL Q
Block 4 Lot t33 Space (9- S(tc_e (3) <1`,
Date: / / Time: ',A/L-0--0-4- L C tkr t
(Send email to P &R) 54464-eiri: -pt ``'`'kl c,
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
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 Mark Tokar, cc: Cherise Sarnoff /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 11/24/14
I
Status of Block: 4 Lot: B as of 08/11/2016
INTERMENTS:
SPACE BURIALTYPE DECL
FULL
FULL
URN
DECF
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECM BIRTH DEATH INTERRED
G 6/26/1888 05 / 01 / 1930 1/1/1901
4/23/1910 01 / 28 / 1971 2/1/1971
1/1/1982 08 / 24 / 1982 8/24/1982
Page 1 of 1
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Good Afternoon! Today is Thursday, August 11, 2016
Cemetery Tracking System - View Lot Profile
Block: 4 Lot: B
Profile Summary
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You are logged in as Judith.LaCosse
rClick 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on the
second grid to view the interment details of that individual.
FEAST SIDE OF MYRTLE AVENUE
Space
Owner Last
Owner First
Owner Middle
Max Interred
Total Assigned
Interred
DECL
1
WORLINE
NELLIE
G
1
0
0
View Assigned
A'S%4A.
G
1
1
1
View Assigned
View
WORLINE
NELLIE
G
2
2
2
View Assigned
4
WORLINE
NELLIE
G
1
0
0
View Assigned
5
BRANDON
R
K
1
0
0
View Assigned
6
BRANDON
R
K
1
0
0
View Assigned
7
BRANDON
R
K
1
0
0
View Assigned
8
BRANDON
R
K
1
0
0
View Assigned
Updated on Tuesday, January 06, 2009
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BLOCK
LOT
SPACE
DESIGNATOR
BURIALTYPE
IS_OWNER
DECL
DECF
DECM
DOD
DOB
View
4
B
3
A'S%4A.
01/28/1971
04/23/1
View
4
B
3
URN
NO
BAECHLER
KARLOS
08/24/1982
01/01/1
Updated on Tuesday, January 06, 2009
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LaCosse, Judith
From: Tokar, Mark
Sent: Friday, August 12, 2016 1:36 PM
To: LaCosse, Judith
Subject: RE: Cemetery Staking - Monument Placement
Orange flags. This is the only color I have but the other one you sent me is on the complete opposite side as this one.
Mark
From: LaCosse, Judith
Sent: Thursday, August 11, 2016 4:00 PM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen; Gilmore, Stephanie
Subject: Cemetery Staking - Monument Placement
Importance: High
We received a call from Kevin of Cycadia Monument Co. tel. #727 - 786 -1551, requesting a staking for double monument
placement in the following spaces:
spaces 2 and 3 of Block 4, Lot B
Space 2: Nellie Worline (full)
Space 3: Ruth Baechler (full) and Karlos Baechler (urn)
Please advise me with the color of the flags being used so that we could notify Kevin of Cycadia Monument Co.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
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