Stockman, JohnCemetery Call Work Sheet
Date: l / f / [1
Funeral Home / Mo ument Company: V4x%xIS [U fl&r(L,(
Contact Name: `m Mt) Tel. #:(' W i)5 Q),Fax #: 7d1— 53t- t, 753
Reason for call: / 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:
******************************************************************* * * * * * ** * * ** * * * * * * * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: ' SfoG1
Deceased Name: n &iLrflo()
Block 11° Lot " Space 3
Date of Birth: (° / I / 115`f
Date of Death
L / t(74./ I
Date of Burial: / / [7 Time: am /pm
-7 / ao(7
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /P &R on: / •) • / / 7
$30.00 Staking Fee (Funeral Home) — received on:
Stoket,
&cti F'1. Stock h,,.A
5pAct- Aid-407
Pp/tic-Inn
FJ
4)14-A(4 !`'t 43-
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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: Tokar, Mark
Sent: Monday, July 17, 2017 11:49 AM
To: LaCosse, Judith
Cc: DeWitt, Brian; Bruce, Larry; Anderson, Matthew; Vaughan, Karen; Gilmore, Stephanie
Subject: Re: Cemetery Staking - Urn Burial
Blue flags.
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On Mon, Jul 17, 2017 at 11:10 AM -0400, "LaCosse, Judith" < Judith .LaCosse@myClearwater.com> wrote:
We received a staking request from Jimmy from Veterans Funeral Home for a staking request for an Urn burial for:
John Stockman in Block 16, Lot 28, Space 3 DOB: 10/1/1954 DOD: 7/12/2017
Please note: This space has a full burial currently (Beth Stockman). The foot of the space will need to be marked for
an Urn Burial
Other burials nearby in this plot:
Space 1 = Anthony Polachnick - (full)
Space 3 = Beth M. Stockman - (full)
Staking is needed by Thursday, July 20th at 10 a.m.
Please advise me of the color of the flags being used so that we could notify the funeral home.
Thank You !!
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727- 562 -4093
1
July 18, 2017
Attn: Jimmy
Funeral Home: Veterans Funeral Home
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: John Stockman
Gravesite: Block 16, Lot 28, Space 3
Urn Space
Gravesite flagged with Blue flags
Date of burial: 7/20/17 — Time: 10:00 a.m.
Nearby Burials:
Space 1 = Anthony Polachnick (full burial)
Space 3 = Beth M. Stockman (full 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
✓ DOC MENT LUD 8 VISIBLE FIBERS CH MI AL REACTIVE PRO
VETERANS FUNERAL CARE, INC.
15381 ROOSEVELT BLVD.
CLEARWATER, FL 33760
(727) 524 -9202 OR 1- 800 - 467 -7850
PAY TO THE City of Clearwater
ORDER OF ty
Po
8 AND FEATUR - FO1 HOL • ' RAM.
63- 9138/2631
BB&T 62523
1- 800 -BANK BBT BBT.com
7/20/2017
$ * *30.00
Thirty and 00/ 100****************************«************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
MEMO
City of Clearwater
112 South Osceola Ave
Attn:Official Records
Clearwater, FL 33756
®Shield
"'� /.�� PAPER CONTAINS TONER ADHESION ' - • ' - 1E8
VOID AFTER 120 DAYS
0000006 25 2311' I: 263 L9 L 3871:0000 24 2 LO 2037"
DOLLARS
0/11-1-4
VETERANS FUNERAL CARE, INC.
City of Clearwater 7/20/2017
Date Type Reference Original Amt. Balance Due Discount Payment
7/20/2017 Bill John Stockman 30.00 30.00 30.00
Check Amount 30.00
62523
BB &T - Checking - 20 Staking fee
30.00
CLEARWATER CARETAKER
CLEARWATER, FL
BURIAL PERMIT
PERMIT # 1465
July 25, 2017
Permission is hereby granted for burial of:
Name of Deceased: JOHN STOCKMAN Burial Type: URN
Owner of Property: JOHN STOCKMAN &
Block : 16 Lot: 28 Space: 3 Date of Birth: October 1, 1954
Date of Death: July 12, 2017 Date of Burial: July 20, 2017
Funeral Home Director: JIMMY/VETERANS FUNERAL HOME
Time: 10 :00 Staking Fee: 30.00 Date Paid: July 24, 2017
Clearwater Cemetery
u
By JGc a'Y��
July 25, 2017
CITY OF CLF,ARWAThR
Veterans Funeral Care, Inc.
15381 Roosevelt Blvd.
Clearwater, FL 33760
To Whom It May Concern:
Ori ICI U. Rr:a)R1)S & Li ci,i vriv II Si i vua:s
Crn Fl , 112 Sowni Os : i.v, AN I;y� i:, Ci.i:u■vv vriai. Fi.nzn)v 33 756
(727) 562 - 4091) F vy (727) 562 -4086
We received your Cemetery Staking Fee check #62523 in the amount of $30.00 for the urn
burial of John Stockman in space 3 of Block 16, Lot 28.
Attached you will find receipt No. 448934.
Thank you,
dith LaCosse
Staff Assistant