Frye, MavisDate: " / 5 / a-O li
Funeral Home / Monument Company:
Contact Name:
Rober"f r6r,'r
Cemetery Call Work Sheet
Tel. #: Y-6 -3055
Fax #: 11-113- 0 d-S3
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) yQ.& i f L
Verifying Burial space
Other reason:
******************************************************************* * * * * * * * * * * * * * * * ** * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: M,, , Fry e
Deceased Name: Ku-U'5 Fry e.-
Block Lot 331 Space 00 6or.v. urtn 5r.- 3y-o)36 t, a ?oJ
Date of Birth: `i / 1 / i `t a-9 Date of Death �- / `t / .20/g/
oq °v
Date of Burial: / / a° (e Time: a s•*0
$30.00 Staking Fee (Funeral Home) - received on: 3 / / aofg
1)2A. ,;,,..f - 44- I'+e$
Copy of permit emailed to Mark Tokar, cc: Matt Anderson /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 11/15/17
Re: Cemetery Staking Request - Full Burial
LaCosse, Judith
Tue 2/6/2018 9:32 AM
To:Tokar, Mark <Mark.Tokar @myClearwater.com >;
cc:Anderson, Matthew <matthew.anderson @myclearwater.com >; Vaughan, Karen < Karen .Vaughan @MyClearwater.com >;
Thank you. I will notify the funeral home.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
From: Tokar, Mark
Sent: Tuesday, February 6, 2018 8:19 AM
To: LaCosse, Judith
Cc: Anderson, Matthew; Vaughan, Karen
Subject: Re: Cemetery Staking Request - Full Burial
Yellow flags.
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From: LaCosse, Judith
Sent: Monday, February 5, 2018 3:31:54 PM
To: Tokar, Mark
Cc: Anderson, Matthew; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Mark,
We received a cemetery staking request this afternoon from Robert Grant of Rhodes Funeral Home for a full
burial.
Please stake Block 14, Lot 339, Space 00 (cony. urn spaces #340,269,270) for full burial of Mavis Frye by next
Monday, February 12th.
Cemetery Staking Request - Full Burial
LaCosse, Judith
Mon 2/5/2018 3:31 PM
To:Tokar, Mark <Mark.Tokar @myClearwater.com >;
Cc:Anderson, Matthew < matthew .anderson @myclearwater.com >; Vaughan, Karen < Karen .Vaughan @MyClearwater.com >;
Mark,
We received a cemetery staking request this afternoon from Robert Grant of Rhodes Funeral Home for a full
burial.
Please stake Block 14, Lot 339, Space 00 (cony. urn spaces #340,269,270) for full burial of Mavis Frye by next
Monday, February 12th.
DOD: 2/4/2018
Other burials nearby:
Block 14, Lot 335 (cony. urn spaces #336, 273, 274) = Sabrina Frye - (full burial)
Block 14, Lot 337 (cony. urn spaces #338, 271, 272) = Dustin Frye - (full burial)
If you have any questions please give me a call at 727 - 562 -4093.
Please let me know the color of the flags being used so that I could notify the funeral home.
Thanks.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 - 562 -4093
State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
DATE PRINTED: February 6, 2018 TRACKING NUMBER: 2018023387
1. DECEDENT INFORMATION
Name of Deceased
Date of Death
MAVIS MARY FRYE
February 4, 2018
Place of Death - County City, Town or Location
PINELLAS PINELLAS PARK
Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No. /Reg. No. Phone Number
RHODES FUNERAL DIRECTORS INC F041686 F041686
800 EAST DRUID RD (727) 446 -3055
CLEARWATER, FLORIDA, 33756
Funeral Director /Direct Disposer
Fla. Lic. NoJReg. No.
ROBERT S. GRANT JR
F043193
Medical Verification Statement
Cynthia at the certifying physician's office, was contacted on 02/0512018 by the funeral director listed above; he/she indicated that
MARY CATHERINE WAECHTER, certifying physician, will complete and sign the medical certification of cause of death within 72
hours.
Name of facility, or street address if not a facility
SUNCOAST HOSPICE CARE CENTER MID PINELLAS
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
State Registrar
Permit Number: 2018- F041686 -5004
Date Issued: February 6, 2018
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District
Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: CLEARWATER CITY CEMETERY
Method of Disposition: BURIAL
Date of Disposition:
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V- 1.011, Florida Administrative Code
PAY TO THE
ORDER OF
WORK & SON INC
2600 GANDY BLVD
ST. PETERSBURG, FL 33702
ti OH:9A
CLO
MEMO TQ
WELLS FARGO BANK, N.A.
WELLSFARGO.COM
54245
63 -751 /631
DOLLARS
LL
't
THANK YOU FOR YOUR SERVICE
0000 5 4 24 511' 1:063 L075 L31:20006 258 L6 2370
•,,V�soiliiiii` --
',,.....'� "!= CITY OF CLEARWATER
j ,; bi POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758 -4748
*1, CITY HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
-.. IkeustittON1 � TELEPHONE (727) 562-4090 FAX (727) 562-4086
OFFICIAL RECORDS AND
LEGISLATTVE SERVICES
March 5, 2018
Work & Son Inc.
2600 Gandy Blvd
St. Petersburg, FL 33702
To whom it may concern:
We received your Cemetery Staking Fee (check No. 54245) in the amount of $30.00 for the
interment of Mavis Frye.
The staking for interment was requested by Rhodes Funeral Home on February 5, 2018.
Enclosed you will find receipt No. 449012 for your files.
Thank you,
`2,4
dith LaCosse
Staff Assistant
Enclosure
C
"Equal Employment and Affirmative Action Employer"
CLEARWATER CARETAKER
CLEARWATER, FL
BURIAL PERMIT
PERMIT # 1468
March 05, 2018
Permission is hereby granted for burial of:
Name of Deceased: MAVIS FRYE Burial Type: FULL
Owner of Property: MAVIS FRYE & CONVERTED #340,269,270
Block : 14 Lot: 339 Space: 00 Date of Birth: April 18, 1929
Date of Death: February 4, 2018
Funeral Home Director: ROBERT GRANT
Time: 12 :00 Staking Fee: 30.00
Date of Burial: February 9, 2018
Date Paid: March 2, 2018
Clearwater Cemetery
B