Gallups, Holly• _) Cemetery Call Work Sheet
Date: I° / 1
Funeral Home /
Contact Name:
Reason for call:
/ d01c(
Monument Company:
c11eVN
SaeVkin
53 Szths -t Pt. RL
e T • C (e u .J.cu, PL 33 759
Tel. #:
(7 -Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed
For:
(No fee for staking of monument)
Block Lot Space
Date: / / Time:
(Send email to P&R)
Verifying Burial space
Other reason:
t°'/e/i a
04, 11Ci
Or -4-1,1t ,F4a4 4 W 4.4.e_ u4eS {n
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial __
Owner of Plot:
Deceased Name:
Urn Space
AritkitT eorr aQ
s
Block `J Lot I Space 5
Date of Birth: 1° / X4. / 1°13,). Date of Death I° / `t / X°I9
Date of Burial: I° / i 4 / a° I `l Time: 1 3° a
$30.00 Staking Fee (Funeral Home) — received on: to /DSc /a-017
Copy of permit emailed to Mark Tokar;,cc: Matt Anderson/P&R on: I° / 3° / c) -(7I1
1)PAw.* - I' -e13
atck# 14068- 9 5
**************************************************************************************************
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
LaCosse, Judith
From: Tokar, Mark
Sent: Tuesday, October 8, 2019 8:39 AM
To: LaCosse, Judith; Anderson, Matthew; Brigman, Nathan
Cc: Vaughan, Karen
Subject: Re: Cemetery Staking Request for Full Burial
Orange flags.
Mark Tokar
Get Outlook for iOS
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Monday, October 7, 2019 12:23:03 PM
To: Tokar, Mark <Mark.Tokar@myClearwater.com>; Anderson, Matthew <matthew.anderson@myclearwater.com>;
Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>
Subject: Cemetery Staking Request for Full Burial
Mark,
We received a cemetery staking request this morning from Steve James of Sylvan Abbey F.H. for a full burial.
Please stake Block 5, Lot 17, Space 5 for a full burial.
Deceased Name: Holly Gallups - DOB: 10/24/1932 DOD: 10/04/2019
Note: Per funeral home there should already be a marker with the name of Holly Gallups in this space.
Other burials nearby in Block 5, Lot 17:
Space 3 = Ernest A. Marshall — full burial
Space 4 = Katie T. Marshall — full burial
Space 7 = Emma Brumby — full burial
Space 8 = Paul H. Ficht Jr. = urn burial & Elizabeth H. Ficht = full burial
The burial is scheduled for Thursday, October 10th at around 1:30 p.m.
Please let me know the color of the flags being used so that 1 could notify the funeral home.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727-562-4093
1
Vendor City of Clearwater official records Legislative 10/21/2019
Vendor No. 4424831 Amount *******$30.00 14068451
PAYMENT DETAILS
39217712S-985401003692-$ 30-Gallups, Holly C
1.71
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THE FACE OF THIS CHECK IS PRINTED BLUE -THE BACK CONTAINS A SIMULATED WATERMARK
Sylvan Abbey - Funeral Home
2853 SUNSET POINT RD
CLEARWATER FL, 33759
PAY Thirty and 00/100 Dollars
Amegy Bank, N.A.
Porter, TX
35-1125
1130
14068451
10/21/2019
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PAY TO THE City of Clearwater official records Legislative
ORDER OF 600 CLEVELAND ST
CLEARWATER FL 33755
Memo: 985401003692 Gallups Holly
****$30.00
Void After 180 Days
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OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
October 17, 2019
CITY OF CLEARWATER
TO: Steve James
Sylvan Abbey Funeral Home
2853 Sunset Point Rd
Clearwater, FL 33759
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
600 CLEVELAND STREET, SUITE 600, CLEARWATER, FL 33755
TELEPHONE (727) 562-4090 FAX (727) 562-4086
INVOICE
REMIT TO: City of Clearwater
Official Records &
Legislative Services
600 Cleveland St.
Suite 600
Clearwater, FL 33755
Make check payable to: City of Clearwater
Cemetery Staking Fee for Full Burial: Holly Gallups
TOTAL DUE S30.00
PLEASE REMIT AMOUNT OWED WITHIN 30 DAYS
Jay Polglaze, Councilmember
Dr. Bob Cundiff, Councilmember
George N. Cretekos, Mayor
David Allbritton, Councilmember
Hoyt Hamilton, Councilmember
"Equal Employment and Affirmative Action Employer"