Houston, Acquilina CCemetery Call Work Sheet
Date: / / --r'
Funeral Home / Monument Company:�-y C CC R v1u "L € �� C
Contact Name: (A-��y Cw��� Tel. #: - 7 " l5 6 /Fax #:
Email: /
Reason for call:
**
Staking Request — Interment
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
Full Burial Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Plot:
Deceased Name:
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / / Time: am/pm
**
Monument (Marker) being placed - (No fee for staking of monument)
For: (<:. C 440 (4, St° el 2)wv. \ wPv.
Block 5 Lot S Space 3
Affidavit (Burial Rights)
Other reason:
0 rctv,e, zz k (Q
Date: � / 3 / / 9-°A0 Time: r fr t fr
Verifying Burial space
**************************************************************************************************
`/ Send email to P&R to stake the space Dr4-1^-
V Notify funeral home/monument company with color of the flags used to mark the space
Staking fee received on: / / From:
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Jarvis Sheeler in 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
ORLS/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 9/4/2020
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, September 17, 2020 1:56 PM
To: Sheeler, Jarvis; Brigman, Nathan
Cc: Anderson, Matthew; Chaplinsky, Timothy; Vaughan, Karen; Horsely, Christopher
Subject: RE: Cemetery Staking Request for Placement of a Marker
Thank you. I will notify the monument company.
From: Sheeler, Jarvis <Jarvis.Sheeler@MyClearwater.com>
Sent: Thursday, September 17, 2020 1:38 PM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Cc: Anderson, Matthew<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Re: Cemetery Staking Request for Placement of a Marker
N
Get Outlook for i0.
Staking is completed with orange flagging. Green flags a adjacent vaults.
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Thursday, September 17, 2020 10:52 AM
To: Brigman, Nathan
Cc: Anderson, Matthew; Sheeler, Jarvis; Chaplinsky, Timothy; Vaughan, Karen; Horsely, Christopher
Subject: Cemetery Staking Request for Placement of a Marker
Good Morning,
We received a cemetery staking request this morning from Nancy Cantrell of Cvcadia Monument Co. for placement of a
marker for deceased person, Acquilina C. Houston, who was a full burial.
Please stake Block 15, Lot 58, Space 3
Staking is needed by Monday, September 21St in the morning.
(Burial status of Block 15, Lot 58 document attached)
Please let us know the color of the flags being used so that we could notify the monument company as soon as
possible.
If you have any questions please give me a call at 727-562-4093.
Thanks !!
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727-562-4093
3