McKisson, Earl WDate: / 6 /
Funeral Home / Monument Company:
Contact Name:
Email:
Cemetery Call Work Sheet
Me1,,,o,,.ia 2 ' k a- Cek,.etcf
1.371
Tel. #: 52'1- 11 it.
Xawl4• VIKGI C? -
Reason for call:
**
Fax #:
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: Zw- L7. Kt. kissbh.
f}5 .Rp
Block S Lot a -it Space t Date: / / Time:
Affidavit (Burial Rights) Verifying Burial space
Other reason: Fc.:tivot. tow„,:..cit (GA.e ...e....t( P re" waa:c.K 5) 46Z lN.ri d.j kc ki: 5 sem. .
N 2 w M.w. ke.A. �ZeLz j 6e ce c( 1.& L .h v 14j Y, 4 m_e s , lJ . � 1�-t-LS �j b h
Q I Ch- is -(.3
/- /tc IS 5 r ba,.. .
**************************************************************************************************
vZSend email to P&R to stake the space
1/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
Get Outlook for iOS. Northeast side,orange flags.
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Tuesday, December 8, 2020 9:42 AM
To: Brigman, Nathan
Cc: Anderson, Matthew; Sheeler, Jarvis; Chaplinsky, Timothy; Vaughan, Karen; Horsely, Christopher
Subject: Cemetery Staking Request - Placement of a marker
Good Morning,
We received a cemetery staking request from Laura of Memorial Park & Cemetery for placement of a marker.
Please stake Block 5, Lot 24, Space 4
Deceased Name: Earl W. McKisson — (full burial)
(See attached printout of burial status for Block 5, Lot 24)
Note: There will be an urn burial at the end of December for Christine McKisson, wife of Earl W. McKisson in space 4.
Request is for the staking to be done in the next couple of days. Marker is being replaced with another one showing
both names of husband & wife.
Please let me know the color of the flags being used so that I could notify Memorial Park & Cemetery.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
2