Patterson, George L & Patterson, Betty AnnDate: C( / 4-41 l 3-"s°
so
Funeral Home / Monument Company:
Cemetery Call Work Sheet
ReK., 5s" Feer
Contact Name: Ro pw`l` v `''j S Tel. #: c65° -)-c13 -(8? F? -Fax #:
Email: )0natke.:,v, Lwvw5 e.,hSrnc.LOh1,
Reason for call:
— -11
e 3 S, Ljtli QC kL a .
CleGrwc1. eA 337(' Li
e14-7— 7- to Jo
** 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: 6cor .-. e`,÷tei, 5 0 vt .
Deceased Name: T htr Avon_ s
Block 5 Lot ri Space `{ /2,54;o 19
`-t 1 G a 5 rs`uty
Date of Birth: f o 1) 7/ I3 B{% Date of Death s/ i 't / ao (g
Date of Burial: 1 0 / OS / ° a u Time: I °:0' ar /pm
tJyQcb
**
Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space Date: / / Time:
Affidavit (Burial Rights) Verifying Burial space
Other reason:
cad -4-7
1A6A. k -
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Send email to P&R to stake the space (Li 9 4
Notify funeral home/monument company with color of the flags used to mark the space
Staking fee received on: f / 5 / ° fi`
1 From: \eKori 13c<4.14 tAa -How et Cew�efer
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Jarvis Sheeler in P&R on: If / / a°A (
�c.4fr t4S'3
**************************************************************************************************
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: Wednesday, September 30, 2020 8:48 AM
To: Sheeler, Jarvis; Brigman, Nathan
Cc: Anderson, Matthew; Chaplinsky, Timothy; Vaughan, Karen; Horsely, Christopher
Subject: RE: Cemetery Staking Request for a double urn burial
Tracking: Recipient Read
Sheeler, Jarvis
Brigman, Nathan
Anderson, Matthew
Chaplinsky, Timothy
Vaughan, Karen Read: 9/30/2020 9:31 AM
Horsely, Christopher Read: 9/30/2020 8:49 AM
Thank you. I will notify the funeral home.
We appreciate that you take the time to take a picture of the staking which we could forward to the funeral home.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727-562-4093
From: Sheeler, Jarvis <Jarvis.Sheeler@MyClearwater.com>
Sent: Wednesday, September 30, 2020 8:07 AM
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 a double urn burial
1
Plot has been staked with blue flagging and location is north east side of cemetery.
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From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Tuesday, September 29, 2020 4:10 PM
To: Brigman, Nathan
Cc: Anderson, Matthew; Sheeler, Jarvis; Chaplinsky, Timothy; Vaughan, Karen; Horsely, Christopher
Subject: Cemetery Staking Request for a double urn burial
Good Afternoon,
We received a cemetery staking request this afternoon from Rob Barrows of Memorial Park/Moss Feaster for a double
urn burial for:
Betty Ann Patterson & George L. Patterson Sr.
Please stake Block 5, Lot 7, Space 8
(See attached burial status for block 5, Lot 7)
I'm sending this email a little early... The date of the burial is scheduled for next week, October 8th at around 10:00 a.m.
— (per funeral home marker is already in place with their names)
Please let us know the color of the flags being used to mark the space so that we could notify the funeral home.
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
OFFICIAI. RFC0RI1,, A\Ti
LEGISLATIVE SERVICE!.:
March 2, 2021
Memorial Park
Moss Feaster
693 South Belcher Road
Clearwater, FL 33764
Attn: Rob Barrows
Mr. Barrows:
CITY OF CLEARWATER
1S -i -
1r OFFICE BOX 48, CLEARviA ER. Rolm):: 337758-4 7i8
GA -AFL -Am) i,R.ii r;(, ,.J TP. 600, \.i.rg\Ff !:,CFL 33755
7 i.l ! ,•,.\I: (72 7) 562-4090 FAN (72') 562-40$
On September 29, 2020 you requested a staking be completed for the urn burial of Betty Ann
Patterson in the Clearwater Municipal Cemetery, Block 5, Lot 7, Space 8 on October 8, 2020.
We notified you that the space was marked with blue flags by our Parks and Recreation Dept.,
and that there is a $30.00 staking fee.
We have been trying to reach you by email and telephone regarding the staking fee of $30.00 due
to the City of Clearwater.
Please submit a check made payable to the City of Clearwater for the staking fee of $30.00. This
payment is required in order for us to print out the burial permit and close our file.
Please let me know if you have any questions.
Thank you,
'''ctlik- Jcteer2,,L._
J dith LaCosse
taff Assistant
Mark Bunker, Councilmember
Kathleen Beckman, Councilmember
ilcui!trr
Frank V. Hibbard; Mayor
David Allbritton, Councilmember
Hoyt Hamilton, Councilmember
.nt <-td i i tip c .i:ti:�
SENDER: COMPLETE THIS SECTION
• Complete Items 1, 2, and 3.
• Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
COMPLETE THIS SECTION ON DELIVERY
A. Signature
x / . C71
A.Agent
❑ Addressee
B. Received by (Printed Name)
e fr)
C. Date 0 Delivery
Memorial Park
Moss Feaster
693 South Belcher Road
Clearwater, FL 33764
Attn: Rob Barrows
1111
11111
111111 I 111111
11
11
1111
9590 9402 5703 9346 3146 45
D. Is delivery address different from
If YES, enter delivery address b
item 1? • Yes
elow: .0 No
2. Article Numher (Transfer from service label)
7019 1640 0001 5951 0432
PS Form 3811, July 2015 PSN 7530-02-000-9053
3. Service Type
0 Adult Signature
o 4dult Signature Restricted Delivery
BCertifled Mail®
0 Certified Mall Restricted Delivery
0 Collect on Delivery
0 Collect on Delivery Restricted Delivery
i Mail
5MM�1 Restricted Delivery
0 Priority Mail Express®
o Registered Mailrm
0 Registered Mail Restricted
Dery
eturn Receipt for
Merchandise
0 Signature Confirmation)"^
0 Signature Confirmation
Restricted Delivery
Domestic Return Receipt
U.S. Postal Service
CERTIFIED MAIL® RECEIPT
Domestic Mail Only
For delivery information, visit our website at www.usps.com®.
Certified Mail Fee
Extra Services & Fees (check box, add fee as appropriate)
0 Return Receipt (hardcopy) $
0 Return Receipt (electronic) $
0 . ertified Mail Restricted Delivery $ ___
0 Adult Signature Required $ "
0 Adult Signature Restricted Delivery $
Postage
Total Postage and Fees
D-' Sen
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O S(re t and Ap
r` (oCo
City, Sta
Cwtar c.,Q PC.P'F k.'ss
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Postmark
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PS Form 3800, April 2015 PSN 7530-02-000-9047
3 74 i!
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See Reverse for Instructions
Kasha Bopp
From:
Sent:
To:
Cc:
Subject:
LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Wednesday, March 31, 2021 11:05 AM
Kasha Bopp
Vaughan, Karen; Horsely, Christopher; Sprague, Nicole
[External] Clearwater Municipal Cemetery Staking Fee
LEG SLATIVc
Good Morning Kasha,
Thank you for speaking with me this morning. Back in September of 2020, we received a cemetery staking request from
Mr. Rob Barrows of Memorial Park Moss Feaster Funeral Home. This request was for the urn burial of Betty Ann
Patterson in Block 5, Lot 7, Space 8 in the Clearwater Municipal Cemetery. The date of burial was scheduled for October
8, 2020.
I had notified Mr. Barrows that the staking was completed by our Parks and Recreation Dept. and told him the color of
the flags used. I had also mentioned to Mr. Barrows that there was a $30.00 staking fee due to the City of Clearwater
after the burial was completed.
I have tried to reach Mr. Barrows by phone and email (several times) since last year and was not able to get in touch
with him.
Please provide us with the staking fee payment of $30.00 due to the City as we need to process the burial permit for
our files.
Please make check payable to: City of Clearwater
Mail to:
City of Clearwater
Official Records Dept.
600 Cleveland St., 6th Floor
Clearwater, FL 33755
I appreciate your assistance regarding this matter.
Thank You.
Judith LaCosse
Staff Assistant
ORLS Dept.
727-562-4093
1
MEMORIAL PARK FUNERAL
HOME AND CEMETERY
5750 49TH STREET NORTH
ST. PETERSBURG, FL 33709
(727) 527-1196
PAY TO THE
ORDER OF City of Clearwater
---Thirty And 0/100 ---
MEMO Staking fee for Betty Patterson
BANK OF AMERICA
64-1278/611
1863
3/31/2021
$30.00
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
TWO SIGNATURE EDED IF • $5,000.00
6:7?
0
A
S
a`
8
DOLLARS 4•
burial
II■LLO100L86311' 1:06LLL27881: 0033598L005L11■
AUTHORIZED SIGNA
8