Faison, MattieCemetery CaII Work Sheet
Date: 3 // 1
Funeral Home / Monument Company: T.�````�`�►`"�
Contact Name:�v `` �' Tel. #: a�' 33c "'('41 Fax #:
Email:
Reason for call:
**
S i Loc CCsv
V --Staking Request — Interment
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
Full Burial Urn Burial V
(One full burial and one urn, or two urns per space)
Owner of Plot: M `.' L
Deceased Name: N\ kits e 5 41
Block 1'-t Lot 3 i7 Space 00
Date of Birth: dl'—/15 / 19 D -`t
Date of Burial: b 3 / dL /° f l
**
Date of Death 03 / / 1
Time: A477f'e am/pm
Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space Date: / / Time:
Verifying Burial space
Affidavit (Burial Rights)
Other reason:
Send 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: ' / ( / r-° '� From: T l� ` `'`�''"G" l `r`'```��``� 00—e—
Copy of permit emailed t67—
Nathan
o:Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Jarvis Sheeler in P&R on: ) / i I / ;',10ix I
**************************************************************************************************
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
Status of Block: 14 LOT: 315 as of 3/8/2021
INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PERMIT
SP TYPE
JOSEPHIN
00 FULL HARRIS E 5/16/1921 8/16/1999 8/21/1999 2502
WILLIE
00 URN TURNER JEAN 6/29/1937 4/5/2016 5/16/2016 1455
DISINTERMENTS
REINTERMENTS
7?1- LHong - -1 `i a-7
'/246 - frLi ft
c ie fc4 So
3/-t/au61-�
0 13
l �,� c-z;ru ,6,(7 '7 7 - 3 - L. (..
,View Lot_Status - Report Viewer
Enter
Block
Page 1 of 1
14
Enter
Lot
317
1
of > N 0 O
Find 1 Next
100%
Status of Block: 14 LOT: 317 as of 3/8/2021
INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PEI
SP TYPE
00 FULL LASTER MARIE 6/30/1919 2/15/2006 2/25/2006
DISINTERMENTS
REINTERMENTS
http://msb-db-prd/ReportServer/Pages/ReportViewer.aspx?%2FCemetery%2FView Lot St... 3/8/2021
LaCosse, Judith
From:
Sent:
To:
Cc:
Subject:
Thanks!
Vaughan, Karen
Thursday, March 25, 2021 2:30 PM
Sheeler, Jarvis
LaCosse, Judith
RE: Clearwater Cemetery Staking Request - Urn burial
Karen B. Vaughan
Administrative Assistant
City of Clearwater
Official Records & Legislative Services
Ph: 727-562-4091
Fax: 727-562-4086
From: Sheeler, Jarvis <Jarvis.Sheeler@MyClearwater.com>
Sent: Thursday, March 25, 2021 2:01 PM
To: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>
Subject: Re: Clearwater Cemetery Staking Request - Urn burial
Flags are orange.
From: Vaughan, Karen<Karen.Vaughan@MyClearwater.com>
Sent: Thursday, March 25, 2021 10:13 AM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Sheeler, Jarvis <Jarvis.Sheeler@MyClearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher<christopher.horsely@MyClearwater.com>
Subject: RE: Clearwater Cemetery Staking Request - Urn burial
Hello!
Just asking that you copy myself and Chris Horsely on the color of flags since Judy is out today.
Thanks!
1
Karen B. Vaughan
Administrative Assistant
City of Clearwater
Official Records & Legislative Services
Ph: 727-562-4091
Fax: 727-562-4086
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Wednesday, March 24, 2021 2:22 PM
To: Brigman, Nathan <Nathan.Brigman@MvClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Sheeler, Jarvis <Jarvis.Sheeler@MyClearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MvClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Clearwater Cemetery Staking Request - Urn burial
Good Afternoon,
We received a cemetery staking request this afternoon from Theodore Dallas of T.R. Dallas Funeral Home for an
urn burial.
Please stake Block 14, Lot 317, Space 00 for an urn burial.
Deceased Name: Mattie Faison - DOB: 02/15/1924 DOD: 03/04/2021
Note: Marie Laster, sister of Mattie Faison, is buried in this plot — (full burial) — (Mattie Faison would be buried at the
foot of this grave)
If possible, this space needs to be marked by this Friday, March 26th and there is no set time. The service is on
Saturday, March 27tH
(See attached burial status for Block 14, Lot 317)
Please let us know the color of the flags being used so that we could notify the funeral home.
If you have any questions please give me a call at 727-562-4093.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
2