Nickelson, Hazel MDate: "1' / /
Cemetery Call Work Sheet
Funeral Home / Monument Company: Rr
Contact Name:
Email:
Reason for call:
**
Tel. #: 5i':?.- a-", 0
Fax #:
V Staking Request — Interment
$30.00 staking fee (Weekdays) -$50.00 staking fee (Saturday, Sunday & Legal Holiday)
Full Burial t'/ Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Piot: icy z� N < S vt
Deceased Name:
Block 1S- Lot 1 Space;1.
Date of Birth: / )1 /
(\.1,•
< k j S o ,'
Date of Death '- / 1 / r�� .}-
Date of Burial: `f /;}-4 / Time: `am/pm
** Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space Date: / / Time:
Affidavit (Burial Rights) Verifying Burial space
Other reason:
**************************************************************************************************
`"Send email to P&R to stake the space
Notify funeral home/monument company with color of the flags used to mark the space
Staking fee received on: 5 / 3 /01-09-1 From: M055 55 Fe 5-C2A. r
,te.
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in P&R on: =' /
t - - 1` -9
**************************************************************************************************
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 4/21/2021
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, April 22, 2021 8:35 AM
To: Peterson, Erick; Brigman, Nathan; Anderson, Matthew; Chaplinsky, Timothy
Cc: Vaughan, Karen; Horsely, Christopher
Subject: RE: Cemetery Staking Request - Full Burial
I just saw this other email and I saw the picture you took.
My question has been answered regarding the marker.
Thank You.
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: Peterson, Erick <Erick.Peterson@MyClearwater.com>
Sent: Thursday, April 22, 2021 8:12 AM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; LaCosse, Judith <Judith.LaCosse@myClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Full Burial
Hi Judith there is no marker for Wanda Souter earn I found David Souter marker
From: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Sent: Thursday, April 22, 2021 7:28:16 AM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com>; Peterson, Erick
<Erick.Peterson@ MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Full Burial
Purple flags south side of graveyard back of shed near the fence grave marker
Thank You,
Nathan Brigman
City of Clearwater Parks and Recreation Department
Landscape Manager
B.S. Ornamental Horticulture
1
ISA Certified Arborist
Office - (727) 562-4270 ext 7808
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Wednesday, April 21, 2021 2:54:57 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com>; Peterson, Erick
<Erick.Peterson@MvClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Cemetery Staking Request - Full Burial
Good Afternoon,
We received a cemetery staking request this afternoon from Paul of Moss Feaster Funeral Home for an Full burial.
Please stake Block 15, Lot 11, Space 2 for a full burial for Hazel M. Nickelson.
DOB: 08/11/1935 DOD: 04/21/2021
(See attached burial status for Block 15, Lot 11) — Harvey A. Nickelson, Jr., husband, is buried in space 1(full burial).
If possible, this space needs to be marked by this Friday, April 23rd. The service is scheduled for Saturday, April 24th in
the morning.
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
Status of Block: 15 LOT: 11 as of 5/4/2021
INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PERMIT
SP TYPE
NICKELSON,
1 FULL JR. HARVEY A 7/25/1928 7/3/1979 7/5/1979 1321
3 FULL ROBERSON OREN S 1/1/1914 1/11/1978 1/11/1978 1241
4 FULL ROBERSON ERMINE 6/25/1916 5/4/2006 5/9/2006 2568
DISINTERMENTS
REINTERMENTS
CLEARWATER CARETAKER
CLEARWATER, FL
Permission is hereby granted for burial of:
Name of Deceased: HAZEL M NICKELSON
Owner of Property: HAZEL M NICKELSON
Block: 15 Lot: 11
BURIAL PERMIT 5/4/2021
PERMIT # 1492
May 4, 2021
Burial Type: FULL
Space: 2 Date of Birth: August 11, 1935
Date of Death: April 21, 2021 Date of Burial: April 24, 2021
Funeral Home Director: PAUL/MOSS FEASTER
Time:
Staking Fee: $30.00 Fee Paid: 5/3/2021 12:00:00 AM
Clearwater Cemetery
By +tt L C�. .. (-tai } _
MOSS FEASTER FUNERAL HOME
AND CREMATION SERVICES
693 SOUTH BELCHER ROAD
CLEAR WATER, FL 33764
(727) 562-2070
PAY TO THE
ORDER OF
MEMO
City of Clearwater
---Thirty And 0/100 ---
BANK OF AMERICA
64-1278/611
L L J J
6
2
4/24/2021
30. 00 DOLLARS
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
TWO SIGNATURES NEEDED IF OVER $5,000.00
0467300 2239e 1:06 L L L 27881: 0033598100510
AUTHORIZED SIGNATURE
LTJ
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2239
Comments Amount
Nickelson Staking Fee 30.00
30.00
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2239
L# Comments
Amount
1 Nickelson Staking Fee 30.00
Total forNickelson Staking Fee 30.00
•)DELUXE COW 1+800-328-0304 www.deluxeforms.com
881064/03-16
�Vi�e�,,, 2565058700
031E CHI40K03 01/13,/202011:54 -33-
LaCosse, Judith
From: LaCosse, Judith
Sent: Wednesday, June 16, 2021 8:26 AM
To: Peterson, Erick
Cc: Horsely, Christopher; Vaughan, Karen
Subject: RE: Cemetery Staking Request - Placement of a marker
Thank you. I will notify Laura Vinci from Memorial Park.
Have a great day !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: Peterson, Erick <Erick.Peterson@MyClearwater.com>
Sent: Wednesday, June 16, 2021 7:51 AM
To: LaCosse, Judith <Judith.LaCosse@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>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Placement of a marker
Grave mark with hot pink flags thanks
Get Outlook for iOS
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Tuesday, June 15, 2021 3:53:46 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: RE: Cemetery Staking Request - Placement of a marker
Thank You !!
From: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Sent: Tuesday, June 15, 2021 3:47 PM
To: LaCosse, Judith <Judith.LaCosse@mvClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
1
<Karen.Vaughan@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Placement of a marker
Judith,
We will have this staking done first thing Wednesday morning 6/16/21. My apologies. We have been under emergency
response for Red Tide.
Thank You,
Nathan Brigman
City of Clearwater Parks and Recreation Department
Landscape Manager
B.S. Ornamental Horticulture
ISA Certified Arborist
Office - (727) 562-4270 ext 7808
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Tuesday, June 15, 2021 3:29:07 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@ MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: FW: Cemetery Staking Request - Placement of a marker
Good Afternoon,
We have not yet received your response regarding this staking request.
Please advise,
Thank You.
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: LaCosse, Judith
Sent: Thursday, June 10, 2021 1:45 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@myclearwater.com>; Peterson, Erick
<Erick.Peterson@myclearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: FW: Cemetery Staking Request - Placement of a marker
Importance: High
Good Afternoon,
2
I just received an email from Laura Vinci of Memorial Park. She's requesting that Space 1 (Harvey Nickelson -full burial)
in Block 15, Lot 11 also be staked with space 2 (Hazel Nickelson -full burial) for marker placement.
Thanks !!
Judith LaCosse
Staff Assistant
ORLS Dept.
727-562-4093
From: LaCosse, Judith
Sent: Thursday, June 10, 2021 9:51 AM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@myclearwater.com>; Peterson, Erick
<Erick.Peterson@myclearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Cemetery Staking Request - Placement of a marker
Importance: High
Good Morning,
We received a cemetery staking request from Laura Vinci from Memorial Park for placement of a marker as soon as
possible.
Please stake Block 15, Lot 11, Space 2
Deceased Name: Hazel M. Nickelson — (full burial)
(See attached printout of burial status for Block 15, Lot 11)
Please let me know the color of the flags being used so that I could notify Memorial Park.
Thank You !!
Judith LaCosse
Staff Assistant
ORLS Dept.
727-562-4093
3
LaCosse, Judith
From: Laura Vinci<Laura.Vinci@memorialparksp.com>
Sent: Wednesday, June 9, 2021 11:54 AM
To: LaCosse, Judith
Subject: Needing Grave Spaces Flagged - Hazel Nickelson for Clearwater Cemetery
Attachments: Nickelson.pdf
CAUTION: This email originated from outside of the City of Clearwater. Do not click links or open attachments unless you
recognize the sender and know the content is safe.
Hello,
We have a 24 x 12 going on a companion base 56 x16 , and needing to place Harvey Nickelson onto this new companion
base. The marker we have is a Hazel Nickelson.
Blk 15 Lot 11 Spaces #2
I have attached what her marker looks like, the family service advisor is Susan Laramee.
Respectfully,
oZ i,ia Vinci
Clerical/Administration Specialist
5750 49th St. N
St. Petersburg, FL. 33709
(727) 527-1196 ext.213
F(727) 528-9404
MEM PARK
CREMATION
1
IETLRY - FUNERALS
•
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Font Size BL L1 L2
GT 1 in. 3.9 8.2
GT 3/4 in. 8.8 3.4 3.5
111
3965263
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11
11
Emblems
00124375 (105040) - EMB-4X6,CROSS,& DOVE
Note
0105522831
Account: 0010053026 Date: 05/21/2021
Name: NICKELSON SKU: 71014363 (001082)
Description:
Vase: Color: GOVERNMENT Size: 24x12
Scrolls
HAZEL M NICKELSON
AUG 11 1935 APR 21 2021
\(11 (5c 1 •