Rubino, HolllyDate: (0 / Co/
Funeral -Lome / mpany:
Contact Name: L1.''A'°;r10
Email: InruLll'Jir10 e ao CQrr)
Cemetery Call Work Sheet
Tel. #:
Reason for call: r'C.1VG rf_e •
x sae mca.vv-eft IA '4`-e
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:)) ,,Q�
Deceased Name: 0 la.�' v\
w�ci, (
Block Lot' Space
Date of Birth: / l? / t $-S $ Date of Death 9 / 3 / ccs O
Date of Burial: CI / 11/ Lgci O Time: am/pm
**
Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space
Affidavit (Burial Rights)
Other reason:
Date: / / Time:
Verifying Burial space
Send email to P&R to ea. Wg.(--e0
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, Erick Peterson in P&R on: 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 4/21/2021
• • • •
Vaughan, Karen
From: Vaughan, Karen
Sent: Friday, October 6, 2023 4:42 PM
To: Brigman, Nathan
Cc: Peterson, Erick; Chaplinsky, Timothy
Subject: Citizen Request
Hello!
I received a call today from Holly Rubino in Arizona. Her aunt is buried in our cemetery in Block A, Lot 28, Space 2. From my records, looks like Block A is County
owned.
Holly would like to know if there is a marker on her aunt's space. I told her I would request p&R take a picture. She said it is not urgent but she would really
appreciate it.
Please advise if it would be possible if anyone is out there working they could snap a picture and email to me.
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INTERMENTS
BURIAL DECL
SP TYPE
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Status of Block: A LOT: 28 as of 10/6/2023
DECF DECM BIRTH
MARGARE
ALDERTON T
POLAK IMA
RAYBURN JOSEPH
PRINCLER MILDRED
11/13/1903
3/17/1898
5/13/1897
5/21/1906
2
DEATH INTERRED PERMIT
8/20/1990
9/3/1990
8/27/1990
8/20/1990
9/20/1990
9/17/1990
9/12/1990
8/25/1990
1900
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Vaughan, Karen
From: Vaughan, Karen
Sent: Tuesday, October 17, 2023 10:51 AM
To: hrubino@aol.com
Subject: Clearwater Municipal Cemetery / Block A Lot 28 Space 2/ Polak
Attachments: IMG_0109 jpeg
Holly,
Please see attached picture of your aunt's grave site.
Per Parks & Rec staff: No one in the block has headstones, the orange flag indicates the block marker, yellow probe is on top of space two vault,
If you decide to have a marker placed, you will need to contact a monument company in this area (Clearwater, St. Pete). Once they are ready to come out and
place it, they can contact me and I will have Parks & Rec flag it for them. P&R needs a couple of days notice to place flags.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
Official Records & Legislative Services
Ph: 727-562-4091
Fax: 727-562-4086
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