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Cemetery Call Work Sheet
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Staking Request - Interment \TOC_4"1, e
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturd
Full Burial Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Plot:
Decease Name:
Block Lot ?0Space 4l 5�
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Date of Birth: / / Date of Death / / ' t C._'_ --t 'o4—CCS-1
Date of Burial: / / Time: am/pmNI (1)
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Monument (Marker) being placed - (No fee for staking of monument) 0.12-Q
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Block Lot Space Date: / / Time:
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Affidavit (Burial Rights)
Other reason:
Verifying Burial space
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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: / / From:
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson 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 4/21/2021
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Photos of Meares markers / Clearwater Municipal Cemetery
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Karen B. Vaughan
'.. Administrative Assistant
City of Clearwater
'.. City Clerk Department
Ph: 757-560-409t
Fax: 707-560-4086
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•
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Vaughan, Karen
From:
Sent:
To:
Subject:
Attachments:
Vaughan, Karen
Tuesday, May 9, 2023 4:36 PM
jmcollins46@gmail.com
Photos of Meares markers / Clearwater Municipal Cemetery
Photo; Photo; Photo; Photo
Hello!
Here are the photos you requested. You may need to scroll down. The pictures are large.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-562-4091
Fax: 727-562-4086