Wallace, WilliamCemetery Call Work Sheet
Caller Name / Funeral Home / Monument Company:
Nc P —4
Contact # or Email:
�J
77?
Reason for call: (Circle A, B, or C below and fill in info
** STAKING REQUEST FOR INTERMENT **
Full Burial Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Plot:
Deceased Name:
Verify Ownership/Burial Rights in cemetery program before confirming:
Block 4-- Lot \ Space 13 e-, 14 ? �/ 1 g/
Date of Birth: '/ 13 (to Date of Death , . 1
Date of Burial: P5/
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
B:
CiPyv•Ow,
** STAKING REQUEST for Monument / Marker to be placed **
Deceased Name:
Block Lot Space
Verify Ownership/Burial Rights in cemetery program before confirming. No staking fee for placement of monument.
C:
** OTHER REASON:
Sent email to P&R to flag the space: �45/7P-1
Notified funeral home/monument company with color of the flags used to mark the space:1 >1
Staking fee received (if applicable): / / From:
Copy of burial permit emailed to Nathan Brigman, Tim Chaplinsky in P&R: la /gyp/
zki
**************************************************************************************************
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
City Clerk/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 9/30/24
•
Vaughan, Karen
• •
From: Vaughan, Karen
Sent: Friday, December 20, 2024 10:38 AM
To: laney.perry@nsmg.com
Subject: FW: Cemetery flagging request / Block 2 - Lot 9 - Space 13 or 14 / burial is this Monday 12/23
Attachments: I MG_0464.j peg
Hi Laney!
See picture attached.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-444-7150
Fax: 727-562-4086
From: Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com>
Sent: Friday, December 20, 2024 10:16 AM
To: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Subject: Re: Cemetery flagging request / Block 2 - Lot 9 - Space 13 or 14 / burial is this Monday 12/23
East side of cemetery purple flags.
Get Outlook for iOS
From: Vaughan, Karen<Karen.Vaughan@MyClearwater.com>
Sent: Thursday, December 19, 2024 2:32:57 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
1
Cc: Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com>
Subject: RE: Cemetery flagging request / Block 2 - Lot 9 - Space 13 or 14 / burial is this Monday 12/23
Yes, will do. And sorry to rush you, but Tim, please send me one of your awesome pictures of the flagged space so I can share it with Laney at Moss
Feaster in time for them to open the space.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-444-7150
Fax: 727-562-4086
•
4-
1 Cemetery Call Work Sheet
.
� / 4
ate. / Caller Name:Ectc Ceievta-A-et-0)
Funeral Home / Monument Company:
Contact # or Email:
cel l :off.'- 5ef t g l( c6,,„„23 -to • C 1
Reason for call: (Circle A, B, or C below and fill in information)
A: ** STAKING REQUEST FOR INTERMENT **
s
Full Burial Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Plot:
Deceased Name:
Verify Ownership/Burial Rights in cemetery program before confirming:
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / /
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
** STAKING REQUEST for Monument / Marker to be placed **
Deceased Name:
Block Lot Space
Verify Ownership/Burial Rights in cemetery program before confirming. No staking fee for placement of monument.
** OTHER REASON:..}}--
QJ t i AJC (kak-v.k
Mee
Sent email to P&R to flag the space: / /
Notified funeral home/monument company with color of the flags used to mark the space: / /
Staking fee received (if applicable): / / From:
Copy of burial permit emailed to Nathan Brigman, Tim Chaplinsky in P&R: / /
**************************************************************************************************
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
City Clerk/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 9/30/24
Vaughan, Karen
om: Vaughan, Karen
ent: Friday, October 4, 2024 10:01 AM
To: Darlene Elliott
Subject: RE: Municipal Cemetery, Block 6, Lot 23
Hi Darlene!
You can mail the original to me and I will enter it into our cemetery records with the City of Clearwater.
City of Clearwater
ATTN: Karen Vaughan / City Clerk Dept.
P.O. Box 4748
Clearwater, FL 33758-4748
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
727-444-7150
ax: 727-562-4086
From: Darlene Elliott <delliott3418@gmail.com>
Sent: Friday, October 4, 2024 9:19 AM
To: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>
Subject: Municipal Cemetery, Block 6, Lot 23
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.
Dear Karen Vaughan,
I talked with you about six months ago concerning claiming a plot for future use among the unused ones that had
been purchased by my great grandfather, Lucien Stillwagon. I have completed the affidavit pictured below, but
don't know where to send the original. Please let me know where it should be sent, and if there is anything further
that I need to do at this time
Thank you for your assistance.
Sincerely,
Darlene Dort Elliott
•
1
•
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
RECEIVED
OCT 142024
CITY CLERK DEPARTMENT
I, Dn r len P Dort Ell t ort , the undersigned, do hereby attest that I am the
descendant of Luft St; 1i wa ion , my greritottrorAfatit, , owner of
Space(s) 7 of Block .6_, Lot 23_ in the Clearwater Municipal Cemetery.
Please take this affidavit as your authority to note the right to property described
above to myself. Per the City of Clearwater Rules and Restrictions the maximum
capacity of a space is two burials provided at least one person is cremated or two
cremated remains.
I agree to release, indemnify and hold the City of Clearwater harmless from
liability in the event of any claim arising from the use of the above described property as
stated above.
SIGNATURE ADDRESS/PHONE
C1/I,UmL�'
eee6;itt
2.047 PoiAseta Ave
Clearwater, FL 33755
813 -(83y7 -9 R0
SWORN TO and subscribed before me this day of dhet" , 0260-ci
by�t�. -s lc�c �.-4 ei/;d t7' who produced identification in the form of
�`-' — G 4ao cr ct97-e) and who did/did not take an oath.
•'
FRANCISCO O. Sort TORRES
Notary Public
State of Florida
Comm* HH184670
Expires 10/18/2025
Notary Public
My commissi n expires: