Anderson, AlbertCemetery
Call Work Sheet
74)
*te: / /
Contact Name: ✓ Q,......
Funeral Home / Monument Company:
Contact # or Email:
C1(01 Ceot b fla-
Reason for call:
A: ** STAKING REQUEST for 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:
Deceased Name:
Verify Ownership/Burial Rights in cemetery program before confirming:
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / /
B: ** STAKING REQUEST for Monument to be placed
No fee for staking of monument
Deceased Name:
•
C:
Block Lot Space
Verify Ownership/Burial Rights in cemetery program before confirming:
* OTHER REASON:
11/1/3
T 1 c.CA- L N . - cg-Q-QtcS) --.-
*****************************************************************************************************************************
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, cc: Matt Anderson, Tim Chaplinsky 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
III3.) Written authorization from the individual(s) who would be permitted to authorize burial
City Clerk/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 12/27/2023
Status of Block: 11 LOT: 21 as of 6/14/2024
• INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PERMIT
SP TYPE
1 FULL SHAW SYDNEY H 1/1/1879 7/28/1953 7/28/1953 0
2 FULL SHAW JEAN M 1/1/1875 4/8/1957 4/8/1957 1264
3 FULL ANDERSON ALBERT L 11/21/1899 7/28/1953 7/30/1953 1032
DISINTERMENTS
REINTERMENTS
•
•
6/14/24, 2;23 PM
Cemet
Transaction
Reports
iSDairbid
Dnererneents
Deceased
Location
A,iph,abet ca`.
Deceased File
Deceased
Pe .mtS List by
Loca l:Da
PRBu
Maintenance
Control Data
Valid Loci-
[ Previous Page ]
Cemetery Tracking System
d Aftern000l Today is Friday/uniz 14, 2024
Cemetery Tracking System - Interment Detail
Block: 11 Lot: 21 Space: 3
Rights Granted:
You are logged in as Karen.Vaughan
Interment Processed:
Burial Type:
First Name:
Date of Birth:
(FULL
(ALBERT
111/21/1899
Owner of Space?
MI: n Last Name:
Date of Death:
ANDERSON
107/28/1953
Interment Date:
Interment Director:
Staking Fee $
07/30/1953
MOSS
Time of Service:
Permit:
Date Paid:
11032
Interment Notes:
Updated on Tuesday, January 6, 2009
Home 1 Feedback l Departments 1 Contacts l Forms
[Top of Page]
https://clearwater.clearwater-fl.com/Apps20/cemetery/intermentdetail.aspx?mid=3937 1/1