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Finding cures. Saving children.
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Contact # or Email: "t 3 C� .� / 9
Reason for call:
A: ** STAKING REQUEST for Interment 4
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
U9+ 23
ceS
re) 1Lo
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:
Blok Lot Space _ Q�
Date of Birth: / / Date of Death / / `
spea,c—e_
6— ‘' ra20._
Date of Burial: / /
B: ** STAKING REQUEST for Monument to be placed _
No fee for staking of monument
Deceased Name:
•
C: ** OTHER REASON:
`95
Block Lot Space t L
Verify Ownership/Burial Rights in cemetery program before confirming:
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ca.�J �-e . .� t—c w.; � hQ,,r..e
*****************************************************************************************************************************
Sent email to P&R to flag the space I I
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
3.) Written authorization from the individual(s) who would be permitted to authorize burial
•
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City Clerk/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 12/27/2023
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Vaughan, Karen
From: Vaughan, Karen
Sent: Tuesday, April 30, 2024 2:00 PM
To: delliott3418@gmail.com
Subject: Clearwater Municipal Cemetery / Block 6 - Lot 23 - Spaces 1 thru 12 / Stillwagon
Attachments: Stillwagon.pdf
Hi Darlene!
It was nice talking with you today! Please find attached a map showing where Block 6 — Lot 23 is located. And a printout of who is buried in what space.
Please contact me (email is best) with any questions.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-444-7150
Fax: 727-562-4086
1
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59 as 111.1 59 34
SEE SHEET I
MYRTLE
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46 33 30 19 14 3
anon
44 37 aa 21 12 3
43 38 27. 55 11 4
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AVENUE
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5
17
36
31
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29
27
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20
17
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22
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25
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30
5
31
4
32
33
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PROSPECT
AVENUE
Y77, M v)f »J,.
on
INTERMENTS
BURIAL DECL
SP TYPE
1 FULL DORT
2 FULL STILLWAGON
3 FULL STILLWAGON
4 FULL STILLWAGON
5 URN JORDAN
6 INFANT MONGER
12 INFANT DORT
12 INFANT DORT
DISINTERMENTS
Status of Block: 6 LOT: 23 as of 4/30/2024
DECF
MAY
FRED
LUCIEN
CLARA
LINDA
UNKNOW
N
IRENE
ROBERT
DECM BIRTH
I
L
A
A
K
5/15/1917
12/19/1887
1/1/1855
1/1/1860
7/11/1951
1/1/1935
1/1/1949
1/1/1901
DEATH INTERRED PERMIT
1/28/1977
12/22/1969
1/1/1924
1/1/1923
5/18/2000
1/1/1935
1/1/1949
1/1/1949
1/31/1977
12/24/ 1969
1/1/1924
1/1/1923
9/24/2001
1/1/1935
1/1/1949
1/1/1949
REINTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED
SP TYPE
5 URN JORDAN LINDA K 7/11/1951 5/18/2000 6/21/2000
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2487
2486
0
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Vaughan, Karen
rom: Vaughan, Karen
Sent: Tuesday, June 11, 2024 11:05 AM
To: delliott3418@gmail.com
Subject: Cemetery Notes
Attachments: StillwagonNotes.pdf
Hi Darlene!
I found some notes in our cemetery program regarding spaces 3-6. See attached. Just wanted you to have them.
Thanks!
Karen B. Vaughan
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-444-7150
Fax: 727-562-4086
•
•
1
6/11/24, 10:12 AM
Cemetery
8 Fila
Good Morni
Reports
Parrras Lat. by
Deceased
Pf.Bua..ai
a Ma ntenance
Locate
[ Previous Page ]
•
Cemetery Tracking System
Cemetery Tracking System - Interment Detail
Block: 6 Lot: 23 Space: 3
Rights Granted:
?
You are logged in as Karen.Vaughan
Interment Processed:
7
Burial Type:
First Name:
Date of Birth:
FULL
LUCIEN
01/01/1855
Owner of Space?
MI: n Last Name:
Date of Death:
STILLWAGON
01/01/1924
Interment Date:
Interment Director:
Staking Fee $
01/01/1924
0
Time of Service:
Permit:
Date Paid:
2488
Interment Notes:
CHANGED FROM CLARA TO LUCIEN PER GRANDDAUGHTER RETA JORDAN
9/27/2001
Updated on Tuesday, January 6, 2009
Home I Feedback I Departments I Contacts I Forms
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6/11/24, 10:12 AM
s Cemetery
o File
Cemetery Tracking System
• Reports
Search, Did t cat :.
L ocat:
R Burial
• Maintenance
C ;nt of Data
[ Previous Page ]
•
Cemetery Tracking System - Interment Detail
Block: 6 Lot: 23 Space: 4
Rights Granted: ?
You are logged in as Karen.Vaughan
Interment Processed:
Burial Type:
First Name:
Date of Birth:
FULL
CLARA
1
01/01/1860
MI:
Owner of Space?
Last Name:
Date of Death:
STILLWAGON
01/01/1923
Interment Date:
Interment Director:
Staking Fee $
01/01/1923
0
Time of Service:
Permit:
Date Paid:
2487
Interment Notes:
CHANGED FROM LUCIEN TO CLARA PER GRANDDAUGHTER RETA JORDAN
9/27/2001
Updated on Tuesday, January 6, 2009
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6/11/24, 10:13AM
Cemetery Tracking System
Good Morning! Today is Tuesday, Jury 11, 20.14
8 Cemetery
File
7-11-33 t.;r
a Reports
. to
Lcacation
Ptm0%.Llist-
D.oc.ea,sed
Location
Q Maintenance
Control !rata
u'a id 'L•oco.t
[ Previous Page ]
Cemetery Tracking System - Interment Detail
Block: 6 Lot: 23 Space: 5
Rights Granted:
09/27/2001
You are logged in as Karen.Vaughan
Interment Processed:
Burial Type:
First Name:
Date of Birth:
URN
LINDA
07/11/1951
Owner of Space?
MI: n Last Name:
Date of Death:
NO
JORDAN
05/18/2000
Interment Date:
Interment Director:
Staking Fee $
09/24/2001
MOSS
30
Time of Service:
Permit:
Date Paid:
2486
09/24/2001
Interment Notes:
DISINTERRED FROM BLK 6, LOT 23, SPACE 6 AND REINTERRED IN SPACE 5
Updated on Tuesday, January 6, 2009
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Cemetery Tracking System
ISITMET Good
rCemetery
s File
Ti accost. sr
View Lot Profile
S Reports
Ritint &total Pernitit
Deceased by
Location
Alphabetical List of
Deceat-ied
List of Owners
Reii,terments
Perrnits List toy
Deceased
Pierntibts List by
°cation
PREurial
Control Data
Valid Locations
Security
[ Previous Page ]
Morning' Today is Tuesday, ltine 11 2023
•
Cemetery Tracking System - Interment Detail
Block: 6 Lot: 23 Space: 6
Rights Granted:
HomeI Feedback
You are logged in as Karen.Vaughan
Interment Processed:
Burial Type:
First Name:
Date of Birth:
(INFANT
(UNKNOWN
101/01/1935
Owner of Space?
MI: n Last Name:
Date of Death:
MONGER
01/01/1935
Interment Date:
Interment Director:
Staking Fee $
01/01/1935
0
Time of Service:
Permit:
Date Paid:
0
Interment Notes:
SON OF FF
Updated on Tuesday, January 6, 2009
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INTERMENTS
BURIAL
SP TYPE
1 FULL
2 FULL
3 FULL
4 FULL
5 URN
6 INFANT
12 INFANT
12 INFANT
DECL
DORT
STILLWAGON
STILLWAGON
STILLWAGON
JORDAN
MONGER
DORT
DORT
DISINTERMENTS
REINTERMENTS
BURIAL DECL
SP TYPE
5 URN JORDAN
Status of Block: 6 LOT: 23 as of 11/18/2020
DECF DECM BIRTH DEATH INTERRED PERMIT
MAY I
FRED L
LUCIEN A
CLARA A
LINDA K
UNKNOW
N
IRENE
ROBERT
5/15/1917 1/28/1977 1/31/1977
12/19/1887 12/22/1969 12/24/1969
1/1/1855 1/1/1924 1/1/1924
1/1/1860 1/1/1923 1/1/1923
7/11/1951 5/18/2000 9/24/2001
1/1/1935 1/1/1935 1/1/1935
1/1/1949 1/1/1949 1/1/1949
1/1/1901 1/1/1949 1/1/1949
DECF DECM BIRTH DEATH
LINDA K 7/11/1951 5/18/2000
INTERRED
6/21/2000
1186
738
2488
2487
2486
0
0
0
•
•
•
•
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, , the undersigned, do hereby attest that I am the
descendant of , my , owner of
Space(s) of Block , Lot _ 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
SWORN TO and subscribed before me this day of
by who produced identification in the form of
and who did/did not take an oath.
Notary Public
My commission expires:
•
ri1/
J‘_--
_ /
` .v
OT - 23
IIFAi S
Son of F. F. Monger '�N'��:.ROB ROBERT DORT
1a3_ .
0
•rcln)) LINDA K.x � Is4J
-its r - 5-/4
-CLA R A
L-uc ier±--A . Sti 11wagon
186o - 1923
rO?, 41-, Sti1Drag or_
- 1923
3_ ✓
Fred Stillwagon
<6(.0-12 1 -69
z- v
MAY IRENE DORT
1` �l-.a-1-77
g-
l
y
Vaughan, Karen
rom: Vaughan, Karen
Sent: Wednesday, June 12, 2024 9:01 AM
To: Darlene Elliott
Subject: RE: Stillwagon, Dale
Good Morning, Darlene!
Thank you for sending me the affidavit for Block 6, Lot 23, Space 11.
In answer to your question about the Funeral Home having access to the affidavit.... The usual process when they
are contacted by a family member saying they'd like a burial to take place in the Clearwater Municipal Cemetery,
they contact us to verify the Block, Lot, and Space the family says the deceased has burial rights for. It is not
mandatory to present the affidavit to the funeral home but is preferred. That way they can match up the info they
have been given to what we have on file.
My question to you: Are you saying you would like burial rights to only space 11 since that is what the affidavit
states?
Thanks!
Administrative Assistant
City of Clearwater
City Clerk Department
Ph: 727-444-7150
Fax: 727-562-4086
From: Darlene Elliott <delliott3418@gmail.com>
Sent: Wednesday, June 12, 2024 7:46 AM
To: Vaughan, Karen<Karen.Vaughan@MyClearwater.com>
Subject: Stillwagon, Dale
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.
Karen,
The link below shows the affidavit my cousin Dale Stillwagon completed and sent to the City Clerks office
in November of 2020, as well as the instructions given to him by Judith LaCosse. Perhaps the procedures
have changed since 2020. Although this affidavit is a public record, do you know whether the funeral
home would know where to find it, or should he have a copy with his Will? In other words, who is
responsible for confirming he has the right to claim that plot?
�ttps://edocuments.myclearwater.com/WebLink/DocView.aspx?id=748483&d bid=0&repo=Clearwater
Sent from my iPad
1
•
•
•
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
RECEIVED
MM 25 202:
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPT.
I, vitt,.€ I . ,CTILLIvA&W4 tee, , the undersigned, do hereby attest thq_lss m the
descendant of Luc t ew sT t L . 4P CzoA/ , my6RFArr- E,R*Ko f i%ner of
Space(s) / / of Block 6 , Lot 2 3 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
G SIPG,2qT ST. ev
f*Frog Lel2 G, t=c, 3 370
—727— S�.�.- -2�Q
AWORN TO and subscribed before me this _
let" y of /V JI�L� ��
by OW 4t LjdaldAi ..- who produced identification in the form of
pidLi,srce/4, .41.42z/-.4 ,and who did/did nottake an oath.
VENINfter
"ti^t CHERYL HOLIES
, MY COMMISSION #1(125413
;4 EXPIRES: November 18,2021
li.� �, Peek VINAI OIllt
My c• missio expires:
RE: Municipal Cemetery Inquiry - Stillwagon
LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Wed 11/18/2020 9:51 AM
To: Dale Stillwagon <dstillwagon@hotmail.com>
2 attachments (65 KB)
Block 6 Lot 23-Stillwagon.pdf; Affidavit -right to property.doc;
Good Morning Mr. Stillwagon,
See attached documentation that shows the burial status of Block 6, Lot 23. The Cemetery program shows that
Lucien Stillwagon was the owner of all spaces (1-12) in this plot.
Spaces 7 through 11 are indeed vacant and will be available pre -need to surviving descendants of the owner,
Lucien Stillwagon.
We just need an notarized affidavit stating that the deceased is a descendant/survivor of the owner and rights
will be granted. (See attached sample)
Note: 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.
If you have any other questions please give me a call.
Thank You.
Judith LaCosse
StaffAssistant
ORLS Dept.
Phone: 727-562-4093
•
•
LaCosse, Judith
•From:
Sent:
To:
Subject:
Attachments:
Importance:
Good Morning Mr. Stillwagon,
LaCosse, Judith
Wednesday, November 18, 2020 9:50 AM
Dale Stillwagon
RE: Municipal Cemetery Inquiry - Stillwagon
Block 6 Lot 23-Stillwagon.pdf; Affidavit -right to property.doc
High
See attached documentation that shows the burial status of Block 6, Lot 23. The Cemetery program shows that Lucien
Stillwagon was the owner of all spaces (1-12) in this plot.
Spaces 7 through 11 are indeed vacant and will be available pre -need to surviving descendants of the owner, Lucien
Stillwagon.
We just need an notarized affidavit stating that the deceased is a descendant/survivor of the owner and rights will be
granted. (See attached sample)
Note: 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.
Off you have any other questions please give me a call.
Thank You.
Judith LaCosse
StaffAssistant
ORLS Dept.
Phone: 727-562-4093
From: Dale Stillwagon <dstillwagon@hotmail.com>
Sent: Wednesday, November 18, 2020 12:35 AM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Subject: Municipal Cemetery Inquiry - Stillwagon
CAUTION: This email originated from outside of the City of Clearwater. Do not dick links or open attachments unless you
recognize the sender and know the content is safe.
•Dear Judith,
1
Per our conversation late Tuesday afternoon, I would like direction on the process of obtaining access or
establishing authorization for access to future occupancy of available unoccupied family cemetery spaces
described below in the Municipal Cemetery, preferably on a pre -need basis.
Lucien Stillwagon, who was my great-grandfather, purchased in the early 1920's or thereabouts what appears
to be twelve adjacent spaces currently described as Block 6, Lot 23, Spaces 1-12. Lucien is interred in space 3
adjacent to his wife Clara in space 4, and his son Fred (my grandfather) in space 2. Other immediate family
members/descendants are interred in spaces 1, 5, and 12. I am not aware of the relation of the deceased in
space 6 to Lucien. According to the cemetery map, remaining spaces 7 - 11 are shown as unoccupied.
Next, I was able to locate an affidavit (copy attached) in the city's limited official public records (cemetery ->
folder "J" -> name: Jordan, Linda Kay) naming Lucien Stillwagon as owner of Block 6, Lot 23, space 6 and also
authorizing the interment of the cremated remains of Linda Kay Jordan in space 6 (subsequently disinterred
from space 6 and reinterred in space 5). One of the two remaining living grandchildren of Lucian at the time
who signed this affidavit, Dale Stillwagon Sr., was my father (and the son of Fred) and is now deceased. Reta
Stillwagon Jordan, the second signor and daughter of Fred, is now deceased as well.
Based on this information, I would like to get confirmation from official city records that those remaining
unoccupied spaces 7 -11 in Lot 23 are indeed part of the original Stillwagon purchase including the currently
occupied spaces in the lot and if so, the procedure required to make those unoccupied spaces accessible pre -
need to surviving descendants of Lucien, or at the time when the need arises such as in the case of Linda K.
Jordan. My late relatives never informed me of the procedure to initiate access to any unoccupied family
spaces (such as for those that followed the interment of owner Lucian: Fred Stillwagon, Irene Dort, May I.
Dort, Linda K. Jordan; or for any living pre -need arrangements) nor provided any documents to show
ownership of designated unoccupied family spaces.
On a final note, I also didn't see any provision for this specific situation in reviewing online availability of City
Code Chapter 11- CEMETERIES, sec. 11.02 (6), so I must make a presumption that any of the unoccupied
family spaces were intended for the benefit of that owner's descendants, if any, such as those referenced in
the preceding paragraph.
Thank you for your assistance and guidance.
Regards,
Dale L. Stillwagon, Jr.
dstillwaeon@hotmail.com
2