Burkhart, Joseph James & Margaret SinclairCemetery Call Work Sheet
Date: I-/ a I/ c9
Funeral Home/ Monument Company:
Contact Name:
9b3- Lka-- 9a9 Fax #: e? -i Q'.`1?,
Tel. #:
Rea jP±IA-S
Dko ?k 9 Lo+ to ( S cc.e, ? - `f B Q°c 9 Lof 8 ?( S p4? /- .
??V1+ ?{.OW i+?5 (,?DJlh.?2Wl. ??S C W?? ?? ?iNti.e Con..n?y )
Deceased Name:
/ a- a -?6 llko?k -i,
Date of Birth: Date of Death
Block 9 Lot 6 Space a 3 `f - v-?L C ck-
Ownerof Plot: I`1?^? c . R ??????? _ ?r4?? "1°-t- ?"?? Si?c,Q
************************ ************************** ****************************** *************** n-11A k-kG lt
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee - received on: / /
Date of Burial: Time: am/pm
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
Monument Being Placed:
?k q, LA Y,?e
oak ?, , Hof 64
a C 4-ti-f' .
(No Fee for Staking of Monument)
sr, a - N , S'.K r- Qu'(r - F
LaCosse, Judith
From: Meg Burkhart Umburkhart@yahoo.com]
Sent: Thursday, December 24, 2009 11:33 AM
To: LaCosse, Judith
Subject: Re: FW: Affidavit to assign interment rights
234 Sand Piper Dr., Poinciana, FL 34759-3234
Enjoy your Christmas tomorrow!
--- On Thu, 12/24/09, Judith.LaCosse@myClearwater.com <Judith.LaCosse@myClearwatencom> wrote:
From: Judith.LaCosse@myClearwater.com <Judith.LaCosse@myClearwater.com>
Subject: FW: Affidavit to assign interment rights
To: jmburkhart@yahoo.com
Date: Thursday, December 24, 2009, 10:32 AM
Ms. Burkhart,
I forgot to get your mailing address. Please provide your address so that I could send you the affidavit in the
mail.
Thank You.
Judith LaCosse
StaffAsslstant
City of Clean ater
Official Records & Legislative Services
11 727-562-4093
From: LaCosse, Judith
Sent: Wednesday, December 23, 2009 2:22 PM
To: 'Meg Burkhart'
Subject: RE: Affidavit to assign interment rights
1
You'ree very welcome. Regarding the part "who did/did not take an oath", some notaries may or may not ask you to take
an oath depending how familiar they are with you or the type of identification you provide.
I will mail you the original affidavit.
Again, Happy Holidays II
Best regards,
Judith LaCosse
StaffAssistant
City of Clearwater
Official Records & Legislative Services
X727--562-4093
From: Meg Burkhart [mailto:jmburkhart@yahoo.com]
Sent: Wednesday, December 23, 2009 12:01 PM
To: LaCosse, Judith
Subject: Re: Affidavit to assign interment rights
Judith, thank you very much for sending the affidavit so promptly. It looks fine. When we get the original we
will complete it and get it notarized. I'm not familiar with seeing "who did/did not take an oath" in a document.
Should we take some oath?
Merry Christmas and a Happy, healthy new year to you, too. Hopefully we won't be needing these cemetery
spaces for many years.
On Tue,12/22/09, Judith.LaCosse@myClearwaterxom <Judith.LaCossegmyClearwater.com> wrote:
From: Judith.LaCosse@myClearwater.com <Judith.LaCosse@myClearwater.com>
Subject: Affidavit to assign interment rights
To: 3 mburkhart@yahoo.com
Date: Tuesday, December 22, 2009, 12:28 PM
Mr. and Mrs. Burkhart,
It was a pleasure meeting you both yesterday. Attached you will find a draft copy of the affidavit regarding interment
rights for your perusal.
<<Affidavit-Burkhart.doc>>
Please let me know if you're in agreement with this document and I will then mail the original copy to your attention.
This affidavit needs both of your signatures, address/phone information and also needs to be notarized.
You may return this completed document to my attention at your earliest convenience. We will then, update our records
to reflect this information.
Thank You.
Have a Wonderful Christmas and a Happy and Healthy New Year!!
Sincerely,
Judith LaCosse
StaffAssistarit
City of Clearwater
Official Records & Legislative Sen>ices
727-962-4093
CITY OF CLEAR 'A1
POST OFFICE BOX 4748, CLEARWATER, FLOR)DA 33 /x"58°Jl' W`k1?
CITY HALL, 112 SOUTH OS/CEOLA A.vENTTE, CLEARWATER, FLORIDA 337-
TELEPHONE (727) 562-4090 FAX (727) 562-4086
TELEPHONE
IL:-OF.DS AND
15'.,'?Thai S -RVICES
December 24, 2009
rlseph James & Margaret Sinclair Burkhart
.234 Sand Piper Dr.
Poinciana, FL 34759-3234
R : City of Clearwater 'Municipal Cemetery
Mock 9, Lot 61, Spaces 1 and 2
!_)ear Mr. & Mrs. Burkhart:
I iq!acj(_)
t?- 0 ct k
VOW-
r;:nclosed please find an affidavit granting interment rights to both. of you Jr tllI::
above City of Clearwater cemetery spaces.
"N"e need to have your signatures on this document and it needs to be
otarized. Please return affidavit to my attention at your earliest convenience,
n
`X'e will then, update our records to reflect this information.
i f you have,, any questions please give me a call at 727-562-4093.
L"I ncerely,
Zidith LaCosse
Staff Assistant
Enclosure
?Vxel
"EQUAI. EMPLOYMENT AND AFFIRMAnw.. ACTION EMPLOITR" I '
AFFIDAVIT
I, Margaret Sinclair Burkhart, the undersigned, do hereby attest that I'm the
descendant of Margaret C. Rehbaum, my grandmother, who is buried in Block 9, Lot
84, Space 4. Margaret C. Rehbaum was the owner of Block 9, Lot 84, Spaces 1
through 4, and Block 9, Lot 61, Spaces 1 through 4 (vacant) in the Clearwater Municipal
Cemetery.
Please take this affidavit as your authority to assign interment rights in Block 9,
Lot 61, space 1 to myself and in Block 9, Lot 61, space 2 to my husband, Joseph
James Burkhart.
We 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
i?
Marg ret Sinclair Burkhart
d l ,yyu5 2 ,1t''
Joseph James Burkhart
ADDRESS/PHONE
rcxL:31/755`
SWORN TO and subscribed before me this day of J ah u-n
t)Q+ by Margaret Sinclair Burkhart & J eph Jam Burkhart who rodu d
identification in the form of E(cTU CZQand who did/ id not
take an oath. _
L
Notary Public
?6] I o I'Q
My commission expires:
=o1Wtr °?aV, Notary Public State of Florida
Christine Robinson
My Commission 00813115
r? ?'r` 0o cue Expires 0812712 0 1 2