Duffey, Dorothy R• Cemetery Call Work Sheet
Date: -a-/ /AQO
Funeral Home / Monument Company: koss F.PCL?+P 112
Contact Name:
Tel. #: 5A - (9wwo Fax #:
Reason for call: -
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Deceased Name: "
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Date of Birth: -i-/ 13 /-8-16 Date of Death & GJ
• Block Lotat Space
Owner of Plot:
Interment: (One full bur/al and one urn, or two urns per space)
Full Burial X Urn Space
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$30.00 Staking Fee - received on: 21 l 31-1 / d 9
Date of Burial: Time: P 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: (No Fee for Staking of Monument)
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CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
. BLOCK : 5 LOT: 24 (CONT.)
DECEASED NAME: KORA FRIEDT
BLOCK: 5 LOT: 24 SPACE: 10 BURIALTYPE: FULL
BORN: 12 / 03 / 1886 DIED: 08 / 02 / 1964 INTERRED: 08 / 06 / 1964
INTERMENT NOTES:
DECEASED NAME: KARLYN FRIEDT
BLOCK: 5 LOT: 24 SPACE: 10 BURIALTYPE: URN
BORN: 09 / 01 / 1925 DIED: 09 / 30 / 1992 INTERRED: 11 / 18 / 1992
INTERMENT NOTES:
CREMATED REMAINS PLACED AT FOOT OF MOTHER'S SPACE
DECEASED NAME: JAMES FRIAR
BLOCK: 5 LOT: 24 SPACE: 11 BURIALTYPE: FULL
BORN: 04 / 23 / 1928 DIED: 06 / 29 / 1987 INTERRED: 07 / 02 / 1987
INTERMENT NOTES:
DECEASED NAME: GEORGE SUMLIN
BLOCK: 5 LOT: 24 SPACE: 12 BURIALTYPE: FULL
BORN: DIED: 04 / 22 / 1968 INTERRED: 04 / 23 / 1968
INTERMENT NOTES:
DECEASED NAME: MINOR DUFFEY
BLOCK: 5 LOT: 24 SPACE: 14 BURIALTYPE: FULL
• BORN: 11 / 06 / 1902 DIED: 07 / 09 / 1978 INTERRED: 07 / 11 / 1978
INTERMENT NOTES:
DECEASED NAME: ALMA DUFFEY
BLOCK: 5 LOT: 24 SPACE: 15 BURIALTYPE: FULL
BORN: 08 / 23 / 1908 DIED: 06 / 05 / 1942 INTERRED: 06 / 05 / 1942
INTERMENT NOTES:
DECEASED NAME: SALETA BERRY
BLOCK: 5 LOT: 24 SPACE: 16 BURIALTYPE: FULL
BORN: 11 / 11 / 1909 DIED: 03 / 14 / 1986 INTERRED: 03 / 18 / 1986
INTERMENT NOTES:
****END OF BLOCK : 5 LOT: 24 ****
•
Page 42 of 64
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Moss Feaster Funeral Home(4674)
1320 Main Street Gelco Check Number 12112186 01 211.21865
Dunedin FL 34698
brongeja 3/247Ab9
PAY TO THE City of Clearwater NOT VALID AFTER SiX[E MONTHS FROM ISSUE DATE
ORDER OF 112 S. Osceola Avenue
Clearwater FL 33757
Thirty Dollars And No Cents************************************************ $ * * * 3 0 0 0
hh __ NOT VALID FOR OVER $5,000 NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
Sus Kelly
! PAYABLE THROUGH 78-858
First PREMIER Bank 914 By signug this irrstrument, the aforesioned confirms that this instrument fas been drawn in accordance with the authonty issued by Gelco Information Network. inc. II any
SIOUX FALLS, S D statement herein be untrue, we, the a oresigned, agree to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement.
un0 L 2 L L 2 La 6Is i:09 L408585i: 2 500000 6 5Smo
SIGNER Susan Kelly USER ID brongeja
01 21121865
DESCRIPTION
City of Clearwater
112 S. Osceola Avenue
Clearwater FL 33757
DATE LOCATION NUMBER GLCODES CONTRACT NUMBER NAME/DESCRIPTION AMOUNT
3/23/2009 4676 8405-0 467601000704 Dorothy Duffey $********30.00
'Clearwater
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City of Clearwater, Florida
Official Records and
Legislative Services Department
Phone (727) 562-4090
Fax (727) 562-4086
FAX MESSAGE
TO: Joe Taylor
LOCATION: Parks and Rec.
FAX NO.: 6551
COMMENTS: See attached Burial Permit #2597.
FROM: Judith LaCosse, (727-562-4093)
DATE: 3/31/2009
NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2
BURIAL PERMIT
CLEARWATER CARETAKER
CLEARWATER. FL
Permission is hereby granted for burial of:
Name of Deceased: DOROTHY R DUFFEY
PERMIT # 2597
March 31, 2009
Burial Type: FULL
Owner of Property: MINOR C DUFFEY &
Block : 5 Lot: 24
Date of Death: March 7, 2009
Space: 13
Date of Birth: January 13, 1915
Date of Burial: March 13, 2009
Funeral Home Director:
Time: 13 :00
BILL - MOSS FEASTER
Staking Fee: 30.00
Date Paid: March 27, 2009
Clearwater Cemetery
By u 44v 4 64d