Christy, KimCemetery Call Work Sheet
Date: 11 / 13 / o S
Funeral Home/ Monument Company:
Contact Name: kM C?ri sfi
Tel. #:
Fax #:
Reason for call: 4c?ft-tis C%? :,
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Deceased Name: J
Date of Birth: Date of Death -/-/,
Block Lot (03 Space D, 3 'f 0L11
Owner of Plot: Fru d,
t****,r*,t,t*,t********,r********************,t**,t********,t,t****,t******,t*****,t*,t********,r*******,t,t*,t**** j?Ah?j?ttnl .
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Leers ???.
$30.00 Staking Fee - received on: / / Pao eS
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: (No Fee for Staking of Monument)
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LaCosse, Judith
Page 1 of 2
From: Christy Kimberly [CHRISTYK@pcsb.org]
Sent: Thursday, December 18, 2008 10:11 AM
To: LaCosse, Judith
Subject: RE: Clearwater Municipal Cemetery - Affidavit
Ms. LaCosse,
Please forgive me for not getting with you sooner, but this affidavit looks fine and I would like you to
proceed and mail an original to my home address. p
Kimberly Christy
1452 Satsuma St. I
Clearwater, FL 33756(
Th u, so or the time you have spent getting this in order. I hope that you and your
At h n e ul, safe, Christmas Holiday!
Kimberly ri'sty
Secretar o the Deputy Superintendent
Curricurd Operations
(727) - 1
-----Original Message-----
From: Judith.LaCosse@myClearwater.com [maiIto: Judith.LaCosse@myClearwater.com]
Sent: Tuesday, November 25, 200810:51 AM
To: Christy Kimberly
Subject: Clearwater Municipal Cemetery - Affidavit
Kimberly,
Here's a copy of the affidavit regarding interment rights for your perusal. If you have any
questions, please give me a call.
Please have your mom and your aunt also take a look at this document. If everything is agreeable,
will then mail the original copy to your attention for signatures and to have it notarized.
12/18/2008
I )
S
m0.
?? too
OFFICIAL. RECORDS Am)
LEGISLATIVE SERVICES
December 18, 2008
Kimberly Christy
1452 Satsuma St.
Clearwater, FL 33756
CITY OF CLEARWATER
POST OFFIcF Box 4748, CLEARWATER, FLORIDA 33758-4748
CI I) I IALL, 112 Sot°rit OscF012\A?TNUF•., CLEARWATER, Roml)A 33756
TELEPHONE (727) 562-4090 FAX (727) 562-4086
Re: City of Clearwater Municipal Cemetery
Block 8, Lot 63, Spaces 2, 3 and 4
Dear Ms. Christy:
Enclosed please find the original affidavit granting interment rights in the
above City of Clearwater cemetery spaces.
Please have this document signed and notarized by the appropriate individuals
and return to my attention at your earliest convenience. We will then, update
our records to reflect this information.
If you have any questions, please give me a call at 727-562-4093.
Sincerely,
dith LaCosse
Staff Assistant a /v?
Enclosure r..e?Q
s? J'U'Q t, kz.?- - L e- &j
FRANK I111MARD, MAYOR
GEORGG N. CREIEKOS, COCNCIIMEMB1i111 JOI IN D()K-kN, COUNC11 IENI IT
PAt1. F. GmsoN, COt*N(ALME BER ® CARLEN A. PRlrRSEN, COUNCILME"I MR
"Et,) Ai. EmPLOYMENI A:tiD AFFtR.wnTtve Ac:no E.NwLOYt::R"
11/19/2008 21:43 FAX 7275886516
PINELLAS SCHOOL MAGNET
FACSIMILE TRANSMITTAL SHEET
TO:
4/-)c m bar
COMPANY: DATE:
FAX NUMBER TOTAL NO. OF PAGES, INCLUDING COVER
5(o2-,W36 3
PHONE NUMBER SENDER'S REFERENCE NUMBER
(DrZY!?AM-,23 0176'x- Q1'2? Vv
RE: YOUR REFERENCE NUMBER
IL
? URGENT ? FOR REVIEW ? PLEASE COMMENT
.OsLk -SDQI?
r' 7 k & pc s6 , o ra-
? PLEASE REPLY ? PLEASE RECYCLE
NOTES/COMMENTS:
IC??cun ? y6U Sb yc?Lj-A
0
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bo-clile, LAtill-,
?uyy? di, I ?
FROM:
a 001
I1c 5a- S'Ll s "W\, C., - t
C(ca r w'i", i FL J37St?
11/19/2008 21:43 FAX 7275886516 PINELLAS SCHOOL MAGNET fj 002
FORM 1109' Florida Phoroans QUIT CLAIM DEED. 74162325 TUTBLANX REGISTERED uS.PAT.OPFICE
`?J 1 Tult/e La w Print Pub/lsheis, Ru!/and.Yl
R OVEP
w?.. ti,13?a?A ?. R. X242 PAcA901
QURk CIRCUIT MRT
f 9.1herever ie.aed heroin, the Eernn"pa?rty" shall include the h.elre, per6oYUal repreeentMUued,
17 ? ? successors and/or assigns of the reapecttoe parties Isereto; the use of the singu&r,nwnber, 1111 shaft include the plurraall and the plural the singular; the use of any (ender shall ivclade'
at1 gendesY; and, if used, the term, "note" shall inc&cde all the notes heroin desosibed if more
thQSS One .
Made this day of December, .1. D. 1,9 74
Between WALTER H. FREEZE, A Widower,
of the County of
Pinellas, and State of Florida , party of the first part,
and JOYCE LEWIS, 500 N. Missouri Avenue, Clearwater,
rRN To:
Pinellas-, Florida of, the `County bf
and State of , party of the second part,
Witnesseth, that- the said party of the first part, ' for and in consideration of
the sum of other valuable considerations and Ten ($10.00) ------- Dollars-,-
in hand paid by the said party of the second part, the receipt whereof is hereby acknowl-
edged, has remised, released and quitclaimed, and by these presents does remise,
release and quitclaim unto the said party of the second part all the right, title, interest
claim and demand which the said party of the first part has in and to the following
described lot , piece or parcel of land, situate lying and beings in t;.e County of
Pinellas, State of Florida, to wit:
Lot Sixty-three (63), Block Eight (8), the
southernmost space, Clearwater Cemetery.
, A'.... .. , , .V`!. ..^!?.:. +, ..^rYV`: a^...', .... r..'rr.-r ?ti^. wyvvv'r, .:. --..?....-.. - .. . , , ....... , rw• ..... . ........: r.•.ti•?r:
r JY rVV'. ?.
DnCUMENTARY ,, STATE oF= FLORIDA
DOCUMENTARY ?,MSTAMP TAXI
r' `_ DEPT. OF REVENUE a I
au otel. DEC i 7'7G PEl U. '? ° L n - P.B. -DEC 17'74 00.30-1
OF IOS34
0 7LYEMUE 0047 To Have and to Hold the same, together with all and singular the
appurtenances thereunto belonging or in anywise appertaining, and all the estate,
f4k!I7t, title, interest and claim whatsoever of the said party of the first part, either in
lau+ or equity, to the only proper use, benefit and behoof of the said party of the second
part.
In Witness Whereof, the said party of the first part has hereunto set his
hand and seal the day and year first above written.
Signed, Sealed and Delivered in Our Presence: i
Walter H. Fr e
State of Florida, 1
County of PINELLAS, J
I HEREBY CERTIFY, That on this day personally appeared before me, an officer
duly authorized to administer oaths and take acknowledLimentsf;. Walter H.
Freeze, a widower, `
to me well known to be the person described in and who- executed 4,he fore - goin'd
instrument and he acknowledged '- beforg„??
executed the same freely and voluntarily for the pu>M1pgses O677., dxp_ ¢` sed.
WITNESS my hand and official seal at C.ty',oflarwaa?e,
County of Pinellas , and Stare. of Flbr,'id thl"s, ...
dad of December, .q. D. 19 74 = t ?yy/y?_
?fl?i+T? ? 1 / 12 ? J
This Instrument was prepared by
Robert A. Freeze, Attorney-at-Law aNotaTy':a ;blaze: ' `-?`v,;
New Port Riche, Florida my C°irti?s??o? 1??pa>e?k 1978
y' l?I,H?IIHIN1
11/19/2008 21:44 FAIL 7275886516 PINELLAS SCHOOL MAGNET Q003
WALTER H. FREEZE
TO
JOYCE LEWIS
Date December. 1974
En:cau cI Vitcl S,--fis CS Pc-at No.
Pc: al No.
PERMfT FOR DISII7ETIi ITIENT, TRA.IISPORTATION, AND RFI 1'F..RP. WT,
T
. Sex Date of Do,,,,h t7 J1 Q 44c
-
.I,:r.a; burial ?j
PILC-
Q
? emeten,•)?
;?• ( tn ruin -cf i X-41;.
Funeral (Add
g !7l r5 i
(Naz \, (License No.)
Pert zsion is hereby t-.anted to disin'er, transport, and reinter the body described .hove subject to the reguiaticns on the reverse
side of this form.
Date Permit Issued .. 1. l9?AI.-. Signed:..-
_ Registrar
QQ q ? .....
_. ? $1
Rpm MS. Nn, ? e6l Address .. 1?.U0 X:U.'lL?G
?. ..
Endorsement of agent of cemetery from which remains are to be disinterred: I
Date
Crmttety At er,t
En•'_ors ment or agent of cemettry in which remains were, reinterred:
D
Cemetery ?£tn;
This r .; n- be sari', ,:cl r• i by th.. funend dir(rt.,r to the cenx•trry where reintrrnu•nt is n;;ul•. THE AGE\T OF THE
CE)IETERY (OR THE FUNERAL DIREITOR IF THERE IS No AGENT) MUST F(11 VL?D THIS PERMIT WITHIN 10
DAYS TO THE LOCAL REGISTRAR OF HIS DISTRICT.
,oor v s s -
(Over)
n
ROBERT R. MANUEL
PRESIDENT AND GEN. MANAGER
CLINTON B. HOLDEN
SENIOR VICE PRESIDENT
M. E. WILDER
SENIOR VICE PRESIDENT
ROBERT C. KREGE
VICE PRESIDENT
L. GREER BISHOP
VICE PRESIDENT
N. H. KELLY
VICE PRESIDENT
ELWOOD U. KANE. JR.
VICE PRESIDENT
FORT HARRISON CHAPEL
802 N. FORT HARRISON AVE.
POST OFFICE BOX 60
CLEARWATER. FLORIDA 33517
446-2375
LAKESIDE CHAPEL
683 S. BELCHER ROAD
POST OFFICE BOX 60
CLEARWATER. FLORIDA 33517
442-3111
DUNEDIN CHAPEL
1320 MAIN STREET
POST OFFICE BOX 287
DUNEDIN. FLORIDA 33526
733.2111
LARGO CHAPEL
587 N. CLEARWATER LARGO RD.
LARGO. FLORIDA 33540
554-8603
EAST BAY CHAPEL
2481 EAST BAY DRIVE
LARGO. FLORIDA 33540
531-7749
LICENSED FUNERAL
DIRECTORS
L. GREER BISHOP
ROBERT I- COLEMAN. 111
ROBERT C- COTTRELL
CLINTON_B. HOLDEN.____
ELWOOD U. KANE, JR.
N. H. KELLY
ROBERT C. KREGE
ROBERT R. MANUEL.
F. MALCOLM MCMULLEN
RONALD M. NOBLE
TERRY D. RILEY
RONALD L. TROW
JOHN H. WICE
M. E. WILDER
?l4y1u?rterxa/?ze,
Clearwater City Hall
Clearwater, Florida-33516
Attention: Mr.Whitehead
Dear Sirs
October 31, 1974
In accordance with the request of the family,
this is to advise we are to disinter the remains
of Walter Howard Freeze, Jr, from:
Lot 630 Block $, Clearwater cemetery 59 ?
to Sylvan Abbey Memorial Park.
The disinterment is to take place as of November 1,
1974.
Yours very truly,
JHW/cb
MOSS FUNERAL HOME,INC.
John H. Wice
gas MaNow
NSM j