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Wambles, Juanita \07 Cemetery Call Work Sheet Date: (? ' 1(? - CAS Funeral Home: MUSS r-c a 4e- f- M Contact Name: C( Tel. #: u ?- o 3' 7S Te: Fax #: R RE: OA-xC -c-i 6-ML Qgde?Q LLA-YIPC C3 ? L3I K i C? Deceased Name: : duo-n to wO-rn 6I-f<POD: (-o- 15-OS DOB: 4 a 1- ) S Owner of Property: Ono-r" I oT"e Dean - DCLU, "Vificj- Block \ (o Lot 3' Space LA Interment: 30 Full Burial: „ Urn Space: ($30.00 Staking Fee) - (One full burial and one urn, or two urns) Date of Burial: JCtfu-rLiTime: : I a pm Disinterment: The following authorization should be obtained prior to disinterment: 1.) A disinterment permit and burial/cremation transit permit 2.) Written authorization from the individual(s) who currently own the burial rights for the plot; and 3.) Written authorization from the individual(s) who would be permitted to authorize burial Monument Being Placed: (No Fee for Staking of Monument) USS Fec AM 5- ,? Clearwater U City of Clearwater, Florida Official Records & Legislative Services Department Phone (727) 562-4090 Fax (727) 562-4086 FAX MESSAGE TO: Deb Davis LOCATION: Moss Feaster Funeral Home FAX NO.: 562-2073 COMMENTS: Affidavit for Charlotte Dean to sign for Right of Interment for Juanita Wambles. FROM: Stacy Keenan, (727-562-4097) DATE: June 16, 2005 NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2 ,- ) , (0- \ ?( <- ` , 0, 00 ?m AFFIDAVIT STATE OF FLORIDA) COUNTY OF PINELLAS) I, the undersigned, Charlotte Dean, owner of Space 4, Lot 8, Block 16, do hereby Grant Right of Interment to my mother: Juanita Wambles, in Space 4, Lot 8, Block 16 in Clearwater Municipal Cemetery. I further agree to release, indemnify and hold the City of Clearwater harmless from liability in the event of any claim arising from the use of the above described property for the interment of Juanita Wambles. SIGNATURE Charlotte Dean (Address Witness (Address Relationship to Witness SWORN TO and subscribed before me this day of , 200, by personally known to me or has made herself known to me by (SEAL) (identification). Notary My commission expires: Dated: J A-16-201015 14:17 FOSS BELCHED 72756220075 P.01/01 r.??z STATE OF FLORIDA) COUNTY OF PMIJ As) I, the uudcmdp d, Charltrik Dean, owner of Spada 4, Lot 8, Block 16, do hetrby Otani RWt of Iatmnmt to .aw Moe= Juanita WamWc$, in Space 4, Lot S, Block 16 in Clearwater mmicipal Cemday- I fiutha agree to Morse, iademni fy aW hold the City of Clearwater hm mless flvm liability in the evcnt of aayclaim arising fia m the use of the above described properly for the intament of Juanita Wambkt SIGNATURE Y ttc Deno 3 ,mess - Relatioosmp to Wataesa SWO TO and bed betme me this __,Z L &y of ?DO? by peT? to we br has merle bsamlf lct awn mo rm by zu (idepbif catirm}, 0111-' 1, (SEAL) My comaaadoo w pjm.' Dated: egg.,. 4-. pJ 0"e11st1on t; bD 413779 L(@tabf10ed =42.91,17 IIaFn. " 17 ttwiiZl Moss1? P1?e?e - S4Na at florid! FiommhWa+ Eepree 0i0-at, TOTAL P.01 ' l Keenan, Stacy From: King, JoEllyn Sent: Thursday, June 16, 2005 2:27 PM To: Keenan, Stacy; Call, Rosemarie; Chase, Susan; Gracie, Rhonda; Kaushal, Mona; LaCosse, Judith; Lewis, Eric; Vaughan, Karen; Zitouni, Trish Subject: RE: Staking Request for Juanita Wambles We will take care of first thing Friday June 17th- will be done by 8:00 AM. We will mark with red flags. Any problems I will call you. Thanks, Jo Ellyn -----Original Message----- From: Keenan, Stacy Sent: Thursday, June 16, 2005 11:30 AM To: Call, Rosemarie; Chase, Susan; Gracie, Rhonda; Kaushal, Mona; King, JoEllyn; LaCosse, Judith; Lewis, Eric; Vaughan, Karen; Zitouni, Trish Subject: Staking Request for Juanita Wambles I received a request from Deb Davis requesting the staking for the full burial for Juanita Wambles that will take place Saturday, June 18, 2005 in the morning. The area to be staked would be Block 16, Lot 8, Space 4. Other spaces nearby: Status of Block: 16 Lot: 7 (to the North) SPACE BURIAL TYPE DECEASED 1 FULL Hilda Wills 2 FULL Willie Pearl Mahone Status of Block: 16 Lot: 13 (to the West) SPACE BURIAL TYPE DECEASED 1 FULL Clyde Shaw Sr. 2 FULL Jesse Wendhan 4 FULL Wanda Glisson Status of Block: 16 Lot: 9 (to the South) SPACE BURIAL TYPE DECEASED 1 FULL Weisalw A. Sobiech 2 FULL James Johnson 3 FULL Mellie Riley Please let me know if this is enough time to have the staking done and what color flag you will be using or if you need additional information. Stacy Keenan Clerk Specialist - ORLS (727)562-4097 BURIAL PERMIT To: Cemetery Caretaker Permit No. Clearwater, FL Date: ©(p - \ o -,qoo Date of Birth: o cA -0) - I g I k Date of Death: U Co - i eb - awS Permission is hereby granted for burial of:t aC?n'y'?"G (?Ccm ?? 2 PLEASE CHECK ONE (Very Important) URN FULL Name of deceased: ?t jr A-ni frA (JJO rn kyle Owner of Property: &- r 1UH-e-- Dea-n-- I K.wqh r Space: Lot: _f Block: (_ Clearwater Cemetery. Funeral Home: I''1 6s 1=eG5f-e.r Funeral Director: Deb l?Gv ?S Date of Burial: -)?xJu.rd aj-i 0005- Time: r t (A PM) Staking Fee $ 3(7),0b Paid Date: , CITY OF CLEARWATER (lb/dbf/plat/call 6579 & fax to 6551 (Parks & Rec) By: ? ALSO EMAIL TO: JoEllyn King, Brian Murphree (cell if needed 224-7105) S:\Records\CEM\BURIAL PERMIT.doc