Burke, Betty W
Cemetery Call Work Sheet
01-*11 -
Date: lhgjo
Funeral Home: _?i1,h(.it'l5 G'-bbl ko 6t jj Monument Company: ick(1,U, 11fioi?,YIei 4
Contact Name: i?et l Contact Name:
Tel. #: (AP7 - f?C150 Tel. #:
Fax #:
Fax #:
RE: IM1CE???1t?Tf 1?1CN?11Y -Iyl-(?Vy Sr?? t`???i?zvLk_ (tqj3)6>"7'
C? E? - (?13) "L - 7a ? Q? ,r? `:? n ' rn i 11 (alCau C( I?1 ?f ?(X1ce C' bin-ci6,C.
Il1tbafj l? t Abl ulal Twu VU 1,11 faLc ??lL ' toy- i4i,IC4
Deceased Name: t? Y? Ul i? it DOD: -21'4 icy DOB: ° Z Z3
Owner of Property: 0-It 1t-0
Block 'D Lot 3C
Interment: ?/
Full Burial:
($30.00 Staking Fee) - (One full burial and one urn, or two urns)
Date of Burial: 11 ( fto 0.kx _) Time: am/pm
Disinterment:
Urn Space:
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)
S:/Jlacosse/Cemetery Call Work Sheet.doc
Space I )--
6/8/04
Alfaro, Rosemarie
From: Alfaro, Rosemarie
Sent: Wednesday, August 11, 2004 10:37 AM
To: King, JoEllyn; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie
Subject: RE: Cemetery Issue - Re: Betty Burke
fyi - Apparently the remains of Mr. Grundy (urn) were found in Space 12 during the interment service. They have placed
Betty Burke's remain in the same space. This information will have to be corrected as well as the future burial note.
Rosemarie
-----Original Message-----
From: King, JoEllyn
Sent: Wednesday, August 11, 2004 6:51 AM
To: Alfaro, Rosemarie; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie
Subject: RE: Cemetery Issue - Re: Betty Burke
It is taken care of and marked with purple flags.
-----Original Message-----
From: Alfaro, Rosemarie
Sent: Monday, August 02, 2004 10:28 AM
To: King, JoEllyn; Norman, Lois; Chase, Susan; LaCosse, Judith; Kaushal, Mona; Reehling, Dottie
Subject: Cemetery Issue - Re: Betty Burke
Jo Ellyn:
Request for staking - the interment will take place on Wednesday, August 11; to be staked Aug. 10
Betty W. Burke
Block 5, Lot 30, Space 12
Located in the Grundy plot: between Ada Mae Davis (space 13) and Giralda K. White (space 11); Myrtle
McMichael Loesher is adjacent to the empty lot (space 5)
Thank you.
Rosemarie
Alfaro, Rosemarie
From: Alfaro, Rosemarie
Sent: Friday, July 30, 2004 10:57 AM
To: Norman, Lois; LaCosse, Judith; Chase, Susan; Kaushal, Mona; Reehling, Dottie
Subject: Cemetery Issue
Re: Interment of Betty W Burke (urn space)
Block 5, Lot 30, Space 12
Spoke with Brenda Burke today - the family is not sure if the memorial service and interment will take place at the same
time. She will be calling later this afternoon with a definitive answer. Could possibly take place on August 6th.
I have not contacted Jo Ellyn yet - waiting for confirmation.
Norman, Lois
From: Norman, Lois
Sent: Tuesday, May 04, 2004 3:02 PM
To: Norman, Lois
Subject: Future burial - urn - Betty Burke
Brenda Burke, daughter of Betty Burke has been calling to set up a future interment of an urn. Betty Burke is the daughter
of H. Grundy (owns Block 5, Lot 30, Spaces 12, 13, 14 and 15). The cemetery pending file in the vault has a copy of the
death certificate of Herbert Grundy and a US Naval Servie Coast Guard Notice of Separation showing Betty Grundy; then
a Veterans Affairs statement for Betty Winifred Burke, connecting her identification as Betty Grundy.
Space 14 will be for placement of an urn for Betty Winifred Burke. Mrs. Burke's son has terminal cancer and will be one
urn (additional) in Space 14 at some future time.
The interment for Betty Burke has not yet been done.
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OFFICE of VITAL STATISTICS
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Clearwater
City of Clearwater, Florida
Official Records and
Legislative Services Department
Phone (727) 562-4090
Fax (727) 562-4086
FAX MESSAGE
TO: Brenda Burke
LOCATION: Tampa, FL
FAX NO.: 813 839 6201
COMMENTS: See attached VA Form 40-1330 re Betty Winifred
Burke marker request. Thank you for the other
copies you supplied.
FROM: Lois Norman, (727-562-4091)
DATE: 4/28/2004
NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2
Fax From: Brenda Burke April 28, 2004
Attached: 1. Department of Veterans Affairs application for
government headstone
2. Office of Vital Statistics-Certlficate of Death (Burke)
3. Notice of Separation-Coast Guard (Grundy)
Regarding: Betty Winifred Burke
(Formally Betty Winifred Grundy)
Re: Burial plots originally purchased by Herbert and A. Mae (Davis)
Grundy at Clearwater Cemetery
Department of Veterans Affairs-type of headstone (upright granite)
permitted in Clearwater Cemetery area owned by the Grundy family
Fax to: City of Clearwater
Attention: Lois Norman *** (Thank you Lois for all of your help.)
Fax #: 727-562-4086
Kindly sign Department of Veterans Affairs application for
government headstone, # 24 and fill in # 25 and 26 (# 27 if there are
remarks) and return to:
Brenda Burke
4007 Knights AV
Tampa, FL 33611-1357
Phone 813-837-2535 or cell 813-892-5738
Form, approved, OMB No. 2800.0222
Resoondsnt Burden: 16 minutes
IMPORTANT: Please read the General Information Sheet before completing this form. Type or
' print clearly all information except for signatures. Illegible printing could result in an incorrect
QUEST
7 headstone ormarker or delivery, Blocks outlined In bold are optional Inscription items. Unless
P'Irst time) REQUEST indicated otherwise all other blocks must be completed. MILITARY DISCHARGE
REQUEST
SECOND DOCUMENTS OR RELATED SERVICE INFORMATION IS REQUIRED,
? CORRECTED APPLICATION/REPLACEMENT
2. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (NO NICKNAMES OR TAMES PERMITTED) 3. CHECK BOX BELOW IF REMAINS ARE
FIRST (Or InltlaJ) MIDDLE (Or Initial) LAST SUFFIX NOT BURIED AND EXPLAIN
BLOCK 27 (e. g., [apt of sea, remains
sc tered, etc.)
W1 Nt 9, U P, Vve REMAINS NOT BURIED
VETERAN'S SERVICE AND IDENTIFYING INFORMATION (Vgenumber#only, cg,, 05-154941)
4, VETERAN'S SOCIAL SECURITY NO. OR SERVICE NO, (failure to complete PERIODS OF ACTIVE MILITARY DUTY (For addirlonal space use Block 27)
will delay pro-sing.)
^ n
BA. DATE(S) ENTERED
BB. DATE(S) SEPARATED
? I
r ? ? .D- . MONTH DAY YEAR MONTH DAY YEAR
BA. DATE OF BIRTH 150. DATE OF DEATH 0 09 43
f 0C
J ' l<
`
R YEAR U o ?
YEA
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7. HIQHEST RANK ATTAINED (No pay grades) 8, BRANCH OF SERVICE (Check bar(es) - must be consistent with rank (Bar 7))
D G(, ft55
M(,tSlCi AN TNtR MARIE OAST ARMY MEp?HANT OTHER D AIR
RINE ?Spec[Jy)
ORCE
FOR ES
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9. VALOR OR PURPLE HEART AWARD(S) (Documentation mull be p?arided) 10, WAR SERVICE (Check applicable boz(es))
BRONZE
MEDAL OF DST SVC NAVY AIR FORCE SILVER STAR PURPLE OTHER WORLD PERSIAN OTHER
HONOR CROSS CROSS CROSS STAR MEDAL HEART is ecjfy) WAR 11 KOREA VIETNAM GULF clJj)
S Des V PH II 71KO VN
1 1. TYPE OF HEADSTONE OR MARKER REQUESTED (Check one) 12. DESIRED EMBLEM OF BELIEF
WHEEL OF STAR OF
FIAT FLAT UPRIGHT FLAT BRONZE UPRIGHT LATIN CROSS RIGHTEOUSNESS DAVID OTHER (Speei/y)(See reverse oJback copy
BRONZE GRANITE "ARBLE MARBLE NICHE GRANITE NONE Chr/stlan) Buddhist) Judaism) or illustrated authorized emblems)
?B ?G U ?F ?2 V ? 01 ?02 03
13A. NAME AND MAILING ADDRESS (No., street, r.[ry. Stare, and 13B. DAYTIME•PHONE NO, OF PERSON TO CONTACT 1 e, ARE YOU:
-121PViide) OF PERSON, TO CONTACT FOR ADDITIONAL.. - FOR-AD TIONAL INFO.R
INFORMATION -
NEXT OF•KI
-
N
1
FUNERAL V
ETERANS
14. E-MAIL ADDRESS (Optional)
?DIRECTOR SERVICE OFFICER
C
EM
ETERY
p
I
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-, 001 N 1
c
OFF
ICIAL
16. FAX NO. (Options!) ?
OTHER (5pectf'y)
~ 135
CERTIFICATION- I certfty the headstone or marker will be installed in the cemetery listed In block 21 at no expense to the Government and all statements
made are true and correct to the best of my knowledge,
17. SIGNATURE OF PERSON NA APP RS IN BLOCK 13A 18. DATE
LJ
19. NAME AND DELIVERY ADDRESS OF BUSINESS (CONSIGNEE) THAT WILL 20. DAYTIME PHONE NO. 21. NAME AND ADDRESS OF CEMETERY WHERE
ACCEPT PREPAID DELIVERY (No., Street, City, State and ZIP Code); P.O. BOX (Include Area Code) GRAVE IS LOCATED (No., Street, City, Slate and
IS NOTACCEPTABLE ZIP Cade)
CERTIFICATION: I a ee to accept prepaid deliver of the headstone or marker.
22. SIGNATURE OF PERSON REPRESENTING BUSINESS (CONSIGNEE) NAMED IN BLOCK 18 23, DATE
CERTIFICATION: I certl the type of headstone or marker checked In block 11 is permitted In the cemeter named in block 21.
24. SIGNRY OR OTHER E ONSIBLE OFFICIAL 25. DAYTIME TELEPHONE NO. 2e. DATE
(Include Area Corte)
7ZI- 66;(- cat 04 -3C$-A0o
27. REMARK ( ptlonnl Inscrlpllan space will nary /n ,s[¢e arrarding In the type of marker) 29. GRAVE IS!
CURRENTLY MARKED
?
i
h
i
l
(W
t
pr
vate
y purchased marker)
NOT MARKED
STATE VET AAN$' CEMETERY AND GRAVE LOCATION C"neterl Use Onl y)
29. ID CODE 30. SECTION N0.
JAN 2003 IRS) 40-1330 APPLICATION FOR STANDARD GOVERNMENT HEADSTONE OR MARKER
? •
:Clearwater
City of Clearwater, Florida
Official Records and
Legislative Services Department
Phone (727) 562-4090
Fax (727) 562-4086
FAX MESSAGE
TO: Jillian
LOCATION: Affordable Memorials
FAX NO.: 823 1640
COMMENTS: See attached map for Clearwater Cemetery, Block
5, Lot 30, Space 12 (Bet . Burke). The headstone
spot will be marked with white flags on East side of
Cemetery. Please come in from the East gate on the
East side, there is a large tree blocking the road on
the East side. If you have any questions, please
call.
FROM: Lois Norman, (727-562-4091)
DATE: 9/29/2004
NUMBER OF PAGES THIS MESSAGE (INCLUDING THIS PAGE): 2
SEE
SHEET
?I
AVENUE
25 I6 15 6 5
44 [371 281 21 12 5
43 3B 27 22 II 6
29 1 28 1 23 1 22 1 13 1 12 1 7 6
30
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19 14 3
18 15 2
17 16 9 1
I
16 15 6 5
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9 2
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12 1,9
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PROSPECT AVEWE
24 17 14 7 4 18 17,
23 18 13 B 3 19 16
22 I :19:] 1,2 i 9 2 20 ? IS
21 20 I I 0 I 21-_. 14
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20 17 B? 5 J 23 12
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22 15 W 10 3 M 25 10
23 14 II 2 G 26 9
24 13 12 I F 27 U1 8
16 IS ? 5 E 28 7
17 14 7 4 D 29 6
18 13 ?
19 12 ? 3 C F-?O-
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20
21 II 10
24 25 1 A
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33 3
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MYRTLE