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Prater, Rosa N3 Date: / 1 / a-oa� Funeral Home / Monument Contact Name: Reason for call: Cemetery Call Work Sheet coir t-tt_ Company: Va Co Son) P-f #: F�a-1- 5')71- 'fa a - re Tel. Fax a-)-14 - 39 — Staking Request (Interment/Disinterment) #: to 81 l°l1 l Sf, 1,1.0 i FL 3 3 1.3 Affidavit (Burial Rights) Monument (Marker) being placed (No fee for staking of monument) For: Block Lot Space Date: / / Time: (Send email to P&R) Verifying Burial space Other reason: Interment: (One full burial and one urn, or two urns per space) bo4ia. it „-1-24, 4o- L (. .Q S4. N• 'Prc.ter h� '� nOr1dk veuc • c Full Burial Owner of Plot: Deceased Name: Urn Space Rosa. ►J . Pr- ter - Block a- Lot I Space 4 Date of Birth: 9 / `r / (1'f-3 Date of Death Date of Burial: 3 / t' / aoa.d C. .. /d l / .D.0<;.‘c. Time: q:30 $30.00 Staking Fee (Funeral Home) - received on: p1-&1tr.] ir 3 / 1(0 / go 2-o ! CcjL .ifem-‘- ri, trate• Copy of permit emailed to Mark Tokar, cc: Matt Anderson/P&R on: 3 /j3 / ao 3o Disinterment: The following authorization should be obtained prior to disinterment: 1.) A disinterment permit and burial/cremation transit permit 2.) Written authorization from the individual(s) who currently own the burial rights for the plot; and 3.) Written authorization from the individual(s) who would be permitted to authorize burial Revised 11/15/17 LaCosse, Judith From: Chaplinsky, Timothy Sent: Tuesday, March 17, 2020 11:23 AM To: LaCosse, Judith Cc: Anderson, Matthew; Brigman, Nathan; Vaughan, Karen Subject: Re: Clearwater Municipal Cemetery Staking Request Pink flags east side of cemetery. Space 4 seems vacant ,Gussie must be sharing space 3. Get Outlook for iOS From: LaCosse, Judith <Judith.LaCosse@myClearwater.com> Sent: Monday, March 16, 2020 9:17:59 AM To: Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com> Cc: Anderson, Matthew <matthew.anderson@myclearwater.com>; Brigman, Nathan <Nathan.Brigman@ MyClearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com> Subject: Clearwater Municipal Cemetery Staking Request Good Morning, We received a cemetery staking request this morning from a Vault Company who will be doing an urn burial. Please stake Block 12, Lot 11, Space 4 Deceased Name: Rosa N. Prater - DOB: 9/4/1943 DOD: 1/29/2020 Note: This space already has an urn burial (Gussie Catrett) Other burials nearby in Block 12, Lot 11: Space 3 = Johnnie M. Catrett — (full burial) Space 4 = Gussie Catrett — (urn burial) The burial is scheduled for this Friday, March 20th at around 9:30 a.m. Please let me know the color of the flags being used so that 1 could notify the vault company. Thank You. Judith LaCosse Staff Asst City of Clearwater ORLS Dept. 727-562-4093 1 40 RecV.. 84:218395 FO Rec?- Q 41 DS q CEMETERY DEED ?$s PACES $8O 16 Pos___-r?-4-; p?3 Int ...?....wr Cotat___--D Tot J u UTHIS INDENTURE; Made this 12 th day of October A. D., 198 4 between the city of Clearwater, Florida, a municipal corporation created and existing under the laws of the State of Florida, party of the first part, and Rosa N. Prater ' whose mailing address is: 7018-Darien Way, Clearwater Florida 3 3 5 4 6 of the County of (Pine 11 a s , State of F l or i d a , party of the second part; W I T N E S S E T H : That the said party of the first part, for and in consideration of the sum of $ 2 0 0 . 0 0 to it in hand paid by the said party of the second part, the receipt whereof is hereby acknowledged, has,. remised, released, and quit-claimed, unto the said part Y--- of the second part, and her heirs forever, all the right, title and interest, which the said party of the first part has in and to the following D Lot 11 described parcel of land, lying and being in Pinellas County, State of Florida to wit: Space Block 12-- Clearwater Cemetery, as recorded in Plat Book S 0 Page - 3 Public Records of Pinellas County, Florida. This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written consent of the Grantor, and to the furthcfhe nd ulies andt resaid gulations rty shall be the City of Clearonly waterr may adopt cemetery pertaining human burial sites and is also subject to such to use of said described property. is iS653880 44 1. 170 41 0.4$ TO HAVE Al D TO HOLD the same to the only proper use, benefit, and behoof?of4 said part TOTAL of the second0 C Documentary Tax Pd. $. • • • • • • • ••• • ` • • "" part her _ heirs and assigns forever. $ Intangible Tax Pd. •• Kar F. De 131aker, Clerk, ',nclias ?ounh Q?I pep t IN WITNESS these presents to be execgted said City of dear', ?l?gor`ation, ?i s Clem caused WHEREOF, in its name by its Mayor Commissioner, by its. ftE3Ptag0f,. ?,f'"a U attested and its corporate seal, affixed by its City i © C CC GG ?S e J cn ?f Eta -- CY 7 ?.t e-°F I° Z Z Z 0 O Q o o C; M W U Z W LL W LL O W O co o L.? Z O d cr U U) w 0 w Q U W W LL U' Z Y (00/l0 6000-HOO