Chauncey, Robert• Cemetery Call Work Sheet
Date:
Funeral Home / Monument Company: Moss ???
Contact Name:
Tel. #: 5&a.-
Reason for call: C?'Ztvl--t?
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Deceased Name:
lltrtl? : bol- 0-11
Date of Birth: 3 3 Date of Death (- / 19 / o
Fax #: 5C a- -Lo-7 3
l are.
• Block 15 Lot 2-Lt Space _I
Owner of Plot: 0,LXvt«, ? .borof " U4Lc4.,h G
Interment: (One full burial and one urn, or two urns per space)
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Full Burial Urn Space V--? (x>","+ e'7°? f?K'j- tV
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$30.00 Staking Fee - received on: / a Lf l 1 °
6
Date of Burial: 10 Time: a: oo am'n--m?
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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Crystal Reports Viewer
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E f t F1 1 Main Report 100%
Status of Block: 15 Lot: 24 as of 06/21/2010
INTERMENTS:
SPACE BURIALTYPE
2 FULL
4 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECL DECF DECM BIRTH DEATH I
CHAUNCEY DOROTHY 5/15/1929 02 / 27 / 2003 3.
PAPPAS ANNA E 10/24/1900 02 / 20 / 1985 2.
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LaCosse, Judith
From: LaCosse, Judith
Sent: Tuesday, June 22, 2010 2:30 PM
To: Wells, Alexis
Cc: Sprague, Nicole; Gilmore, Stephanie; Vaughan, Karen
Subject: RE: Staking Request
Thank you. I will notify Moss Feaster Funeral Home.
Judith LtWosse
Stec . f Asst.
Official Records & Le( gislative Services
727-562-4093
From: Wells, Alexis
Sent: Tuesday, June 22, 2010 2:10 PM
To: LaCosse, Judith; Taylor, Joe
Cc: Tokar, Mark; Sprague, Nicole; Gilmore, Stephanie; Vaughan, Karen
Subject: RE: Staking Request
The plot has been marked with yellow flags
From: LaCosse, Judith
Sent: Monday, June 21, 2010 2:35 PM
To: Taylor, Joe
Cc: Tokar, Mark; Wells, Alexis; Sprague, Nicole; Gilmore, Stephanie; Vaughan, Karen
Subject: Staking Request
Importance: High
Hi Joe,
We received a call this afternoon from Moss Feaster requesting a staking for a urn burial for:
Robert Chauncey in Block 15, Lot 24, Space 1, who passed away on June 19th. His wife, Dorothy Chauncey, is buried in
space 2.
Other burials nearby in Blk 15, Lot 24:
Space 4 = Anna Pappas - Full burial
Staking is needed for burial this Saturday. June 26`h at 2:00 P.M.
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith L uCosse
Stuff ASSf.
Official Recoi-ds & Lenislutive Services
June 22, 2010
Attn: Paul
Funeral Home: Moss Feaster
Fax: 727-562-2073
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Robert Chauncey
Gravesite: Block 15, Lot 24, Space 1
Urn Space
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 2 = Dorothy Chauncey - Full
Space 4 = Anna E Pappas - Full
Staking Fee: 30.00
Please make check payable to: City of Clearwater
Mail to: City of Clearwater
Official Records Dept. - 2nd Floor
112 S. Osceola Ave.
Clearwater, FL 33756
Please contact me with any questions.
Thank you
' ''4.
?'d Sith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4090
Moss Feaster Funeral Home (4673) Gelco Check Number 13460394
0134603946
693 South Belcher Road
Clearwater FL 34624 USER ID ISSUE DATE
bencifcl 6/21/2010
PAY TO THE NOT VALID AFTER SIX (6) MONTHS FROM ISSUE DATE
ORDER OF City of Clearwater
8 6ecuriry reamres
Details on back.
112 s. Osceloa Avenue t ded.
Clearwater FL 33756
Thirty Dollars And No Cents*************************************************' $***30.00 I
NOT VALID FOR OVER $5,000 NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
PAYABLE THROUGH 78.858 Paul MacLaren
First PREMIER Bank 914 By signing this instrument, the aforesiggned confirms that this instrument has been drawn in accordance with the authority issued by Gelco Information Network, Inc. II any
SIOUX FALLS, SD statement herein be untrue, we, the af( resigned, agree to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement.
1110 L3460394611' ??-09L40851B51: 2 5000006 5 511'
SIGNER Paul Mac LarenUSERID bencifcl 01 3 4 6 0 3 9 4 6
DESCRIPTION
City of Clearwater
112 s. Osceloa Avenue
Clearwater FL 33756
DATE LOCATION NUMBER GL CODES CONTRACT NUMBER NAME/ DESCRIPTION AMOUNT
6/21/201 4673 8405-0 467301001218 Chauncey/staking fee $********30.00
BURIAL PERMIT
CLEARWATER CARETAKER
CLEARWATER, FL
Permission is hereby granted for burial of:
PERMIT # 2615
June 25, 2010
Name of Deceased: ROBERT CHAUNCEY Burial Type: URN
Owner of Property: ROBERT CHAUNCEY & DOROTHY CHAUNCEY
Block : 15 Lot: 24 Space: 1 Date of Birth: February 26, 1933
Date of Death: June 19, 2010 Date of Burial: June 26, 2010
Funeral Home Director: PAUL - MOSS FEASTER
Time: 14:00 Staking Fee: 30.00 Date Paid: June 24, 2010
Clearwater Cemetery
B k t ?a C