Sloan, Edward
• Cemetery Call Work Sheet
Date: 10
Funeral Home/ Monument Company: oc,<J` , Te(,1- ,ie v
Contact Name: TG-tj -7 3
Tel. #: b (D - AM ( Fax #: -
Reason for call: ei&V1W (A=?Q LV C4
Deceased Name: WLGDA Scao
Date of Birth: /L/ Date of Death / ?)?js LL
• Block Lot _A Space A-
?(?? 1
Owner of Plot: V--) ICI o
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee - received on: V C?'? C?
Date of Burial: / ?q/ IL% Time: _ am/prn
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)
•
Crystal Reports Viewer
Page 1 of 1
1 Main Report I 100%
•
Status of Block: 7 Lot: 129 as of 01/25/2010
INTERMENTS:
SPACE BURIALTYPE
i FULL
2 FULL
3 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
•
DECL DECF DECM BIRTH DEATH I
HARRIS LEMUEL G 8/9/1913 01 / 20 / 1942 11
HARRIS SR LEMUELN G 1/1/1889 12/21/1960 1.
HARRIS SALLIE B 1/1/1889 01/12/1977 1,
Page 1 of I
m i ? m 1/1
•
http ://msb-crystal-ent/businessobj ects/enterprise 11 /infoview/viewers/rpt/DHTMLV fewer. a... 1/25/2010
Moss, Feaster Funeral Home (4673) Gelco Check Number 13239477 01 3 2 3 9 4 7 7 9
693 south Belcher Road
Clearwater FL 34624 USER ID ISSUE DATE
wellsjh 1/26/2010
NOT VALID AFTER SIX (6) MONTHS FROM ISSUE DATE
se r
TROFF City of Clearwater 8 dd 3rVfe5
112 S. Osceloa Avenue pP1115O t`k
Clearwater FL 33756
Thirty Dollars And No Cents*********************************************** $***30.00J
NOT VA FOR OVER $5,000 NOT REDEEMABLE FOR CASH BY DRAWERS AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
PAYABLE THROUGH 78-858 Philip ay
First PREMIER Bank 914 By signing this instrument, the aforesiggned con firms that this instrument has been drawn in accordance with the authority issued by Gelco Information Network, Inc. II any
SIOUX FALLS, SD statement herein he untrue we the afores)gned, agree to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement.
11'013239477911' 1:090,085851: 2 500000 6 5 5 1'
sicNEn Philip Gray USER IO we 11 s j h
01 32394779
DESCRIPTION
City of Clearwater
112 s. Osceloa Avenue
Clearwater FL 33756
rE LOCATION NUMBER GL CODES CONTRACT NUMBER NAME / DESCRIPTION AMOUNT
1/26/201
i 4673 8405-0 467301001108 Sloan - Staking Fee $********30.00
I
i
I
CONSENT TO CONVEYANCE
THIS INDENTURE is made this day of 200
between GRACE C. HARRIS, as Grantor and SALLY S. SLOAN,
PURCHASER(S), whose mailing address is 1624 Keystone Court, Clearwater,
Florida 33756 of the County of Pinellas State of Florida, as Grantee:
WITNESSETH: That the said Grantor transfers ownership to Grantee
and has remised, released and quit claimed unto the said Grantee, and heirs
forever, all the right, title and interest which the said Grantor has in and to the
following described parcel of land, lying and being in Pinellas County, State of
Florida, to wit: Spaces one (1), two (2), three(3), and four (4) Lot One 03-028563 JAN-23-2003 3: 13pM
Hundred Twenty-eight (128), Block Seven (7), Clearwater Cemetery, as PINELLAS CO BK 12489 PO 2 143
recorded in Plat Book 60, Page 30, 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 City of
Clearwater, Florida and to the further condition that said property shall be used only for cemetery purposes as human burial sites,
and is subject to such other regulations the City of Clearwater may adopt pertaining to use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and heirs and assigns
forever.
IN WITNESS WHEREOF, said Grantor has signed and sealed these presents on the day and year first above written.
(Granter(s) name:) (Grantor(s) address:) i
t Xi OCC70
Grace C. Harris
(Witness (2) Signed, Sealed and Delivered (Witness) names and addresses) -
in the pr sence of us:)
(?:za
STATE OF Fi oc.r i?r? 1
COUNTY OF i?i?v?i?/?.5 ?
Acknowledged before me on this ? 'day of cCi G4i 20 C?Z, by who personally
known '
to me or has produced ?Q . jt as identification and who did take an oath.
Po ailly Public Mary iano
MYCOMMISSION# CC976267 EXPIRES
October 19, 2004
CONSENT TO CONVEYANCE BONDED ? uuraovrnwiNSUUnNcE.xrc
The City of Clearwater, Florida, a municipal corporation, hereby consents to the conveyance of Spaces one (1), two (2),
three(3), and four (4), Lot One Hundred Twenty-eight (128), Block Seven (7), Clearwater Cemetery, from the Grantor, to the
Grantee.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor Commissioner, by
its City Manager, and to be attested and its corporate seal affixed by the Depu its Clerk on the day and year first above written.
Countersigned: OF CLEARWATER, FLORIDA
By
Brian J. A gst, t r mm si er , William B. Hor ity Manager
Approved as to form( Attest: /
R it Susan Stephenson, Deput City Cle k
r?yan, Ruff, Assistant'City Attorney
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me personally appeared Brian J. Aungst, the Mayor-Commissioner of the above named city, who acknowledged that he
executed the foregoing instrument. He is personally known tRme and did not take an oath.
WITNESS my hand and official seal thiso7'?'`-?'day of 20 dal
?dQ4A 't l1UFjuC . EC1. OF HLCI ? l?
CAR`.OIYIJ L BRINK
CUi)9i IS,"NON # CC834678
r xt [t'r'S 5/2212003
<?•88J-NOTARY? Notar Public
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me personally appeared William B. Horne, Il, the City Manager of the above-named city, who acknowledged that he
executed the foregoing instrument. He is p?rsoXIIy known tom and did not take an oath.
WITNESS my hand and official seal this day of 20 0a.
vrict 3;,;:,s Notar Public
't'.wCIIN1CEY-DO_C _ L'ci iy or ?r- 9700-0031
IVI v t?7 Rev. 5/96
CONSENT TO CONVEYANCE
f
THIS INDENTURE is made this if
day of 200
between GRACE C. HARRIS, as Grantor and SALLY S. SLOAN,
PURCHASER(s), whose mailing address is 1624 Keystone Court, Clearwater,
Florida 33756 of the County of Pinellas State of Florida, as Grantee:
WITNESSETH: That the said Grantor transfers ownership to Grantee and
has remised, released and quit claimed unto the said Grantee, and heirs forever,
all the right, title and interest which the said Grantor has in and to the following
described parcel of land, lying and being in Pinellas County, State of Florida, to wit:
Space four (4) Lot One Hundred Twenty-nine (129) Block Seven (7)
Clearwater Cemetery, as recorded in Plat Book 60, Page 30, Public Records of 03-028564 JAN-23-2003 3 : 13PM
Pinellas County, Florida. P INELLAS CO BK 12489 PG 2 144
This Conveyance is subject to the condition that Grantee herein shall not I I??III ??II? I?III ??II? II??I I??il ?III? 111111111 IN
assign or convey said property without the written consent of the City of
Clearwater, Florida and to the further condition that said property shall be used
only for cemetery purposes as human burial sites, and is subject to such other regulations the City of Clearwater may adopt pertaining to
use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and heirs and assigns
forever.
IN WITNESS WHEREOF, Said Grantor has signed and sealed these presents on the day and year first above written.
(Grantor(s) name.) (Grantor(s) address:) +
t 1
x'c,j LnQI,f; C?C.,'70
Grace Harni w -o
(Witness (2) Signed, Sealed and Delivered (Witness) names and addresses)
in the presence of us:)
;7
STATE OF f?,G, G x?rL> ?) i a r C-
COUNTY OF "?i?f CL-?{.)
Acknowledged before me on this day of 20, by 44- 6 /l,P,r'i who personally known
to me or has produced '/'Y, /y r=°r.',' l` t as rJ /= as identification and who did take an oath.
MY COMMISSION # CC976767 EXPIRES
October 19, 2004
CONSENT TO CONVEYANCE V)NOEO THRU TROY FAIN INSURANCE, INC
The City of Clearwater, Florida, a municipal corporation, hereby consents to the conveyance of Space four (4), Lot One
Hundred Twenty-nine (129), Block Seven (7), Clearwater Cemetery, from the Grantor, to the Grantee.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor Commissioner, by its
City Manager, and to be attested and its corporate seal affixed by the Deputy City n the day and year first above written.
Countersign CITY OF EARWATER, FLORIDA
Bria ungst, a r- ommis ' illiam Borne ' y Manager
G'
Apd as to form Attest: ZI/I
Qyy Susan Stephenson, epu City Clerk
Bryan Ruff, Assist t City Attorney
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me personally appeared Brian J. Aungst, the Mayor-Commissioner of the above named city, who acknowledged that he
executed the foregoing instrument. He is perso Ily known to and did not take an oath.
WITNESS my hand and official seal this ) ''"day? of , 20 OoZ
STATE OF FLORIDA Notary Publ
COUNTY OF PINELLAS)
Before me personally appeared William B. Horne, II, the City Manager of the above-named city, who acknowledged that he executed
the foregoing instrument. He is personally knovty to me and d" not take an oath.
WITNESS my hand and official seal thia_ day of , 20 0 a
CONVEY.DOC
Notary P blic
s I A i'C OF FLORIDA
?;l OLYN L. SRINK
00 ri 46SION a CC834678
EXPIRC'S 512=003
i' ,d ,! ZDT ii';U:,SA1-JD3-NOT?.R'Y
9700-0031
Rev. 5/96
CITY OF CLEARWATER
POST OFFICE BOX 4748, CLEARWATER, FLORIDA 33758-4748
CITY HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4090 FAx (727) 562-4086
DEPARTMENT OF THE
CITY CLERK
February 6, 2003
Ms. Sally S. Sloan
1624 Keystone Court
Clearwater, FL 33756
Dear Ms. Sloan:
Enclosed are the cemetery deeds which indicate that you own Spaces one (1), two
(2), three (3), and four (4), Lot one hundred twenty-eight (128), Block Seven (7), and Space
four (4), Lot one hundred twenty-nine (129), Block seven (7) in the Clearwater Municipal
Cemetery. These deeds have been recorded in Pinellas County Official Records Book 12489,
Page(s) 2143 and 2144.
It is important to keep these deeds in a safe place and to make a separate note of the
official record book and page numbers. In the event the original deed is lost or destroyed,
this information will be needed to obtain a copy from the Pinellas County Clerk of the
Circuit Court.
If you have any questions, please contact me at 562-4097.
Sincerely,
Susan Stephenson /
Document & Records Supervisor
ss
BRIAN J. AUNGS'I', MAYOR-COMMISSIONER
WHITNEY GRAY, VICE. MAYOR-COMMISSIONFR Ho%,r HMN11170N, COMMISSIONER
FRANK HIBBARD, COIMMISSIONER BII.I.JONSON, COMMISSIONER
"EQUAL EMPI.OYMGNT ANI) AFFIRM.ATIVIi ACTION EMPLOYFR"
November 7, 2000
AFFIDAVIT
I, Grace C. Harris, the undersigned, do hereby attest that I am the widow of Boyd
Harris, deceased, and the present owner of cemetery property described as Block 7, Lot
128, Spaces 1, 2, 3 & 4.
Please take this letter as your authority to transfer interment rights to Edward M.
Sloan in Space 1; Sally Smith Sloan in Space 2; Arthur Edward Smith in Space 3; and
Barbara Harris Smith in Space 4.
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 interments made at the request of the above.
SIGNATURE
rac C. ar is
20 C elot, Apartment 11
earwa , FL 33763
SWORN TO and subscribed before me this ay of Nd ?ewt?ie? , 2000, by
G racE C. Orr i r S , personally known to me or has made herself known to
me by'7/a deiye-es 1?tKst (identification).
(SEAL) o
BWEN R. HOLDER K ?. o l l4 .?oC 2?
g?
% MY COMMISSION g CC 889274 M commission expires:
EXPIRES: Januoy 13, 2W Y P
.nr.. , Bw ftd Tft Nary Nft WftMM
7d
Cemetery Call Work Sheet
Date: 5 / 3 / ao to
Funeral Home / Monument Company: Cick-RUA- R r%LtftLe.J CL .
Contact Name: ke-vih ?" re:? Uc,,•.,c?,
Tel. #: -7 8 6 - 1 SS I Fax #:
Reason for call: For e ,Zt' ?
Deceased Name: E S Q h
Date of Birth: Date of Death
l a Le ??¢
? e. I _ G. j4a, s
• Block 7 Lot ? Space s
1 - Le G. kotrr?r Si-,
Owner of Plot: w dl 3
Interme (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee -received on: 0"?` A5new
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)
0-
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dL CC),
Vass (=mss
SC c--2 -?o
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