Crosby, MargaretCemetery Call Work Sheet
Date:
Funeral Home/ Monument Company: M° s s ?eer
Contact Name: T?. 1
Tel. #: S(. a - )-o') o Fax #:
Reason for call: Z?f? e o / ?"?? 6 • Cr o s
Deceased Name:w•?
/ a / aO o Y
Date of Birth: 3 / a,/ ('W. Date of Death Ix
Block ?S Lot a3 Space 'Cva?G?.?) &", 3 (FLU)
Owner of Plot: 5 2°r C', os?y (owe ?) _ M? G• eros6?_(oc,? a)
Interment: (One full burial and one urn, or two urns per space)
Full Burial ? Urn Space
$30.00 Staking Fee - received on:
Date of Burial: /!A !) ? Time: aL to 'cD 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)
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Crystal Reports Viewer
1 / 1 Main Report iss
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Status of Block: 15 Lot: 23 as of 12/29/2009
INTERMENTS:
SPACE BURIALTYPE
1 FULL
2 FULL
3 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
2 FULL
DECL DECF DECM BIRTH DEATH 1
DANIELS CURLEY 9/25/1899 12 / 05 / 1982 1:
TONGEL NANCY R 10/30/1931 11/27/1982 1
CROSBY J. ROY 12/20/1919 09 / 22 / 1998 9,
Vol C C-
L -7
TONGEL NANCY R 11/27/1982 10 / 30 /
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Cemetery Tracking System
Page 1 of 1
" `"A a.¦ Good Afternoon! Today is Tuesday, December 29, 2009 Home I Feedback
III T1tq?ET
Fs Cemetery Cemetery Tracking System - View Lot Profile
:.j File
Block: 15 Lot: 23
Transaction
View Lot Profile E Profile Summary
-i Reports
Print Burial
Permit
Search Names and
Notes
Search Old
Locations
Print/View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List of
Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Permits List by
Location
PRBurial
s
1u1 Maintenance
Control Data
Valid Locations
Security
[ Previous Page I
Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on
the second grid to view the interment details of that individual.
WEST SIDE OF MYRTLE AVENUE
Space
Owner Last
Owner First -------------
Owner Middle
Max Interred
Total Assigned
Interred
1 BRYANT ALTAMESE 1 1 1 View A.ssigned
2 SIVILLO KATHY 1 1 1 View.Assi.gned
3 CROSBY J ROY 1 1 1 View Assigned
4 CROSBY J ROY 0 0 0 View Assigned
1
Updated on Tuesday, January 06, 2009
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http://intranet 1 /Apps20/cemetery/viewlotprofile. aspx?b=15 &1=23 12/29/2009
011305 21 C Branchpayr'u 1-(800) 444-6899 Another service of Gelco tnformat- Network, Inc. Eden Prairie, MN 60522000 03
Moss Feaster Funeral Home (4673) Gelco Check Number 13239436 0132394365
693 South Belcher Road
Clearwater FL 34624 USE. 10 ISSUE DATE
wellsjh 12/30/2009
PAY THE NOT VALID AFTER SIX (6) MONTHS FROM ISSUE DATE
ORDER OF City of Clearwater se<?r„Y,ea,?res
112 s. Osceloa Avenue
Clearwater FL 33756
Thirty Dollars And No Cents************************************************* $***30 00
NOT A7 FOR'f77$5,000 NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
._... ._ _._._?
SIGNATURE OF DRAWERS AUTH
78 ORIZED REPRESENTATIVE
PAYABLE THROUGH Phi 1 ip ra
-858
First PREMIER Bank 9144 By signing this instrumen aforesiggned cc s at this instrument has been drawn in accordance with the authority issued by Gelco Information Network Inc It any
SIOUX FALLS, SD statement herein be untrue, we, the aforesigned, es to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement.
1110132394365,I' 1:090,085851: 2500000ESSI1'
sicNen Philip Gray useRlo wellsjh
01 323943f 5
DESCRIPTION
City of Clearwater
112 s. osceloa Avenue
Clearwater FL 33756
DATE LOCATION NUMBER GLCODES CONTRACT NUMBER NAME/ DESCRIPTION AMOUNT
12/30/200 9 4673 8405-0 467301001089 Crosby - Staking Fee $********30.00
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Cemetery Call Work Sheet
Date:
Funeral Home/ Monument Company: ?-( uz s Tc . t
Contact Name: e7aw-/--?
Tel. #:Fax #:
Reason for call: ??Gu Si.,
16-5 O n&CAVAjrVWP-
Deceased Name: ?ACL! ae OKLAa
Date of Birth: P 1 Date of Death
. Block 15 Lot Space
Owner of Plot: .? R? ?XeS b? f
Interment: (One full burial and one urn, or two urns per space)
Full Burial ? Urn Space T? s?' " $30.00 Staking Fee -received on:
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
0 Monument Being Placed: (No Fee for Staking of Monument)
at . Cemetery Tracking System
N1 \'v ET Geod Morning! Today is Friday, January 22, 2010
Cemetery
File
Transaction
View Lot Profile
•.
C
Reports
Print Burial
Permit
Search Names and
Notes
Search Old
Locations
Print/View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List of
Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Permits List by
Location
PRBurial
Maintenance
Control Data
Valid Locations
Security
[ Previous Page ]
Page 1 of 1
Home I Feedback
Cemetery Tracking System - View Lot Profile
Block: 15 Lot: 23
Profile Summary
Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on
the second grid to view the interment details of that individual.
WEST SIDE OF MYRTLE AVENUE
Space Owner Last Owner First Owner Middle Max Interred Total Assigned Interred
1 BRYANT ALTAMESE 1 1 1 Vlew Assigned
2 SIVILLO KATHY 1 1 1 Vi..w_A.s..si.gned
3 CROSBY J ROY 1 1 1 View Assigned
4 CROSBY J ROY 2 1 1 View_A..s..signe...d..
t
Updated on Tuesday, January 06, 2009
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[ Top of Page ]
1/22/2010
Date: 3 / /(o / -1-0 /'P
Cemetery Call Work Sheet
Funeral Home / Monument Company:
Contact Name:
Tel. #: 3 5 a- i 3(- - b a S S Fax #:
Reason for call: ?-ko?-r?e-s `? -1,?c L'Afi-IG-0 _ -
Deceased Name: 1`'??a Cr o s L
E
Date of Birth: Date of Death
• Block /S Lot 2-3 Space `? Spw« 1 -Jw"^.c-Qsl? d-
Owner of Plot: °y CG,S3- Crns?y 'T.
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee - received on: -/-/,
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)
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