Williamson, Lisa•
Date: t° / S
Cemetery Call Work Sheet
Funeral Home/ Monument Company:
Contact Name: L-4-5A. W;1kA"Zm'5ew
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Tel. #: 935-- 3-gol
Reason for call
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Deceased Name:
Date of Birth: Date of Death
• Block a- Lot 51t Space _ No c7a 4% ces"Aatid y J"A
Owner of Plot: Miry .8Q4-wks
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)
Fax #: --hcyf'-ogV- wikj Sf '%
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Crystal Reports Viewer Page 1 of 1
• ° 1 / 1 Main Report 100%
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Status of Block: 12 Lot: 54 as of 10/06/2010
INTERMENTS:
SPACE BURIALTYPE
1 FULL
2 FULL
3 FULL
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
DECL DECF DECM BIRTH DEATH INTERRED
KAUER ELIZABETH C 1/1/1876 05 / 23 / 1961 5/23/1961
CARPENTER FORREST E 1/1/1901 01/13/1962 1/13/1962
BLANKS FERLIE 7/2/1920 05 / 06 / 1961 5/10/1961
Page 1 of I
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http://msb-crystal-ent/businessobjects/enterprise 11 /infoview/viewers/rpt/DHTMLV iewer.aspx?skin=skin... 10/6/2010
LaCosse, Judith
From: LaCosse, Judith
Sent: Tuesday, October 26, 2010 1:05 PM
To: 'fancyfrog@windstream. net'
Subject: FW: Cemetery Matter
Importance: High
Hi Lisa,
Per our telephone conversation yesterday, I'm attaching a copy of the Consent to Conveyance form for you to review
and get an idea what it states and the information that we're going to need in order to complete the form.
I have also attached a copy of an affidavit form which is simpler if your mother in law just wants to grant interment
rights to her sons in space 4 of Block 12, Lot 54.
These are just samples and if you have any questions, please give me a call.
Conveyance-CemetAFFIDAVIT-Williams
ery Lot-Willia... on.doc
Best regards,
Judith LaCosse
Stuff Asst.
Official Records & L egislntive Services
727-562-4093
From: LaCosse, Judith
Sent: Friday, October 08, 2010 4:18 PM
To: 'fancyfrog@windstream.net'
James ?
Odell 13l?Lk.ks
1500 NU 65-f4 St,
FruP ?h?s
as I y ? ? ? ???. ?-t
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Subject: Cemetery Matter
Importance: High ?>,-a
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Hello Ms. Lisa Williamson, Cep.-eJery Lv ?o
-+-U 40 K-31 ----o .
First of all I checked our cemetery program and we're showing that the two spaces owned by your mother in law, Mary V?,tll I
K. Blanks Williamson are spaces 3 (B) & 4 (A) in Block 12, Lot 54. We don't have a copy of the deed in our files but the ?p
cemetery program does show Ms. Blanks Williamson as the owner. P`
You mentioned per our telephone conversation that your mother in law would like to transfer the vacant space, which is
4, to her two sons. Ferlie Odell Blanks is buried in space 3.
We will be sending Ms. Blanks Williamson a Consent to Conveyance form in order to have space 4 under the name of
her son(s), but we need additional information in order to complete this document.
- Address of Ms. Blanks Williamson
- Names and addresses of her two sons
1
Is the space going to be under both sons or just one?
If Ms. Blanks Williamson just wants to grant interment rights to her sons, we just need to have an affidavit
completed
Please advise and I you have any questions, please give me a call.
Thank You.
Judith LaCosse
Stir. . f'Asst.
Official Records & Legislative Services
727-562-4093
January 21, 2011
Mary K. Blanks Williamson
9060 Northwest 33`d Terrace
Branford, FL 32008
Re: City of Clearwater Municipal Cemetery
Block 12, Lot 54, Space 4
Dear Mrs. Williamson:
Enclosed please find the Consent to Conveyance document to transfer ownership to your
two sons to the above referenced cemetery space.
We need your signature on this document as well as two witness signatures and their
addresses. We also need to have this document dated and notarized.
Please return the completed document to my attention at your earliest convenience. We will
then have the appropriate officials sign the bottom Consent to Conveyance portion and the
document will be sent to the Pinellas County Courthouse for recording.
After the document gets recorded with the County we will send you a copy for your records.
We will then update our records in our Cemetery program to reflect this information.
If you have any questions please give me a call at 727-562-4093.
Sincerely,
Judith LaCosse
Staff Assistant
Enclosure
CONVEYANCE-CEMETERY LOT
THIS INDENTURE is made this day of 2011,
between Marv K. Blanks Williamson as Grantor
whose mailing address is 9060 NW 33r Terrace, Branford, FL 32008 of the
County of Gilchrist State of Florida , and sons. Odell Blanks and Fred
Blanks , as Grantee(s):
WITNESSETH: That the said Grantor transfers ownership to Grantee(s)
and has remised, released and quit claimed unto the said Grantee(s), 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: Block 12 Lot 54 , Space(s)
4 Clearwater Cemetery, as recorded in Plat Book 60 , Page 30 ,
Public Records of Pinellas County, Florida.
This Conveyance is subject to the condition that Grantee(s) 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(s) and heirs and assigns
forever.
IN WITNESS WHEREOF, said Grantor has signed and sealed these presents on the day and year first above written.
(Grantors name.) (Grantors address.)
Mary K. Blanks Williamson
(Witness (2) Signed, Sealed and Delivered
in the presence of us.)
By:
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Acknowledged before me on this
to me or has produced
9060 NW 33`d Terrace, Branford, FL 32008
(Witness) names and addresses)
2011, by
who personally known
as identification and who did take an oath.
Notary Public
day of
CONSENT TO CONVEYANCE
The City of Clearwater, Florida, a municipal corporation, hereby consents to the conveyance of Block 12 Lot
54 , Space(s) 4 , Clearwater Cemetery, from the Grantor, to the Grantee(s).
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor, by its City Manager,
and to be attested and its corporate seal affixed by the City Clerk on the day and year first above written.
Countersigned: CITY OF CLEARWATER, FLORIDA
Frank V. Hibbard, Mayor
Approved as to form:
Leslie Dougall-Sides, Assistant City Attorney
William B. Horne, II, City Manager
Attest:
Rosemarie Call, City Clerk
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me personally appeared Frank V. Hibbard, the Mayor of the above named city, who acknowledged that he executed the
foregoing instrument. He is personally known to me and did not take an oath.
WITNESS my hand and official seal this day of 2011.
Notary Public
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me personally appeared William B. Horne, ll, the City Manager of the above-named city, who acknowledged that he executed
the foregoing instrument. He is personally known to me and did not take an oath.
WITNESS my hand and official seal this day of 2011.
Notary Public
9700-0031
Rev. 01/2011
CITYOFCLEARWATER
Inter-department Correspondence
ivet
MM 2-011.1
City Attorney
TO: Legal/City Manager
FROM: Official Records & Legislative Services
SUBJECT: Cemetery - Consent to Conveyance
Mary K. Blanks Williamson - Block 12, Lot 54, Space 4
DATE: March 21, 2011
The attached document needs city official signatures and also needs to be notarized. The original
will be sent to the courthouse for recording.
Please return to my attention.
Thanks,
Judith LaCosse
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CITY OF CLEARWATER
_ y POST OFFICE BOX 4748, CLEARWATER, FLORIDA 33758-4748
QA CITY HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 33756
. ...„TELEPHONE (727) 562-4090 FAX (727) 562-4086
'goy. 1 i+y 9 f
OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
April 7, 2011
Mary K. Blanks Williamson
9060 Northwest 33rd Terrace
Branford, FL 32008
Re: City of Clearwater Municipal Cemetery
Block 12, Lot 54, Space 4
Dear Ms. Williamson:
Enclosed please find the original recorded copy of the Conveyance-Cemetery
Lot document which was recorded with Pinellas County on April 1, 2011. This
document transfers ownership of Space 4, Block 12, Lot 54 in the City of
Clearwater Municipal Cemetery to your sons, Odell Blanks and Fred Blanks.
Our Cemetery program and files have been updated to reflect this information
and a copy of the Conveyance-Cemetery Lot document is in our files.
If you have any questions, please give me a call at 727-562-4093.
Sincerely,
'udith LaCosse
Staff Assistant
Enclosures
TQUAL EMPLOY?NEN1' AND AFFIRMATIVE ACTION EMPLOYER"