Wesley Ashley, Dale• Cemetery Call Work Sheet
Date: '3119)10,9
Funeral Home/ Monument Company: IN Lk,
Contact Name: k4o ss P S-tC -
Tel. #: SO - ) Dbc) Fax #:
Reason for call: U
Deceased Name: bale UZ51tq rl!S'?ik-,q
Date of Birth: Date of Death .3 115 /
• Block Lot A Space 13
Owner of Plot: ,t La 1 -) hs
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space / 1`
$30.00 Staking Fee -received on: / /er g -? )L-?-j
Date of Burial: _/ Iq Time: am/pm
Disinterment: --J A fO t ? g?L
`J l
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)
•,, -
6 A
•
CITY OF CLEARWATER CLERKS OFFICE
ADMINISTRATOR OF THE CLEARWATER CEMETERY
112 SOUTH OSCEOLA AVENUE
CLEARWATER FLORIDA 33756
ATTENTION: CAMILLE MOTLEY
I, KAY FRANCES HOLLEY, ONE OF THREE SURVIVING LINEAL DESCENDANTS
OF ELIZABETH J. HOLLEY, ORIGINAL OWNER OF THE HOLLEY FAMILY PLOT,
BLOCK 1, LOT 4, SPACES 5,6,7,8,13,14,15, AND 16..D0 HERE BY GIVE
PERMISSION FOR DALE WESLEY ASHLEY, ONE OF THE THREE SURVIVING
LINEAL DESCENDANTS, AFTER CREMATION, TO BE BURIED IN SPACE 5 OR
13 OF THE HOLLEY FAMILY PLOT.
AS PER THE CITY CLERKS OFFICE AND CEMETERY OFFICE, NO REGULAR
BURIAL CAN BE DONE IN SPACES 5 AND 13 DUE TO LARGE OAK TREES.
THE THIRD SURVIVING LINEAL DESCENDANT IS LELA ELIZABETH ASHLEY YOUNG.
KAY FRANCES HOLLEY
DATE U? 1 ?
State of Florida County of Pinellas
Beiore me this 13 day of. lzv 19)1
personalty appeared Kam. i 41
wllo is personally known to me or no
has produced ??- •??'L ? ide l
otary
ALAN J. PULNIK
MY COMMISSION # CC 704488
EXPIRES: January 9, 2002
Panded Thru Notary Public undenN brs
U es
yr ? ? • ? V
(-6 NS e rU i -Tc
Co??VC--y?q-NEE
•
•
CITY OF CLEARWATER CLERKS OFFICE
ADMINISTRATOR OF THE CLEARWATER CEMETERY
112 South Osceola Avenue
Clearwater Florida 33756
ATTENTION : CAMILLE MOTLEY
/?Sr?LeI
I, Lela Elizabeth Ashley Young, one of Three Surviving
Lineal Descendants of Elizabeth J. Holley, Original
Owner of The Holley Family Plot, Block 1, Lot 4, Spaces 5,
6, 7, 8, 13, 14, 15, and 16 do here by give permission for
Dale Wesley Ashley, one of the Three Surviving Lineal
Descendants, after Cremation, to be buried in Space 5 or
13 of The Holley Family Plot.
• AS per THE CITY CLERKS OFFICE AND CEMETERY OFFICE, no
Regular Burial can be done in Spaces 5 and 13 due to
Large Oak Trees.
The Third Lineal Descendant is Kay Frances Holley.
Date Georgilk.
Notary Public, Butts Sepia September 24, 2000•
NAy Commission Expires
Lela Elizabeth AShley Young
CEMETERY BURIAL INFORMATION BY BLOCK/LOT/SPACE
• BLOCK : 1 LOT: 4
DECEASED NAME: MALCOLM F STUDSTILL
BLOCK: 1 LOT: 4 SPACE: 1 BURIALTYPE: FULL
BORN: 01 / 01 / 1879 DIED: 01 / 01 / 1933 INTERRED: 01 / 01 / 1933
INTERMENT NOTES:
DECEASED NAME: SARAH C STUDSTILL
BLOCK: 1 LOT: 4 SPACE: 2 BURIALTYPE: FULL
BORN: 01/01/1885 DIED: 02 / 08 / 1971 INTERRED: 02 / 08 / 1971
INTERMENT NOTES:
DECEASED NAME: JAMES F HOLLEY
BLOCK: 1 LOT: 4 SPACE: 6 BURIALTYPE: FULL
BORN: 01 / 01 / 1881 DIED: 01 / 01 / 1957 INTERRED: 01 / 01 / 1957
INTERMENT NOTES:
DECEASED NAME: ELIZABETH J HOLLEY
BLOCK: 1 LOT: 4 SPACE: 7 BURIALTYPE: FULL
BORN: 01 / 01 / 1854 DIED: 01 / 01 / 1901 INTERRED: 01 / 01 / 1901
INTERMENT NOTES:
DECEASED NAME: ANNIE L BEATTY
BLOCK: 1 LOT: 4 SPACE: 8 BURIALTYPE: FULL
• BORN: 01 / 01 / 1877 DIED: 01 / 01 / 1896 INTERRED: 01 / 01 / 1896
INTERMENT NOTES:
DECEASED NAME: WILLIAM G LOSEY
BLOCK: 1 LOT: 4 SPACE: 9 BURIALTYPE: FULL
BORN: 12 / 02 / 1863 DIED: 01 / 30 / 1941 INTERRED: 01 / 30 / 1941
INTERMENT NOTES:
DECEASED NAME: HETTIE M LOSEY
BLOCK: 1 LOT: 4 SPACE: 10 BURIALTYPE: FULL
BORN: 04 / 14 / 1873 DIED: 12 / 25 / 1934 INTERRED: 12 / 25 / 1934
INTERMENT NOTES:
DECEASED NAME: DALE WESLEY W ASHLEY
BLOCK: 1 LOT: 4 SPACE: 13 BURIALTYPE: URN
BORN: 01 / 01 / 1901 DIED: INTERRED:
INTERMENT NOTES:
INTER RIGHTS LETTER - DEED FILE HOLLEY X WESLEY
DECEASED NAME: ELIZABETH ASHLEY
BLOCK: 1 LOT: 4 SPACE: 14 BURIALTYPE: FULL
BORN: 06/11/1907 DIED: 04 / 02 / 1987 INTERRED: 04 / 06 / 1987
INTERMENT NOTES:
L_J
Page 6 of 43
BALLYHOO INVESTMENTS INC 201
P O Box 996 63-466/631
St Petersburg, FL 33731
DATLd
V ? ??C,'+s
Q
¢o
s F "`s
DOLLARS
j"tBANK
THE RELATIONSHIP PEOPLE
1:0631046681: 0053505980 0201
rr.oku>n ?ernrcrr.?eNr or•
HEALT State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (TYPE)
T Name of First Middle Last Date Month Day Year
Deceased DALE ASHLEY of March 18, 2006
Death
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Volusia Daytona Beach Hosp. or 1920 Mason Avenue
Inst.
3. Name of Medical Address Phone Number
Fermin A. Ano, M.D.,
Certifier 2089 South Ridgewood Avenue 386-767-7533
Medical Examiner M Physician Daytona Beach, Florida. 32119
4. Name of Funeral Home/Llireet Biap? l Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 333 South Yonge Street
Newlife Cremation and Funeral Chape Ormond Beach, Florida 32174 2092 386-676-1333
5. Check a. F] The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ® Eileen was contacted on March 22, 20OG
lie/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Fermin A. Ano, M.D., will complete and sign the medical
certification of cause of death within 72 hours.
C. was contacted on lie/she verified that
, Medical Examiner, will complete and sign the
medical certification of cause of death within 72 hours.
6. Funeral Director/ ?-_•?--?_- --- Si F
G .E. No./Reg. No. D. le Signed
o.. ?r L V It/ lam- ` -71W j.L`y`y C,
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 2092-060317
50 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within
72 hours.
nNo extension of time for filing the death certificate has been requested.
Registrar or Date Date Certificate
Subregistrar Signature , -a0 _(l . Issued: pqe.
ka/\-
c?
C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: C f J?? Date
Medical Examiner, gave authorization by to lone o
c? G? L° f tLf t(?? ?h j«? ?y Funeral Director/Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is
required for all cremations.
D• CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition All Florida Crematory
EIBURIAL
OCREMATION
Signature of Sexton
or Person-in-Charge
STORAGE
OTHER (Specify)
Date of Disposition -O(6
3
N,
• Cemetery Call Work Sheet
Date: 09
_
Funeral Home / Monument Company: C&Z UUOUjk?
Contact Name:
Tel. #: OOS 1 Fax #:
Reason for call: V X l? & i0,Vi VX-6? - I l l vyirl I . I I ((log
Deceased Name: -Dwe Weslc?j KkIeA-A
Date of Birth: Date of Death ?51 IT /
40
• Block Lot Space
Owner of Plot:
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
$30.00 Staking Fee - received on: -/-/.
Date of Burial: Time: am/pm
Disinterment:
The following authorization should be obtained prior to disinterment:
1.) A disinterment permit and burial/cremation transit permit
2.) Written authorization from the individual(s) who currently own the burial rights
for the plot; and
3.) Written authorization from the individual(s) who would be permitted to authorize burial
Monument Being Placed: No Fee for Staking of Monument)
-Q'M? "j
tt?? ?b8
02/28/1994 20:37 7273279820 CASKET AND MONUMENT PAGE 01
el: (727) 327 8575
(727) 327 9820
011 Free: 1-800-390-5428
www.caskctdiscount.com
2927 22nd Avenue North
St. Petersburg, Ft. 33713
FAX COVER SMT
Send to: C
jwW
rwater From: Titraay J Hues
Attie on: Nicol Date: November 7, 200$
Ref to, Dale Ashley ]DOD 311W%
Fax number Total pages, inahydilmg cover 1
Comments:
good Afternoon Ms. Ni e,
We taiked a monTn or so o abonT a graveske tor Mr. imic W estey ASnley, ane you ToW me To just
simply notify you when w ready to do the installation.
We would 1>sdw to come on?this coming Monday, November 10", 2008, to install.
Can you please have the
If you have my
,Aiso, please advise iY this
and faxing this back to a
Thanks so mom&,
fiiiany iames
Manager
- I D ' 0
Date Will Flag Grave site: F64
(0 T, r[ CA
S
t urt-q)
flagged at that time, if not coo, you advise of when it could be flagged.
please do not hesitate to contact us.
poasiia* via peone and or fax, by signift, sating and acimowiedging beiOw
31 32 !3 11 K --37 139 139 140
30 29 20 27? 21 23. 22 21
11 12 13 11 -iS 16 17 le 19 20
10 f • 7 6 3 4 S 2 1
Fiji 112 113 114 115 116 117 118 Its 120
110 109 108..107 106 103 104 1031102 101
91 92 95.- 94 95 96 97 98 99 100
90 89 oe.787 is SS 94 s3 82. 01
774 77 7! 7! 00
Fr 7x
1691" 67 Z; 64 63 62 61
51. 32 53 54 S! S6 57 58 60
80 49 48 47 46 4S 44 43 425941
131 32 33 34 33 36 37 38 39 40
1 301Z9 20 27 26 25 24 12312Z 121 J
11 12 13 14 IS 16 17 10 19 20
6 -S 4 3 2 ?.,
11019 B P7
367 568 369 57015? 1 572 373157415 75576
-15661565'S6415631562I561 1560155915581557?
547 548 549 530 553 554 555 556
546 54 S 543 540 539 539 537
527528 529 530531 532 533 534 535 536
126 525 524 523 522 521 520 5t9 518.517
507 506 509 510 511 512 313 rg ?1
506 505 504 SA! 502 501 500 i o 3 ?
L -_J
V .- EEE SHEET -3
2t 27 20 29 30 ! sz ss 34
25 24 23 22 21 20 If' le 17
21 30 31 32 33 34
27 26 25, 24 21 T
10 II If, Is - 18
!
•
7-
6
5. 4 S 21
9go A5mgl?ftRm-
$
9 94 75 70 SI 46 27 22 3
100 f3 7• - 6f A2 45 is 21 4
101 92 77 lee ? 29 io 5
- 1 1021 91 7i 67 30 If 6
103 90 79 66 SS 42 31 If 7
104 69 60 65 56 41 2 17 i
105 66 81 64 O
3!
16
M
s
106 07 02 63
I 58 39 S4 IS 10
1107106 0S 62 S9 !e SS 14 II
65 84 61 60 37 30 13 v
3s
35 se 37
Ix U 10 9
is IS 14` -13 _
/ 7 6- S 4 3 2 1
24 23 22 19 li 17
4 IS 16
9 10 -11 1
• 7 6 ! 4 3 2 1
90 79 66 55 42 31 10 7
as 60 65 . 56 41 32 17,: •
// /1 6/ 67 {O !3 16 f
87 62 63 S/ 3f 34 IS 10'
06 85 62 59 36 33 14 11
84 61 60 37 36 13
154 133 tS2 111 110 89
177 111111
B8 67 66 4S 4{ 2!
22
1
170 175 IS8 153 1 134 131 112 109 90 [g 66 6S 4/ 43. 24 21
179 74 7 IS2 135 130 113 108 91 . 69 64 47 42- 23 20 3
180 173 156 151 136 129 114 107 92 85 70 63 41 41 26 19. 4
list 172 159 15 O 137 Me 115 106 93 84 71 62 4! 40 27 1/ S
182 171 160 149 138 127 116 IOS 94 63 72 61 SO S9 2B 17 6-.
183 170 161 146 139 126 117 104 9S 02 73 60 SI 30 2f 16 7.
1144 1169 1162 147 140 123 116. 103 -96 /1 7{ 59 32 37 30 IS •
185 Iii 163 146 111 124 119 102 97 60 175 58 53 361 31 14 9
tw 1 'm 1"K 1 Aa6 ?' O A04 It 9 1 76 571.S4? SS 1 32 1! 10 1
5,
? i
C
W'
D•
?f
rl
DI
1
n6
m
m
16
AV t fdUF
34 33 In 1.2j, 16 h t 5:
75 94 of 90 es' 04; 49 v s3 u v
U-1 is I saIll
r)!7 si. 93 T! [AT ?t2 '31. is 35 3t1'. IS K 3
9t •!t 9417Y 46 41, 1K _ 46 3i 24 20 IS- 4
!O 93 7i 69•'SO 531 N: 4i • 37 ¢a #I I2` 'S
as < s2 :i. 2s` Ir .• u 7 w+,»
%
6966 ITS 70 59 S? 43 31 27 22 Ili •
S7 !O 29 22 18 -12 -• 2 30 IS C
'457174 71 1311 SS - 42 39 29 23 10 7
73 72 37 Si 41 40 23 24 9 9 - - 21. 20 11 10 1 21 11 T
^3:0
as 29 . 23 22 IS 12 7_ • H J9 t , s' 22 q
r
4.;- ` z0 17 . S 3 - 23 I2
"o 24 21"
.. ai X .,?? - ! ?.? ??--? D
it its s 4 1 24
/? 2s 2s 20 • ?? -
10 22 IS G2 10 3 N 2S l0
19 14 3
10 Is 4 23 1/ 11 2 / 26 f
17 I8. 9 TI 21 13 12 127 (n g VJ
- ---]
16 IS 6 5 16 6 S E 2 8 7 m
O
P
9?' 1 1 T 1 7 1 ?7 4 D 29 6
to
12
E l:12:] 2 6 31 1
20
21 It 'p 10
24 2s I
26
29 J2. }
_ 3y 2 _
13 Ia zx is 26 27 SO .34.. ?.__
V' c /1
/ LS
VVVVs?,?,