Castagna, MariaLJ
Date: II /5J1
Tel. im 0 Fax He
Cemetery Call Work Sheet
Funeral Home / Monument Company:
Contact Name: 1((Li
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Reason for call:
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Deceased Name: M ACIA ( TTAONA
Date of Birth: / /j qj Z) Date of Death _LO / 10 /
Block 12. Lot Space
Owner of Plot: l , h OX 11's ?'1? ?? S TA ?y of
Interment: (One fu// 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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11106/2007 09:47 7275963630 r-IOSS FEASTER PAGE 01/02
I I i
e se State.of Florldp; Dept ent of +?I'h"Vlt2ll ti?s
APPLICATION FO B RIAL-- NSIT PE M T.,
(TYPE)
Middle r •I 'I ? Date
A Month Day " Year
t .? N of ?? I i-atit i
Deceased of.
Marla 1113W na Death October 20, 200'
2. Place of Death City, To%m or Location j am0 9T i I (If Inelther,: l+re Is t address)
. County ? ; i ? ospl or I ; I =
Pinellas I Belleau ' ?. I • st.' rtio P nt ehaU Center
3. Name of Medical Address Phone Number
Certifier Carl Suchar, D 613 S. My e 1 v?e?tuel ' (727) 441-1451.
Medical Examiner Physician Clearw' to 37515
4, Name of Funeral Homel Addr@ss " I Is, L P one s. (Area'Code)
Direct Disposer i3401 Indian Rock Rd ' .
p 2 (',27) 446 - 2375
tit o `
Moss-Feaster Funeral HonaeJ Largo, Florida 33714
6. Check a. The medi?I certMlcatlon has been c¢mp(ated anal signed. A Complete Celt a of-death accompanies this
Appropriate applicatidn.
Box
b. 23 ic I I sta di, 411 b07
He/she vbriFled that-this-death wM f m h?etu I 6 ass? ' Atth b was rio Id rit at " 'r a iris! use of rl ath,
and that will mpletb and sign the rhadical
certificatibn of cause of death within 72 IJaurs..
c. Q wa? tntaMd on . He/she verified that
i Mbdlca] Exami er, wil` complete and sign the
medical derttficatton of cause of death w in 7¢ hours.
6. Funeral Director/ - Signature F.E. No. I I Date Signed r
t7ctober 23 20b7
B. BURIAL, -- TRANSIT PERMIT Permiti No. 02320 - 417
leermlesion Is hereby granted to dispose of thls body.
DA five (6) day extension of time for filing the death certificate (exclusive of weekends) has been reggested,arjd granted since the physician has been
contacted by the funeral director and will not be able to complete ttte medical codification of cause-of-doeth.section of the death certificate within 72
hours.
No extension of time for filing the death certificate requested. -
Registrar or Date Date Certificate
Subregistrar Signature 0 (:d Issued: 10/23/2007 Due: IO/25f2007
D, AUTHORIZATION for CREMATIO. , DISSECTION orBURIAL-- AT -- SEA
Approval Number.d Date
Medical Examiner, gave euthortzotion by telephone to
Funeral'DlrectorlDlrect Disposer. Date
The Medical Examiner's approval must be obtained before disposal by shy of the above methods. A waking perlod of 48 hours after death Is
required for all drematlons.
CEMET1,,ERY OR CREMATORY
D.
Methods of Disposition: ZPIa Disposition Southeastern Crematories
4945 ast Bay Drive, earovater, L
BURIAL STORAGE is sition 4 R -
Q/ CREMATION Ej OTHER (Specify)
Signature of Sexton
• or Person in-Charge
This pertnft must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there Is no Sexton) and returned
within 10 days to the local County Health Department in the county where the disposition occurred.
Dlstributlaw VNW: Cemetery or Cremetory
DH 326, 8I97 (Obooletes all previous editions) Yellow: Funeral Director or Dimet Disposer
(Stock Number: 5740.000.03280 Pink: Local Registrar
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11/06/2007 09:47
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7275963630
MOSS FEASTER
No. :493
Certificate of Cremation
THIS CERTIFIES that the remains of
Maxim casta•na
who died October 20, 2007
n
U
was cremated on the date indicated below,
OCT 2bM
and these are the cremated remains of said deceased.
Permit No. 02320-417
Southeastern Cre ories
Clearwater, da
?. By
lc;i6 WIR
02/02
0
Gilmore, Stephanie
1 rom: Gilmore, Stephanie
nt: Tuesday, November 06, 2007 9:14 AM
ro: Taylor, Joe
Cc: Frith, Renee; Lewis, Eric; Sprague, Nicole; Tokar, Mark
Subject: Moselium - Castagna
Joe,
The Castagna family will be in the cemetery this weekend (an exact date has not been determined) to place the ashes of
Maria Castagna in the family Moselium. The family has a key and is not requiring any assistance from the City. I just
wanted to make you aware in the event that this information is needed for your records.
Please feel free to contact me if there is any additional information needed.
Thank you.
Stephanie Gilmore
City Clerk Specialist
Office of Official Records & Legislative Services
Phone: (727) 562-4227
Fax: (727) 562 - 4086
Email: Stephanie.Gilmore@myclearwater.com
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