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Parks, Virginia. Cemetery Call Work Sheet Date: 9 / lo,-/ 21--? Funeral Home/ Monument Company: Contact Name: -bc;? "Te+-' 15 Tel. #: C4(4(-p -!:;, • Reason for call: 4D-1w,n 6,t-A, -, C-- -? - -f* DS--I I V Y Fax #: (4 qt) O,;?s,5 Deceased Name: y ?????? ct Date of Birth: Date of Death Block q Lot>? Space ©C) Owner of Plot: ************************************************************************************************** Interment: (One full burial and one urn, or two urns per space) `/1-b w/I;n.e c??rern Full Burial Urn Space $30.00 Staking Fee - received on: 9 / 4 q/ ©(-P Date of Burial: lq/ O(-P Time: l? a /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 ATTN: Dow a- Rhodes This fax includes a map of the Clearwater Municipal Cemetery. Deceased: Virginia Parks Gravesite: Block 14 / Lot 230 / Space 00 Urn Space - vacant at present Gravesite will be flagged by a.s.a.p. (I'll call when I know the time) Urn Burial to take place a.s.a.p. after flagging. Surrounding gravesites: To the North: Block 14/1-ot 232 Ressell & Ella Hendricks To the South: Block 14/Lot 227 Antonio Rivera Staking Fee: $30.00 Please make check payable to: City of Clearwater Mail to: City of Clearwater Official Records Dept. 112 S. Osceola Avenue Clearwater, FL 33756 Please contact me with any questions. Thank you, Karen Vaughan Official Records & Legislative Services 727-562-4091 TUSKAIIVILLA STREET 1d ti n 40 a M h N - A t0 N q ? N M p t M h ' O q N l M o N N p q 1 r0 p m M - M N N N t N m M M M M N h M M N M t0 O n N ?+ M N .? p q - q N N q ti O p N N - O N - A N q ? q n n ,p M ? N p - Q N C ps O ? n 0 n r ~ O M N ? O O O O? O O 10 M N A q ? h ti N O O m N Mf M ? h M M v ?r? n n ti ?O h ? ?D a n M M ? n s, h ?a n M ?n M a a? a Wilding L?_J n to n n 40 sa n ? N - l Ir? I I I I :.. 'C, Vj oc -k- l 4/(_ 4- a3c)/Sfc ce <x::) ? 377 249 121 487 359 2 1 379 251 0230 123 485 357 229 381 253 125 483 355 227 383 255 127 481 353 225 385 257 129 479 351 223 387 259 131 477 349 221 389 261 133 4 75 347 219 391 263 155 473 345 217 393 265 137 471 343 215 395 267 139 469 341 213 397 269 141 467 339 21 I 399 271 143 465 337 209 401 273 145 463 335 207 403 2 75 147 461 333 205 405 277 149 459 331 203 407 279 151 457 329 201 409 281 153 455 327 199 411 283 155 453 325 197 413 285 157 451 323 195 415 287 159 449 321 193 417 289 161 447 319 191 419 291 163 445 317 189 421 293 165 E423 315 187 295 167 112 1 2 110 4 108 6 106 8 104 10 102 12 100 14 98 16 96 18 94 20 92 22 90 24 88 26 86 28 84 30 82 32 80 34 78 36 76 38 74 40 72 42 70 44 68 46 66 W `W a W J N? G