Miller, Ann J Cemetery Call Work Sheet
Date: 7 / Ft / a-0 l( 4.01-1 E04
561 - 3.07o
Funeral Home/ Monument Company: r MOSS redde . Fax : 56 a -a-073
Contact Name: &M i LIt C OQ Lu4 124.4%.12 °-6 P'v 7. A i.MA,
Tel. #: 418 - 53. t- 3-7-78 Fax#:
Reason for call: ✓ Staking Request (Interment/Disinterment) . Moss Fe.' a e,t.
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space
Other reason:
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: Ahn J. IA. ktA,
Deceased Name: Ann. J• Itl.c e.�.
Sp cc 3 . Miitc".(krr.)
Block /1, Lot 14 Space 4 CA) I"ld Kra.c Ali&Qe.,, ('F, )
Date of Birth: l0 / zL / 3 1 Date of Death -2 / / / 0 9
Date of Burial: -7 / a1 / a-° it I'LLovl Time: g•30 &pm
$30.00 Staking Fee (Funeral Home) - received on: / a- / ao I ( ' °j,', J"""'`,o, D'
it v1 I?-
Copy of permit faxed to Joe Taylor/P&R- Fax No. 6551 on: / /
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
Revised 6/29/11 144 _ N.,-�, � floss F.:424 AA. p 9k �Qns 10)444.
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Status of Block: 16 Lot: 16 as of 07/21/2011 I
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL BEAVERS JAMES B 1/1/1882 06/11/1979 6/11/1979 1319
2 FULL BEAVERS VIOLA A 4/27/1890 08/03/1987 8/5/1987 1711
3 URN MILLER STEVEN B 2/1/1958 03/10/2004 3/28/2004 2534
3 FULL MILLER MONROE 2/2/1926 08/28/1982 9/2/1982 1480
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
1
Page 1 of 1
II
LaCosse, Judith
From: LaCosse, Judith
Sent: Friday, July 22, 2011 10:12 AM
To: Taylor, Joe
Subject: RE: Cemetery Staking
Thanks. I will notify the funeral home.
Judith
From:Taylor,Joe
Sent: Friday, July 22, 2011 8:57 AM
To: LaCosse,Judith
Cc:Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: RE: Cemetery Staking
We used pink flags
From: LaCosse,Judith
Sent:Thursday,July 21, 2011 11:30 AM
To:Taylor, Joe
Cc:Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Cemetery Staking
Importance: High
Hi Joe,
We received a call this morning from Rick at Moss Feaster requesting a staking for an Urn burial for:
Ann J. Miller in Block 16.Lot 16.Space 4.
See attached status sheet regarding burials in this block and lot:
« File: Block 16 Lot 16.pdf»
Staking is needed by next Thursday.July 28th for a(urn)burial,scheduled at 8:30 a.m.
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith LaCosse
Staff Asst.
Official Records& Legislative Services
727-562-4093
1
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Cemetery Call Work Sheet
• 3 � a.oII
Date. / /
Funeral Home/ Monument Company:
Contact Name: M. LO „fr% A pi J. Q.)
Tel. #: 35a- Lt 73- '7553 Fax#:
Reason for call: C �d�- fi° Ue"^Z f-d /- 9,^^-;-cJ 4r-ce. 4-1 Ah n � "Reit,
Deceased Name: Aviv, U7. M;Otk,
Date of Birth: / / Date of Death
Block 14 Lot I(o Space `f (A) spe...c.c. 3 . Steven i Oak _(Colt-)
Owner of Plot: ht.h. T. 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)
•