Frye, Dustin Cemetery Call Work Sheet
Date: 10 / a° / D o((
I 4-61,-e 313 - 3ctet -
Funeral Home/ Monument Company: L wi.S l,J . MD L Fv a 3 9 8'- 6 Fib 3-
C°e�a4 : Lot-,s
Contact Name: (-b'
Sgb_ �a-ba C. ?a8 - 68.19 oflovoo asl_ C oh" )
Tel. #: Fax#:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space Fr
`2Qoek 141 Lot 3 S. S�!!iriwci rraR
Other reason: ' iii , Lot 3 37=
r -$ it l't tLo 1 //�33`(=
d ocww..c. iek Al. f�.:.S Vot-k 3- Lo-s tta
D t bra, rq� Q.Q
•
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot: F-ry VI 4-vi5 Fe ?).• 9"-- ` `'Qr2-')
Deceased Name: �'•'� h q ,.
Lod 3 3 S (Co.,3; a
Block Hi' Lot 337 Space 0, Lam+ 3 3"1 (Co 1337,v3t 3 77�t 1
Date of Birth: 3 / `� / 19 g t Date of Death 1° /a-D / a-°(1 f c 3� I (C°�y e r-tek
° 4t, 3 (fo) 1b/,
Date of Burial: /° / / a'Q( l (c)cL) Time: .D':°0 a Leal s
$30.00 Staking Fee (Funeral Home) - received on: to / / (9d I( - IA" F'44 . ''f 1 t
Copy of permit R - n: 1° / / 11
**************************************************************************************************
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 (a p 4- b !,3-1--Jed
CEMETERY DEED 00-189775 JUN-26-2000 4 :34pm
PINELLAS CO BK 10958 PG 760
7' 111111111011101VIII1111111111X111101111111III!
THIS INDENTURE made this f 9 day of L 2000, between the City
of Clearwater, Florida, a municipal corporation . Grantor and MAVIS FRYE,'whose mailing
address is 1235 South Highland, Clearwater, FL, County of Pinellas, State of Florida, as
Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of $500.00, to it in hand paid by the said Grantee,
the receipt whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee, and their 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: SPACE zero zero (00), LOT Three Hundred Thirty Seven (337),
BLOCK Fourteen (14), 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 herein shall not assign or convey said property without the written
consent of the Grantor, 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 rules and 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 and their heirs and
assigns forever.
IN WITNESS WHEREOF, said Grantor has caused these presents t be executed in its name by its Mayor-Commissioner, by
its City Manager, and to be attested and its corporate seal affixed by t City Clerk on the day and year first above written.
Countersi ned: CITY OF CLEARWATER, FLORIDA -
By:
Brian . ungst, or-Commissioner Michael J. Roberto, Cityy .pager.
Attest: .I. I if, , r I <�/iii l e!w
Susan Stephenson, Deputy ity Clerk
STATE OF FLORIDA ►
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Brian J. Aungst, the Mayor-Commissioner of the City of Clearwater,
Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to
be her free act and deed for the use and purposes herein s forth.
WITNESS my hand and official seal this / day of Gam_ , 2000.
oy!..
(SEAL) I Notary Public
NOTARY PUBLIC-STATE OF FLORID.
Print/type name: CAROLYN L BRINK
STATE OF FLORIDA ) COMMISSION,'CC834678
EXPIRES 5/22/2003
COUNTY OF PINELLAS) BONDED THRU ASA 1-888-NOTARr
Before me, the undersigned, personally appeared Michael J. Roberto, the City Manager of the City of Clearwater, Florida, to
me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free
act and deed for the use and purposes herein set forth. /
WITNESS my hand and official seal this /,j day of ii=,n - , 2000.
� �t OC, - —7
r� " PiAppro to form an d� al sufficiency. rnt/t
YPe name: Notary Public
UBLIC S7RTz
John Carassas, Assistant City Attorney J� COIy 8hYNL gR, KFLOR, O4
�z= - RONOFD THorde,i �7T8
DEED.DOC 9700-0026
RETURN TO: City Clerk Department
Rev. 7/97
P. 0. Box 4748, Clearwater,'f L 33758_
00-256399 RUG-24-2000 3 :04pn
CEMETERY DEED P INEL II11III11III11IIIII��IIIIII1III1IIII1NIIIIIIIIIII Ieos
f
THIS INDENTURE made this // day of 7 1 r, j� , 2000, between the City
of Clearwater, Florida, a municipal corporation as Gr.4or and MAVIS FRYE, whose mailing
address is 1235 S. Highland, Clearwater, FL, 3375., County of Pinellas, State of Florida, as
Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of $500.00, to it in hand paid by the said Grantee,
the receipt whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee, and their 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: SPACE zero zero (00), LOT Three Hundred Thirty Nine (339),
BLOCK Fourteen (14), 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 herein shall not assign or convey said property without the written
consent of the Grantor, 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 rules and 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 and their heirs and
assigns forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor-Commissioner, 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.
Countersig d: CITY OF CLEARWATER, FLORIDA )
g By ! ' L Gam+2 12
Brian J. Aungst, M r-Commissioner Willia B. Home, II, Inter Cit anager
Attest: A,. /i.'i 1L afie
Susan Stephenson, Deput City Clerk
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Brian J. Aungst, the Mayor-Commissioner of the City of Clearwater,
Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to
be her free act and deed for the use and purposes herein set forth.
WITNESS my hand and official seal this /0 day of Lz , 2000.
(SEAL) Notary Public
Print/type name: c:OTARY PUBLIC)-STATE OF FLOF<'.:;.
STATE OF FLORIDA ) CAROLYN L BRINK
COMMISSION a CC834678
COUNTY OF PINELLAS) EXPIRES 5/22/2003
BONDED THRU ASA 1-685-NOTARY'
Before me, the undersigned, personally appeared William B. Horne, II, the Interim City Manager of the City of Clearwater,
Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to
be his free act and deed for the use and purposes herein set forth.
WITNESS my hand and official seal this ,6 day of ��S((� , 2000.
PAGES - / l�
ACCT ete76 c-` • ::).-�ti
REC 6 Notary Public
Approved as to form and legal sufficiency: DR219 .3.50 Print/type name:
/ 'r DS J f-v LIF ii?;rhir
INT :r}-0 Yc' L.BRNK
—_ CUE,ikItSS;ON d CC834678
Legal Department FEES _ EXPIRES 5."22/2003
IVITF .8O7-iOED THRU ASA 1-883-NOTARY''
REV
DEED.DOC ? ]+Irl -. "71 C 9700-0026
RETURN TO City Clerk Department TOL � 5 ? ` s
Rev. 7/97
P. 0. Box 4748, Clearwater,-t ,'C' AL8
CHG AMT
00-068999 MAR- 9-2000 S :08prt
PINELLAS CO BK 10838 PO 140
CEMETERY DEED 1111111N111111111111111 111E11
THIS INDENTURE made this S427day of /72.a/L-41 , 2000, between the City
of Clearwater, Florida, a municipal corporation as Grantor and --Deflfa FINS t, whose mailing
address is 1230 Gulf Blvd. #1502, Clearwater. FL 33757. County of Pinellas, State of Florida,
as Grantee:
WITNESSETH:That the said Grantor, for and in consideration of the sum of $500.00, to it in hand paid by the said Grantee,
the receipt whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee, and their 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: SPACE zero zero (00). LOT three hundred thirty-five (335).
BLOCK fourteen (14). 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 herein shall not assign or convey said property without the written
consent of the Grantor, 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 rules and 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 and their heirs and
assigns forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to b executed in its name by its Mayor-Commissioner, by
its City Manager, and to be attested and its corporate seal affixed by the ity Clerk on the day and year first above written.
Counters' ned: CITY WATER, FLORIDA
By:
Brian J. Aung ayor- ommiss er Michay J. Roberto, 't Ma .ger
Attest: _e_. _!/t, ii/
Susan Stephenson, De. ty City Clerk
STATE OF FLORIDA 1
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Brian J. Aungst, the Mayor-Commissioner of the City of Clearwater,
Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to
be his free act and deed for the use and purposes erein set forth.
WITNESS my hand and official seal this 3 day of h14140e.Gr , 2000.
(SEAL) ITATEOFFLONRI►ry Public
Print/type name: •
•. L.IRe
STATE OF FLORIDA ) E' • eCes4ste
COUNTY OF PINELLAS) was iM .1 OTARYt
Before me, the undersigned, personally appeared Michael J. Roberto, the City Manager of the City of Clearwater, Florida, to
me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free
act and deed for the use and purposes herein set forth.
WITNESS my hand and official seal this 3�day of b1.44.4.4.4.— , 2000.
PAGES /
ACCT 0 aff, 43.14,14.,
REC .0 0 Notary Public
DR219 • 0
A•• • -: . - :,• ,sufficiency: DS •rint/type name:
ENT CAROLYN L DRINK •.
FEES Conewee ON.COWS
E as EXPIRES ernaooe
John Carassas, Assistant City Attorney MTF MOW TWO ASA i-eee-NOTARYi
P/C
DEED.DOC ✓ 0° fOnta Tax Pd.$ �. SD
_ 9700-0026
RETURN TO: City Clerk Department TO fAL_' Karleen F Do ewer � ' Rev.7/97
P. 0. Box 4748, Clearwater, FICA@!! "'
CHG AMT
Status of Block: 14 Lot: 335 as of 10/20/2011
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
00 FULL FRYE SABRINA 3/22/1964 02/20/2000 2/24/2000 2432
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
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526 525 524 523 522 521 520 519 518 517. 181 172 159 150 137 128 115 106 93 84 71 62 49 40 27 18 5
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SEE SHEET 3 1 185 168 )63 146 141 124 119 102 97 BO 75 58 53 36 31 14 9
1 1 186 167 164 145 142 123 120 101 98 79 76 1 57 54 35 32 13 10 /
1 / 187 466 165 144 143 122 121 100 99 78 77 56 55 34 33 12 11
MYRTLE AVENUE
1
• SEE SHEET 2
I-- - - -- - - - 7
I
Exiting I
Building
I I
— - — — — — — — ——J N
377 249 121 112 I
487 359 231 2
379 251 123 110
O 485 357 229 4
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o W
483 355 227 6
iiii--\
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385 257 129 104
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O Scolei 1 10'
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391 263 155 98
473 345 2)7 16
393 285 137 96
471 343 215 18
395 267 139 94
a 469 ,341 213 20
O 397 340 269 141 92
tr, 467 339 / 211 22
399 338 271 143 90
465 337.1 71 209 24 Z
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>
403 339. 275 147 86 Q
11.1 461 333'X7, 205 28
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457 329 201 32
409 281 153 80 W
W 455 327 199 34
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W cf 453 325 197 36 H
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L!Y
451 323 195 38
415 287 159 74 r
449 321 193 40 2
417 289 161 72
447 319 191 42
419 291 163 70
445 317 189 44
0 421 293 165 68
in
443 315 187 46
423 295 167 66
441 313 185 48
425 297 169 64
439 311 183 50
427 299 171 62
437 309 181 52
tD
0 429 301 173 60
N
435 307 _179 54
•
431 303 175 58
433 305 177 56
CLEARWATER CEMETERY
Dwg. No. 9039-3
Sheet 3 of 3 / 7- � R ��L�/ r —`�Y
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2 4 _c2 .
Lot 33 9 (C.r.v t,ite,Q w; IP 31-0) 2-69 a`�o) p
SEE SHEET I
v, - Z
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MYRTLE AVENUE
34 133 J 26 1 25 1 I8 I 15 I 6 1 5 1
95 94 81 BO 65 64 49 48 33 32 7.-F..." "'
96 93 82 79 66 63 50 47 34 31 18 35 32 27 24 17 14 7 4 18 IT
97 92 83 78 67 62 51 46 35 30 19 14 3`
98 9t 84 77 68 61 52 /, 45 36 29 20 13 4 �//''�� 1
'r 36 31 28 23 18 Y 13 B 3 19 16
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89 86 75 70 59 54 43 38 27 22 11 6
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19 18 7 6 I I( 22 13 C
/ 29 28 23 22 13 12 7 6
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-I
{ PROSPECT AVENUE
LaCosse, Judith
From: Tokar, Mark
Sent: Tuesday, October 25, 2011 8:08 AM
To: LaCosse, Judith; Ortega, Marco
Cc: Wells, Alexis; Gilmore, Stephanie;Vaughan, Karen
Subject: RE: Cemetery Staking Request
Yellow flags
From: LaCosse, Judith
Sent: Monday, October 24, 2011 3:52 PM
To: Ortega, Marco;Tokar, Mark
Cc: Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Cemetery Staking Request
Importance: High
We received a call this afternoon from Louis Starman of Lewis W. Mohn Funeral Home for a staking request for a full
burial for:
Dustin Frye in Block 14,Lot 337,Space 00. (Passed away on 10/20/11)
Lot 335(converted with Lot 336, 273 &274 for full size space) =Sabrina Frye buried here
Lot 337 (converted with Lot 338, 271 & 272 for full size space)= Dustin Frye to be buried here
Lot 339(converted with Lot 340, 269&270 for full size space)=Vacant
Staking is needed by this Wednesday.October 26th at 2:00 p.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.
Citp of Clearwater
Official Records& Legislative Services
727-562-4093
1
October 25, 2011
Attn: Louis Starman
Funeral Home: Lewis W. Mohn Funeral Home
Fax: 727-398-6863
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Dustin Frye
Gravesite: Block 14, Lot 337, Space 00
(converted to full size space with Lots 338, 271 &272)
Full Space
Gravesite flagged with yellow flags.
Date of burial: Wednesday, October 26 Time: 2:00 p.m.
Nearby Burials:
Lot 335 = Sabrina Frye
Lot 339 = Vacant
Staking Fee: $30.00 (Paid by funeral home)
Please make check payable to: City of Clearwater
Mail to: City of Clearwater
Official Records Dept. —2nd Floor
112 S. Osceola Ave.
Clearwater, FL 33756
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4090
LEWIS W MOHN FUNERAL HOME
9700 SEMINOLE BLVD 5871 O
SEMINOLE,FL 33772 +
63-751/631 11171
/ 2649502152530 +I
DATE l Al 5- 4/ .1
,
n S.77 .-
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1 n n
PAY C%�"
v TO THE ORDER OF (V - J�U tt 3)
DOLLARS back
.1
WELLS Wells Fargo Bank,N.A.
fffppp FARGO Florida
wells(argo.com
�.._.._.. _ .._ ._ "x///'/77.
/f FOR a �
fl
11100000 58 7 LOII 1.063L075L31: 2649502L5253011
If
BURIAL PERMIT
•
CLEARWATER CARETAKER PERMIT# 1414
CLEARWATER,FL October 28, 2011
Permission is hereby granted for burial of:
Name of Deceased: DUSTIN FRYE Burial Type: FULL
Owner of Property: MAVIS FRYE& CONVERTED #338,271,272
Block: 14 Lot: 337 Space: 00 Date of Birth: March 4, 1981
Date of Death: October 20,2011 Date of Burial: October 26, 2011
Funeral Home Director: LOUIS STARMAN/LEWIS W MOHN FH
Time: 14 :00 Staking Fee: 30.00 Date Paid: October 27, 2011
Clearwater Cemetery
By `4\-
•
4111