Snyder, June Cemetery Call Work Sheet
Date: 5 / 3 /
literal Home / Monument Company: MOSS f #& t'& TUNait /Il&
Contact Name: P14-IL
Tel. #: 51p2— GD Fax #:
Reason for call: )( Staking Request (Interment/Disinterment)
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)
•ll Burial Urn Space
Owner of Plot: . a Da.
Deceased Name: JUi 3J11I .
Block 14 Lot552 Space 7. pel „,i
Date of Birth: tQ/ 1 / 2W Date of Death 4- / )l/ )2_ )'- -
Date of Burial: 5 / / 12 Time: 10:30 am pm
$30.00 Staking Fee (Funeral Home) - received on: S / -7 /
Copy of permitted to Joe Taylor/P&R - Fax No_$.a on: S / ' / 2 nla-
**************************************************************************************************
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
LaCosse, Judith
From: Ortega, Marco
Sent: Thursday, May 03, 2012 8:30 PM
To: LaCosse, Judith
Cc: Gilmore, Stephanie
Subject: Re: Cemetery Staking - Urn
Flagged in yellow.
On May 3, 2012, at 11:54 AM, "LaCosse,Judith" <Judith.LaCosse @myClearwater.com>wrote:
Oopsy ! Wrong date... staking is needed by tomorrow, May 4th before 10:30 a.m.
Thanks...
From: Gilmore, Stephanie
Sent: Thursday, May 03, 2012 11:06 AM
To: Ortega, Marco
Cc: LaCosse, Judith
Subject: Cemetery Staking - Urn
We received a call this morning from Phil of Moss Feaster Funeral Home requesting a staking for an Urn
burial for:
June Snyder,owner of space below-passed away on April 17, 2012.
Block 14•Lot 552,Space 2
Other burials nearby in this Blk 14, Lot 552:
Space 1 = Ralph Snyder—urn
Space 4= Norman Pultz—Full burial
Staking is needed for burial this Friday,October 1st at 10:30 a.m.
Please advise as soon as you can the color of the flags being used so that we could notify Moss
Feaster.
Thanks for your help.
Stephanie Gilmore
City Clerk Specialist
City of Clearwater
(727)562-4227
Stephanie.Gilmore @myclearwater.com
1
May 4, 2012
Attn: Phil
Funeral Home: Moss Feaster Funeral Home
Fax: 727-562-2043
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: June Snyder
Gravesite: Block 14, Lot 552, Space 2
Urn Space
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 1 = Ralph Snyder- Urn
Space 4 = Norman Pultz — Full burial
Staking Fee: $30.00
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
727-562-4093
ELLIttr ,"D y+
II' 4t L0E% ' State of Florida, Department of Health, Bureau of Vital Statistics
HELT ' BURIAL TRANSIT PERMIT
DATE PRINTED:April 25,2012 TRACKING NUMBER: 2012052913
1. DECEDENT INFORMATION
Name of Deceased Date of Death
JUNE H SNYDER April 17,2012
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
PINELLAS CLEARWATER 1047 SEDEEVA STREET
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No.IRega No. Phone Number
MOSS-FEASTER FUNERAL HOME&CREMATION-DUNEDIN F040918 F040918 (727)562-2040
1320 MAIN ST
DUNEDIN,FLORIDA,34698
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
SUSAN A.KELLY F042884
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2012-F040918-5033
(.2 Ae...41-04 ��T Date Issued: April 23,2012
Meade Grigg,State Registrar_!
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 6 ` Approval Number: 71204094
n
4. CEMETERY OR CREMATORY
r..
Place of Disposition: SOUTHEASTERN CREAMTORIES 9 7 ,l' ^',
Method • Disposition: CREMATI• Date of Disposition:
Si. . re of sexton orperson-in-charge(or by the funeral director/direct disposer when there is no sexton)
DH 3'•-,1/11
64V- •11,Florida Administrative Code
•
' Vendor CITY OF CLEARWATER 05/04/2012
Vendor No. 3141616 Amount *******$30.00 10747755
PAYMENT DETAILS
Cemetery Charge-June Snyder
THE FACE OF THIS CHECK IS PRINTED BLUE-THE BACK CONTAINS A SIMULATED WATERMARK
Moss Feaster Funeral Home and Crema Amegy Bank N.A.
1320 Main Street 35-1125 10747755
Dunedin, FL 34698 Porter,TX
1.130
05/04/2012
PAY Thirty and 00/100 Dollars
s 616)
*„*********$30.00
PAY TO THE CITY OF CLEARWATER
ORDER OF 112 S OSCEOLA AVE
CLEARWATER, FL 33756
Memo: June Snyder •��
11' L074775511' 1: 113 L 105861: 44440 70 7 211'