Kelleher, Kevin (2) Cemetery Call Work Sheet
Date: / /s / �,o(a-
Funeral Home/ Monument Company: C7 c" ca .
Contact Name: ke �''� e�'^�r Tel. #: 186,- /$5I Fax#: 755- O 8'S
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For: Kevin key - ADD : /aq/(a
Block '7 Lot 8 a- Space 1. (corn) cc wA : (,ci QJo" -If•
Date: II / 19 / la- Time: (Sop.ef;4..41w.orti.it) V 12.e.,.tiiNst
(Send email to P&R)
Verifying Burial space
Other reason:
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space
Owner of Plot:
Deceased Name:
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / / Time: am/pm
$30.00 Staking Fee (Funeral Home) - received on: / /
Copy of permit emailed to Marco Ortega, cc: Mark Tokar/P&R 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 10/31/12
LaCosse, Judith
From: Ortega, Marco
Sent: Friday, November 16, 2012 8:29 AM
To: LaCosse, Judith
Cc: Ortega, Marco; Tokar, Mark; Wells, Alexis; Gilmore, Stephanie
Subject: Re: Cemetery Staking Request- Placement of a marker
Marked in yellow flags.
On Nov 15, 2012,at 12:03 PM, "LaCosse,Judith" <Judith.LaCosse@mvClearwater.com>wrote:
Hi Marco,
We received a call this morning from Kevin Cantrell of Cycadia Monument Co. regarding placement of a
marker.
Would it be possible to have Block 7.Lot 82.Space 1 staked for next Monday, November 19th (they will
be there sometime in the morning, not sure of exact time)for placement of a marker.
Deceased's name: Kevin Kelleher—DOD 4/29/12 Owner: Wilson H.Valentine
Other Full Burials nearby:
Space 2—Wilson H.Valentine—(full)
Space 3—Modelle E.Valentine—(full)
Space 4—Wilson H.Valentine (infant)
Please let me know the color of the flags you will be using so that I could inform Mr. Cantrell.
Thanks.
Judith LaCosse
StaffAssistant
Official Records and
Legislative Services Dept.
727-562-4 093
1
•
November 16, 2012
Attn: Kevin Cantrell / Cycadia Monument Co.
Fax: 727-785-0856
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Kevin Kelleher
Gravesite: Block 7, Lot 82, Space 1
Urn space
Gravesite flagged with Yellow flags.
Nearby Burials:
Space 2 = Wilson H. Valentine— (full)
Space 3 = Modelle E. Valentine— (full)
Space 4 = Wilson H. Valentine— (infant)
Please contact me with any questions.
T ankyou„
dith LaCosse
Official Records & Legislative Services
City of Clearwater
727-562-4093