Bjerkenes, Gustav Cemetery Call Work Sheet
Date: t / `) / 40/3
Funeral Home / Monument Company: F/°r;da UawQ " - S r)- 't 9ci
� ,�� _ ALife S5cl -"7-19.) Fax#: 4t- 7 0
Contact Name: 7ri 6tc. Tel. #: `f
Reason for call: ✓ Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed p (No fee for staking of monument)
For: 6ws l4-v l�ha�t/ys JJer ke►wb>
Block I6 Lot S7 Space 1
Date: if / / 01013 Time: ore-K., - (F1ori k V ALa-lt
(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 ✓ ,�// /�/ 1
/4� S �w'N.eK •l"`� Sp�..GG 1 C ('n)
Owner of Plot: G,..sf�.v. 4 c(4 S7s I3;e r k e y ��S�o I16
Deceased Name: G4sf4 v R. ,-kePtes �s s
Block HQ Lot 57 Space a' "� . + Ili 3
Date of Birth: -7 /a S / 19 l' Date of Death / a/ 3 / e)--01(
4 I I a�/3 Time: � '� am/pm (No �rn v�«) - Fio r T Jw V J-t
Date of Burial: / /
$30.00 Staking Fee (Funeral Home) - received on: / / / :).°13
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: Wednesday, April 10, 2013 11:04 AM
To: LaCosse, Judith
Cc: Ortega, Marco; Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Re: Cemetery Staking Request
Gladis is green
Pink is urn for Gustav
Orange is marker for Gustav
On Apr 9, 2013, at 11:55 AM, "LaCosse,Judith" <Judith.LaCosse @myClearwater.com>wrote:
Marco,
We received a call today from Nathan of ALife Tribute for a staking request for an urn burial and
placement of two markers.
Per Nathan, Florida Vault Company will be placing the urn and also placing the marker for this burial and
for the spouse next to him who's already interred.
The Urn burial staking and placement of a marker is needed for Gustav Bjerkenes in Block 16, Lot 57,
Space 2. DOB: 7/25/1919 DOB: 12/3/2011.
Staking for placement of a marker for his wife,Gladys Bjerkenes, is also needed in Block 16, Lot 57,
Space 1. She's already buried in this space.
Burial in space 3 =Stanley Szczepanski—Full
Staking is needed by this Thursday.April 11th—No Service
Please advise as soon as you can the color of the flags being used so that we could notify Nathan of
ALife Tribute. He needs to notify Florida Vault.
Thanks for your help.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
1
April 10, 2013
Attn: Nathan
Funeral Home: ALife Tribute
Fax: 727-559-8704
(This fax includes a copy of Cemetery Map)
#in the circle is the Block,#in the square is the Lot
Deceased: Gustav Bjerkenes
Gravesite: Block 16, Lot 57, Space 2
Urn Space—flagged with Pink flags
Gravesite flagged with Green flags for marker for Gladys (space 1)
Gravesite flagged with Orange flags for marker for Gustav (space 2)
Nearby Burials:
Space 3 = Stanley Szczepanski — Full
Staking Fee: $30.00 due for urn burial (Gustav)
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
LaCosse, Judith
From: Bruce Kaufmann [brucekaufmann7 @ gmail.com]
Sent: Wednesday, April 25, 2012 12:25 PM
To: LaCosse, Judith
Cc: karylkaufmann @gmail.com; rtrevpace @aol.com
Subject: Bjerkenes Cemetery Plots
Dear Ms. Lacosse,
Thank you for talking with me today.
Please assist as my wife, Karyl Kaufmann, who is the nominated Personal Representative of Mr.
Gustav Bjerkenes's will and Father Ron Pace who is Trustee of Mr. Gust Bjerkenes' Trust try
to finalize the last wishes of Gladys and Gustav Bjerkenes. Their email addresses are listed
above and you may contact them or you can contact me as I will get the message to them.
They need to know where the plots are located.
What do they need to do to place Mrs. Bjerkenes tombstone on the grave? The stone is here
ready for placement.
What do they need to do to place Mr. Bjerkenes tombstone on the grave?
They need to order the stone.
What do they need to do to entomb Mr. Bjerkenes cremains?
Are there any costs to those activities?
Who do they contact to make the arrangements?
( I will send you another email about another couple.) Thank you.
Bruce Kaufmann
727 531-2929
Bruce Kaufmann, J.D.
Imaginator - Creative Business Consultant brucekaufmann7Pgmail.com
727 531-2929 (telephone)
727 288 8355 (cellphone)
www.brucekaufmann.com ` ')
beo,k I� 1-07- s7 , Sp, c'
ho,fec -�,t,i.r.K h��tiun.��n�s �^t pr �n,
Ack 1 = C/<«!ys A 13. erkehe s ► ". "s/off
1
LaCosse, Judith
From: LaCosse, Judith
Sent: Wednesday, April 25, 2012 2:26 PM
To: 'Bruce Kaufmann'
Subject: RE: Bjerkenes Cemetery Plots
Importance: High
Hello Mr. Kaufmann,
First of all these plots are located in Block 16, Lot 57, Spaces 1 and 2. Mrs. Gladys
Bjerkenes was buried on January 5, 2006 in Space 1. Space 2 is vacant for Gustav Bjerkenes.
A funeral home or monument company will be in charge of placing the monuments. You will need
to contact a funeral home or monument company to arrange this. Then, they will call our
department to request the staking for placement of the monuments. We will then, notify our
Parks and Recreation Dept. so that they could stake (flag) the area. There's no charge for
staking the area for placement of a monument.
For Mr. Bjerkene's urn burial you will need to contact a funeral home and they will contact
us to request the staking. We will then contact our Parks and Rec. Dept. to have this done.
The City of Clearwater only handles the staking request and we do charge $30.00 to have the
staking done for a burial.
I hope this answers all of your questions. If you have any other questions, please let me
know.
Best regards,
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
Original Message
From: Bruce Kaufmann (mailto:brucekaufmann7 @gmail.coml
Sent: Wednesday, April 25, 2012 12:25 PM
To: LaCosse, Judith
Cc: karylkaufmann @gmail.com; rtrevpace @aol.com
Subject: Bjerkenes Cemetery Plots
Dear Ms. Lacosse,
Thank you for talking with me today.
Please assist as my wife, Karyl Kaufmann, who is the nominated Personal Representative of Mr.
Gustav Bjerkenes's will and Father Ron Pace who is Trustee of Mr. Gust Bjerkenes' Trust try
to finalize the last wishes of Gladys and Gustav Bjerkenes. Their email addresses are listed
above and you may contact them or you can contact me as I will get the message to them.
They need to know where the plots are located.
What do they need to do to place Mrs. Bjerkenes tombstone on the grave? The stone is here
ready for placement.
What do they need to do to place Mr. Bjerkenes tombstone on the grave?
They need to order the stone.
1
What do they need to do to entomb Mr. Bjerkenes cremains?
Are there any costs to those activities?
Who do they contact to make the arrangements?
( I will send you another email about another couple.) Thank you.
Bruce Kaufmann
727 531-2929
Bruce Kaufmann, J.D.
Imaginator - Creative Business Consultant brucekaufmann7(gmail.com
727 531-2929 (telephone)
727 288 8355 (cellphone)
www.brucekaufmann.com
2
(;)///726,0 ,7,07.//5 6731'
� �� )
tho?.;/)
THE GUSTAV BJERKENES REVOCABLE TRUST 1018
GUSTAV BJERKENES TRTEE 63-27/631 FL
RONALD K PACE TRTEE JJ,, 1526
i
1564 OAKADIA LN I ®, ,
CLEARWATER FL 33764-2541
i war Bd.
Bank o'. merica
ACH R/T 063100277 C'f .of.. ••,.u/ f ,21 }' e
/ v ✓ ----/?4,.14-
�, ',t� . 1.
1:063 L00`2771: 002 2907E906 LI; LO L8
Harland Clarke
I
BURIAL PERMIT
CLEARWATER CARETAKER PERMIT# 1431
CLEARWATER, FL May 15, 2013
Permission is hereby granted for burial of:
Name of Deceased: GUSTAV BJERKENES Burial Type: URN
Owner of Property: GUSTAV BJERKENES& GLADYS B BJERKENES
Block: 16 Lot: 57 Space: 2 Date of Birth: July 25, 1919
Date of Death: December 3,2011 Date of Burial: April 11, 2013
Funeral Home Director: NO SERVICE- FLORIDA VAULT
Time: : Staking Fee: 30.00 Date Paid: May 15, 2013
Clearwater Cemetery /
By �cAi,e