Irion, DavonneDate: to / / la-
Cemetery Call Work Sheet
Funeral Home / Monument Company:
..UaVoKhL Orion
Contact Name:
Tel. #: G: 44, 0- 53 b7
Fax #:
e,v,.,..z(2-: 1e ir;o" - ao(. Co
Reason for call: Staking Request (Interment/Disinterment) : L / L II
t'C�SO4.4,4 i;G Tr- io& -
V Affidavit (Burial Rights) 8r- k e r o' h‘t. 5L ,e :JA-7 Tr; o,v
Monument (Marker) being placed (No fee for staking of monument)
Verifying Burial space CL`"`2j` 1 P(o (: S °1 • Pe-ter 5 0.,-J er
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13 r of
Uoc% 9 Lot Lf`f �p
Sec,al. 1 �cy Trio-v-,
/3,2174 9 LC71- So s11 �� �� /- 4.14
****************************************** * * * * * * * * * * *4 * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * ** �(o k 9,
Interment: (One full burial and one um, or two urns per space) Sp‹.c.4.4. 3 a- `t Lod Sb
Full Burial Urn Space /
Other reason:
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 Mark Tokar, Marco Ortega /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 5/31/12
Crystal Reports Viewer
1
100%
Status of Block: 9 Lot: 49 as of 10/22/2012
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL IRION SR LADDIE E 6/23/1931 03 / 09 / 1978 3/13/1978 Y1251
2 FULL IRION DONALD W 10/15/1928 03 / 05 / 1980 3/8/1980 1354
3 FULL IRION J W 10/8/1901 10/26/1983 10/29/1983 1534
4 FULL IRION DOROTHY 9/25/1904 10/07/1986 10/11/1986 1681
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
http: / /msb- crystal- ent/ businessobjects /enterprisell /infoview/ viewers /rpt/DHTMLViewer.aspx ?skin =skin default &sViewerNa... 10/22/2012
Crystal Reports Viewer
Oi 1
100%
Status of Block: 9 Lot: 50 as of 10/22/2012
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
1 FULL PETERSON JOHN E 10/3/1876 05 / 09 / 1950 5/9/1950 0
2 FULL PETERSON ALMA 0 1/25/1884 08 / 09 / 1948 8/9/1948 0
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
http: / /msb- crystal- ent/businessobjects /enterprise1 l /infoview/ viewers /rpt /DHTMLViewer.aspx ?skin =skin default &sViewerNa... 10/22/2012
LaCosse, Judith
From: LaCosse, Judith
Sent: Thursday, October 25, 2012 11:39 AM
To: 'Family Email'
Subject: RE: Affidavit
Importance: High
Davonne,
The Affidavit needs to be signed by your husband and it needs to be notarized.
Please return the completed Affidavit to my attention at your earliest convenience. We will then update our records to
reflect this information.
If you have any questions, please give me a call at 727 - 562 -4093.
Best regards,
Judith LaCosse
Staff Assistant
City of Clearwater
Official Records and
Legislative Services Dept.
112 S. Osceola Ave.
Clearwater, FL 33756
From: Family Email rmailto:leirion@ aol.comj
Sent: Wednesday, October 24, 2012 3:00 PM
To: LaCosse, Judith
Subject: Re: Affidavit
Thank you. This looks good to me.
Davonne Irion
Sent from my iPhone
On Oct 23, 2012, at 9:11 AM, < Judith .LaCossePmyClearwater.com> wrote:
Hi Davonne,
Attached you will find a draft copy of the Affidavit granting interment rights to your husband and his
brother.
I have also attached the burial information in Block 9, Lot 49 spaces 1 -4 and Block 9, Lot 50 spaces 1 -2.
As I mentioned over the phone yesterday, spaces 3 and 4 are currently vacant.
Please review the affidavit and advise if you're in agreement. Please give me a call at 727 - 562 -4093 if
you have any other questions.
1
Thank You.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
From: Family Email jmailto:IeirionCa>aol.coml
Sent: Monday, October 22, 2012 4:26 PM
To: LaCosse, Judith
Subject: Re: Affidavit
My husbands name is Laddie Irion and his brothers name is Jay Irion.
My cell phone is 460 -5367.
Thank you.
Davonne Irion
Sent from my iPhone
On Oct 22, 2012, at 3:46 PM, < Judith .LaCosse@mvClearwater.com> wrote:
Hi Davonne,
I forgot to get your telephone number. I'm working on the Affidavit for your husband
but I need your husband's name and his brother's name.
Please advise when you get a chance or you could give me a call.
Thank you.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562 -4093
<Affidavit- Irion.doc>
<Block 9, Lot 49 and 50.pdf5
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