Burke, Peter H.Date: �� / la / (3-013
Cemetery Call Work Sheet
Funeral Home / Monument Company: i c-ies -- L�3,1-12 4 F. Y.
Contact Name: S -IA S1 k;v. s Tel. #: Ce 't5- I t57 Fax #: i�)- _ 0 a-
Reason for call: / Staking Request (Interment/Disinterment) Ui : Affidavit (Burial (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
(Send email to P &R)
Verifying Burial space
Other reason:
II- 13 - -13
9.
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial Urn Space ✓
Owner of Plot: r` ` j, Rat = kII Il& M. vi s
Sow (.lrv� z.-
�i�, 6rkc1
Deceased Name: ��=t� ', - �t � L.le,)
Block 4> Lot 30 Space ILf
Date of Birth: - / 11 / 19 5 `t Date of Death LI-
Tom+ 4 1Le34.
Date of Burial: 1,1/ 1 / I . Time: 10:0c" pm
C(n. t bG
$30.00 Staking Fee (Funeral Home) - received on: h- / 19 / cl.4,2Q D. - 1141/0
Copy of permit emailed to Marco Ortega, cc: Mark Tokar /P &R on: I - / lR / 13
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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, November 13, 2013 10:44 AM
To: LaCosse, Judith
Cc: Ortega, Marco; Tokar, Mark; Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Re: Cemetery Staking - Urn burial
Pink flags.
On Nov 12, 2013, at 12:02 PM, "LaCosse, Judith" < Judith .LaCosse @myClearwater.com> wrote:
We received a call this morning from Sarah Simkins, Funeral Director at Michels- Lundquist Funeral
Home requesting a staking for placement of an urn.
The deceased name is Peter H. Burke. Please Stake Space 14 of Block 5, Lot 30.
The date of burial will be December 7th at 10:00 a.m.
Other burials nearby:
Space 13: Ada M. David — full burial and Herbert Grundy — Urn burial
Please advise me of the color of flags being used.
Thanks,
Judith LaCosse
StaffAssistan t
Official Records and
Legislative Services Dept.
727- 562-4093
November 13, 2013
Attn: Sarah Simkins
Monument Co.: Michels- Lundquist Funeral Home
Fax: 727- 848 -0232
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Peter H. Burke
Gravesite: Block 5, Lot 30, Space 14
Urn Space
Gravesite flagged with Pink flags.
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
Nearby Burials:
Space 13 = Ada M. David — full burial and Herbert Grundy — urn burial
Please contact me with any questions.
Thank you,
Judith LaCosse
Staff Assistant
Official Records & Legislative Services
City of Clearwater
727 - 562 -4093
MICHAEL D. BURKE
PO BOX 13028 813-892-5735
TAMPA, FL 33681
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638279/2631
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