Haynes, InezCemetery Call Work Sheet
Date: 7 / a9 /
Funeral Home / Monument Company: °� � 5 CWK.F","Q t one.
Contact Name: Ro1,er t P.1). Tel. #: 1a•7- `fi`t a - 2 -388 Fax #:
Reason for call: ✓Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
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Monument (Marker) being placed (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
(Send email to PSBR)
Verifying Burial space
Other reason:
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Interment: (One full burial and one urn, or two urns per space)
Full Burial V Urn Space
Owner of Plot: °.B • I47 v 41/4,/
Deceased Name: Ih L7
Block Lot Sin Space a (c-)
Date of Birth: ll / / 1't?-3 Date of Death 7 / a 3 /
Date of Burial: 8 / a_ / ao1`f Time: /f:oo
$30.00 Staking Fee (Funeral Home) — received on: g / 1 / d-o1`f
Copy of permit emailed to Marco Ortega, cc: Mark Tokar /P &R on: / I / 3-°1`-
ck tr/36,(t7
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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
Status of Block: 14 Lot: 508 as of 07/29/2014
i
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED
1 FULL HAYNES 0 B 12/31/1908 10 / 22 / 1990 10/27/1990
3 FULL DEMPSEY FORREST A 1/1/1915 04 / 07 / 1969 4/7/1969
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
PERMIT
1916
694
LaCosse, Judith
From: LaCosse, Judith
Sent: Wednesday, July 30, 2014 12:13 PM
To: Tokar, Mark
Cc: Official Records and Legislative Services
Subject: RE: Cemetery Staking Request - Full Burial
• ._,t �'. •.a Or�t� � ,� .
—Importance:
Thanks, Mark. I will notify the funeral home.
We will make a note to copy Cherise Sarnoff on future cemetery matters.
Have a nice day !!
From: Tokar, Mark
Sent: Wednesday, July 30, 2014 11:47 AM
To: LaCosse, Judith
Subject: RE: Cemetery Staking Request - Full Burial
1
Red flags. In the future can you please copy Cherise Sarnoff on cemetery matters as well. Thank you, Mark
From: LaCosse, Judith
Sent: Tuesday, July 29, 2014 12:10 PM
To: Tokar, Mark
Cc: Wells, Alexis; Gilmore, Stephanie; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Importance: High
Staking request for full burial received from Robert Young of Young's Funeral Home.
Name of deceased: Inez Haynes
Please Stake Space 2 of Block 14, Lot 508
The date of burial will be for Saturday, August 2 " at 11:00 a.m.
Other burials nearby:
Space 1: O B Haynes –full burial
Space 3: Forrest A Dempsey – full burial
Please advise me of the color of flags being used so that I could notify the funeral home.
Thank you.
Judith LaCosse
Staff Assistant
Official Records and
Legislative Services Dept.
727-562-4093
July 30, 2014
Attn: Robert Young
Funeral Home: Young's Funeral Home
Fax: 727 - 442 -8308
Deceased: Inez Haynes
Gravesite: Block 14, Lot 508, Space 2 (C)
Full Space
Gravesite flagged with Red flags.
Date of burial: Saturday, August 2nd — 11:00 a.m.
Nearby Burials:
Space 1 = 0 B Haynes — full burial
Space 3 = Forrest A Dempsey — full burial
Staking Fee: $35.00
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
Voungs Jm moral fame ,31St.
1663 iquward $1.
Clearwater, N 33756
REGIONS BANK
63- 466/631
13647
7/31/2014
0
PAY TO THE City of Clearwater
ORDER OF * *35.00
Thirty -Five and 00/ 100******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
DOLLARS In
City of Clearwater
100 So. Myrtle Ave
Clearwater, FL 33756
N
MEMO
Stkng (Haynes)
AU- - i'IZED' - NATURE
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