Glisson, Ruth AudisDate: ) / 39" /
Funeral Home / Monument Company:
Cemetery CaII Work Sheet
fv o s s
Contact Name: Tel. #: 1)-1- S -olu 70 Fax #: '73-7 - 5-6,a-a01.3
Reason for call: ✓ Staking Request (Interment/Disinterment)
Affidavit (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:
Interment: (One full burial and one urn, or two urns per space)
Full Burial
Urn Space
Owner of Plot: I). L . GLs -5,cv, S. ,,. d_ : Kee L. 6.0....,50,,_-
C ,A--
Deceased Name: Rw L, f\u ,5 L5_s vi-L, \4
Block 15 Lot t 8 Space 1
Date of Birth: I a / - / 19 11
Date of Burial: 1/ 31 / X`-"
I S
Date of Death 1 / -1 / a-015
Time: ° am /pm
$30.00 Staking Fee (Funeral Home) — received on: / 3 / 2d 15
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /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 11/24/14
,
Status of Black: 15 Lot: 48 as of 01/22/2015
1
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT
2 FULL GLISSON DIXIE L 5/2/1899 05 / 12 / 1983 5/16/1983 1522
3 FULL STALLINGS LONNIE A 9/7/1900 10 / 31 / 1981 11/3/1981 1445
4 FULL STALLINGS MILDRED G 1/12/1911 11 / 05 / 1994 11/8/1994 2184
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
LaCosse, Judith
From:
Sent:
To:
Subject:
Red flags.
Tokar, Mark
Friday, January 23, 2015 8:47 AM
LaCosse, Judith
RE: Cemetery Staking Request - Full Burial
From: LaCosse, Judith
Sent: Thursday, January 22, 2015 11:28 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Importance: High
Today, we received a staking request from Joe from Moss Feaster for a Full burial for:
Ruth Audis Glisson in this plot, Block 15, Lot 48, Space 1 DOB: 12/2/1917 — DOD: 1/21/2015
Owner of plot: D.L. Glisson
Other burials nearby in this plot:
Space 2 = Dixie L Glisson (full burial)
Space 3 = Lonnie A Stallings — (full burial)
Space 4 = Mildred G Stallings — (full burial)
Staking is needed by Tuesday, January 27th at around Noon.
Please advise me of the color of the flags being used so that we could notify the funeral home.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 - 562 -4093
January 23, 2015
Attn: Joe
Funeral Home: Moss Feaster Funeral Home
Fax: 727 - 562 -2073
(This fax includes a copy of Cemetery Map)
# in the circle is the Block, # in the square is the Lot
Deceased: Ruth Audis Glisson
Gravesite: Block 15, Lot 48, Space 1
Full Space
Gravesite flagged with Red flags.
Nearby Burials:
Space 2 = Dixie L Glisson — (full burial)
Space 3 = Lonnie A Stallings — (full burial)
Space 4 = Mildred G Stallings — (full burial)
** 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
Please contact me with any questions.
Thank you,
Judith LaCosse
Official Records & Legislative Services
City of Clearwater
727 - 562 -4093
From:Moss Faastar Belcher GI-tape! 7275622072
02/02/2015 16:06 1170 P _001 /001
State of Florida, Department of Health, Bureau of Vital Statistics
'lOt I� aBURIAL TRANSIT PERMIT
HEALTH DATE PRINTED: January 23, 2015 TRACKING NUMBER: 2015011813
7 . DECEDENT INFORMATION
Name of Deceased Date of Death
AUDIS COPE GLISSON January 21, 2015
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
HILLSBOROUGH TAMPA FLETCHER HEALTH AND REHAB CENTER
Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
MOSS- FEASTER FUNERAL HOMES AND CREMATION SERVICES F080439 F080439 (727) 562.2070
693 SOUTH BELCHER RD
CLEARWATER, FLORIDA, 33764
Funeral Director /Direct Disposer Fla. Lic. NoJReg. No.
JOSEPH GAMBINO F036947
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2015- F080438.5018
/01/1, �_ y�-GQ _ _ Date issued: January 22, 2015
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: CLEARWATER CEMETERY
Method of Disposition: BURIAL Date of Disposition:
TORS maintains all statutorily required information regarding the death record and relater
burial transit.permit, therefore, returning the permit to the county health department is no
,longer'required:
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V- 1.011, Fiorida Administrative Code
MOSS FEASTER FUNERAL HOME
AND CREMATION SERVICES
693 SOUTH BELCHER ROAD
CLEAR WATER, FL 33764
(727) 562-2070
PAY TO THE
ORDER OF
City of Clearwater
- -- Thirty And 0 /100 - --
MEMO
Giissoy. 4..6730121.0.1.0..8. Stakiiig. Fee
BANK OF AMERICA
64-1278 -611
1Ua4
1/29/2015
30.00
DOLLARS
YOID AFTER 180 DAYS
//G4r4e
AUTHOnZED SIGNATURE
6
0467300L084n• 406 LLL2788': 0033598 L005Lu
NOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 1084
Comments
Glisson 467301210108 Staking Fee
RECEIVED
FEB 0 3 2015
FINANCE DEPARTMENT
Amount
30.00
30.00
LOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 1084
L# Comments
1 Glisson 467301210108 Staking Fee
Total torGlisson 467301210108 Staking Fee
Magmata Doer 1 +800- 328-0304 www.deluxeforms.aom
Amount
30.00
30.00
CLEARWATER CARETAKER
CLEARWATER, FL
BURIAL PERMIT
PERMIT # 1446
February 04, 2015
Permission is hereby granted for burial of:
Name of Deceased: RUTH A GLISSON Burial Type: FULL
Owner of Property: D.L. GLISSON & AUDIS GLISSON
Block : 15 Lot: 48
Date of Death: January 21, 2015
Space: 1 Date of Birth: December 2, 1917
Date of Burial: January 27, 2015
Funeral Home Director: JOE / MOSS FEASTER
Time: 12 :00
Staking Fee: 30.00 Date Paid: February 3, 2015
Clearwater Cemetery
By