Smith, Carol A.Date: it / 9t / 9-o) b.
Cemetery Call Work Sheet
Funeral Home / Monument Company: ne��.
Contact Name: -3)' -'4-i.d Tel. #:10)-1-6-1' - a'1 " Fax* 7Y7 - 56)a— ao73
Reason for call: tK Staking Request (Interment/Disinterment) 3t'- °°
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: Pi ��►��h - G S; v01,1 C A
Deceased Name: avvre A ,
Block 1 tt Lot ttL'd- Space b 0
Date of Birth: 6, / 1 / 1S Date of Death
Date of Burial: Lt / `t / a-Q l L Time:
/33/:101.
Woo 01/pm
VLi Ir ci n,,,a'',.g G . S -,, , fl,, - urn
1.,3 11).■ .,a M.5) a d7
f K +)
$30.00 Staking Fee (Funeral Home) - received on: S / 5 / OM('
Copy of permit emailed to Mark Tokar, cc: Cherise Sarnoff /P &R on: 5 /
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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
LaCosse, Judith
From: LaCosse, Judith
Sent: Monday, April 04, 2016 9:36 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Clearwater Cemetery Staking Request - Urn Burial
Importance: High
Tracking: Recipient Read
Tokar, Mark
Wells, Alexis Read: 4/4/2016 9:54 AM
Sarnoff, Cherise
Vaughan, Karen Read: 4/4/2016 9:41 AM
We received a call this morning from Daniel Miller from Moss Feaster requesting a staking for an Urn burial for:
Carol A. Smith in Block 14, Lot 462, Space 00
DOB: 6/18/1945 — DOD: 3/23/2016
Surrounding burials:
Block 14, Lot 461, Space 00 = (for Richmond G. Smith)
Block 14, Lot 463, Space 00 = Buddy Williams (Infant)
Staking is needed this week before Friday
Date of Burial: 4/9/2016 at around 11:00 a.m.
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith LaCosse
Staff Asst
City of Clearwater
OILS Dept.
727 -562 -4093
1
LaCosse, Judith
From:
Sent:
To:
Cc:
Subject:
Orange flags. .
From: LaCosse, Judith
Sent: Monday, April 04, 2016 9:36 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Clearwater Cemetery Staking Request - Urn Burial
Importance: High
Tokar, Mark
Tuesday, April 05, 2016 10:38 AM
LaCosse, Judith
Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
RE: Clearwater Cemetery Staking Request - Urn Burial
We received a call this morning from Daniel Miller from Moss Feaster requesting a staking for an Urn burial for:
Carol A. Smith in Block 14, Lot 462, Space 00
DOB: 6/18/1945 — DOD: 3/23/2016
Surrounding burials:
Block 14, Lot 461, Space 00 = (for Richmond G. Smith)
Block 14, Lot 463, Space 00 = Buddy Williams (Infant)
Staking is needed this week before Friday
Date of Burial: 4/9/2016 at around 11:00 a.m.
Please advise as soon as you can the color of the flags being used so that we could notify the funeral home.
Thanks for your help.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
1
April 5, 2016
Attn: Dan Miller
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: Carol A. Smith
Gravesite: Block 14, Lot 462, Space 00
Urn Burial
Gravesite flagged with Orange flags.
Nearby Burials:
Block 14, Lot 461, Space 00 = (for Richmond G. Smith)
Block 14, Lot 463, Space 00 = (Infant, Buddy Williams)
** Staking Fee: $30.00
Please make check payable to: City of Clearwater
Mail to:
City of Clearwater
Official Records Dept. - 2 "d Floor
112 S. Osceola Ave.
Clearwater, FL 33756
Please contact me with any questions.
Thank you,
iJ dith LaCosse
fficial Records & Legislative Services
City of Clearwater
727 - 562 -4093
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
1
BANK OF AMERICA
64- 1278 -611
1305
4/18/2016
30.00
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
SIGNATURES NEEDE OVER $5,000.00
DOLLARS
L�
AUTHORIZED SIGNATURE
0467300L30511' 1:06 27/381: 0033598 LOO 5LH'
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
Comments
C.Smith Staking fee #1210401
1305
Amount
30.00
30.00
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 1305
L# Comments
Amount
1 C.Smith Staking fee #1210401 30.00
Total forC.Smith Staking fee #1210401 30.00
-)DELUXE CORP" 1 +800- 328 -0304 www.deluxeforms.com
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OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
May 5, 2016
CITY OF CLEARWATER
Moss Feaster Funeral Home
693 South Belcher Road
Clearwater, FL 33764
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
CITY HALL, 112 SOUTH OSCEOLAAVE.NUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562 -4090 FAx (727) 562-4086
To Whom It May Concern:
We received your Cemetery Staking Fee check #1305 in the amount of $30.00 for the interment
of Carol A. Smith in Block 14, Lot 462, Space 00.
Attached you will find receipt No. 448198.
Thank you,
dith LaCosse
taff Assistant
ta4;
"E�n- E1I1'I ILy I APl9RJ1:v1neAcH EyIP10YLi <°
CLEARWATER CARETAKER
CLEARWATER, FL
BURIAL PERMIT
PERMIT # 1454
May 05, 2016
Permission is hereby granted for burial of:
Name of Deceased: CAROL A SMITH Burial Type: URN
Owner of Property: RICHMOND G SMITH & CAROL A SMITH
Block : 14 Lot: 462 Space: 00 Date of Birth: June 18, 1945
Date of Death: March 23, 2016 Date of Burial: April 9, 2016
Funeral Home Director: DANIEL MILLER/MOSS FEASTER
Time: 11 :00 Staking Fee: 30.00 Date Paid: May 5, 2016
Clearwater Cemetery