Black, Stennis D.Cemetery Call Work Sheet
Date: 7 / is / a-b ( )
Funeral Home / Monument Company: C- IcA.a(4. t u,, ,;:t Co .
Contact Name: Ke-v,v Q,wtr Tel. #: 7a"l- 7 %6 155iax #: 18'5- 0 S6
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For: Sfehrtis
Block la- Lot 9 9 Space S
Date: / / Time:
(Send email to P &R) -40 it
Verifying Burial space
✓ Other reason: A tb..avJ cc.zw,.eh
Interment: (One full burial and one urn, or two urns per space) °I+, C St evo -i,S 0. Ux4cri-�,
f A' w ;fL -tkt K., W h. -L
het .
Full Burial
Owner of Plot:
Deceased Name:
Urn Space
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, 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
CEMETERY SEARCH NAMES AND NOTES REQUEST
DECEASED NAME: STENNIS D BLACK
BLOCK: 12 LOT: 99 SPACE: 5
BORN: 07 / 02 / 1963 DIED: 07 / 03 / 1963 INTERRED: 07 / 05 / 1963 BURIAL TYPE: INFANT
INTERMENT NOTES:
NONE
(4r1
a31-30`tC,
C2A-L ( � -
Ke t ) . A k r e , e S 1 7 - ) / 5 S )
Page I of I
Status of Block: 12 Lot: 99 as of 07/07/2016
r
INTERMENTS:
SPACE BURIALTYPE DECL
1
2
3
4
7
8
9
DECF DECM BIRTH DEATH INTERRED
INFANT BENSION ALLEN N 9/4/1960 09 / 04 / 1960 9/5/1960
INFANT GRAY UNKNOWN 1/1/1963 03 / 14 / 1963 3/14/1963
INFANT HASLAM CINDY M 1/1/1961 08 / 07 / 1961 8/7/1961
INFANT WELLS LESA D 6/13/1961 12 / 15 / 1961 12/18/1961
INFANT " : "` ' ' 1> .- 61 7/2/1963 07 / 03 / 1963 7/5/1963
INFANT DUTCHER UNKNOWN 1/1/1963 03 / 16 / 1963 3/16/1963
INFANT LEASURE UNKNOWN 1/1/1961 06 / 26 / 1961 6/26/1961
INFANT SNEDEKER SUNDAY 6/25/1963 06 / 25 / 1963 6/27/1963
INFANT FRALEY CAROL R 1/1/1961 07 / 20 / 1961 7/20/1961
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
PERMIT
71
257
128
157
294
259
122
288
126
LaCosse, Judith
From: Sarnoff, Cherise
Sent: Friday, July 08, 2016 9:23 AM
To: LaCosse, Judith
Subject: RE: Cemetery Staking - Headstone removal and Placement of a marker
Good morning! I put orange flags around headstone. Have a great weekend! O
From: LaCosse, Judith
Sent: Thursday, July 07, 2016 9:29 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen
Subject: Cemetery Staking - Headstone removal and Placement of a marker
Importance: High
We received a staking request yesterday from Kevin Cantrell of Cycadia Monument Company for removal of a headstone
& placement of a marker.
The location is Block 12, Lot 99, Space 5 for Stennis D. Black
The staking is needed ASAP — (Family of deceased moving out of state)
Other Burials nearby in Block 12, Lot 99:
Space 4 = Lesa D Wells — infant
Space 6 = Dutcher (last name) - infant
Please let me know the color of the flags you will be using so that I could notify Mr. Kevin Cantrell.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
July 8, 2016
Attn: Kevin Cantrell / Cycadia Monument Co.
Fax: 727 - 785 -0856
Block 12, Lot 99
Stennis D. Black — Space 5
Gravesite flagged with Orange flags
Nearby Burials:
Space 4 = Lesa D Wells - infant
Space 6 = Dutcher (last name) - infant
If you have any questions please give me a call at 727 - 562 -4093.
Thank you,
,xidith LaCosse
Official Records & Legislative Services
City of Clearwater