Sullivan, Lee R & Sullivan, Virginia (Overby)Date:
/ Id / 61-° /6
Funeral Home /
Monument Company:
Contact Name: ke
Reason for call:
Cemetery Call Work Sheet
Tel. #: gt--/ 551 Fax #:
Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
Lee R (-1,>,) 5412-LA (`--1-‘-
7 Lot 4`f Space
For:
Block
Date: (1 / 1't / a-° /' Time:
(Send email to P&R) 11-10
Verifying Burial space
Other reason:
Interment: (One full burial and one urn, or two urns per space)
Full Burial
Owner of Plot:
Deceased Name:
Urn Space
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / /
Time: am /pm
11 JY- IL'
j e7 c.,, a.
W eAL LA-41.J -t, .
$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
1
Status of Block: 7 Lot: 64 as of 11/10/2016
INTERMENTS:
SPACE
1
BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED
FULL
SULLIVAN LAURA L 1/1/1901 01 / 03 / 1966 1/4/1966
TR iAl\T 7/24/1913 08 / 17 / 2016 9/9/2016
' ' SUVA" LEE 'S''= "' R* 1/1/1905 01 / 01 / 1944 1/1/1944
3 FULL SULLIVAN C W 1/1/1903 01 / 01 / 1944 1/1/1944
4 FULL SULLIVAN ANDREW F 1/28/1866 07 / 05 / 1947 7/5/1947
DISINTERMENTS FROM SPACE:
No Matching Records
RESNTERMENTS:
No Matching Records
Page 1 of 1
PERMIT
473
1457
0
0
0
LaCosse, Judith
From:
Sent:
To:
Subject:
Sarnoff, Cherise
Monday, November 14, 2016 7:58 AM
LaCosse, Judith
RE: Staking Request - Placement of a marker
Good morning All I Orange flags
From: LaCosse, Judith
Sent: Thursday, November 10, 2016 11:14 AM
To: Tokar, Mark
Cc: Wells, Alexis; Sarnoff, Cherise; Vaughan, Karen; Gilmore, Stephanie
Subject: Staking Request - Placement of a marker
Importance: High
This morning we received a call from Kevin of Cycadia Monument Co. tel. #727 - 786 -1551, for a staking request for
placement of a marker in the following space:
space 2 of Block 7, Lot 64
Staking needed by next Monday, November 14`h
For: Lee R Sullivan (full burial) & Virginia Overby (Sullivan) (urn burial)
Other burials in this plot:
Space 1= Laura L Sullivan (full burial)
Space 3 = C W Sullivan (full burial)
Space 4 = Andrew F Sullivan (full burial)
Please advise me with the color of the flags being used so that we could notify Kevin of Cycadia Monument Co.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 - 562 -4093
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