Sutton, Anna J & Sutton JamesDate: 3 / ;-1 / 3 0 i ?
Cemetery Call Work Sheet
Funeral Horne / Monument Company: rc� �'k. 1,4 0kt� Co .
Contact Name: e Vin Tel. #: -7--3--.1.--15-6-/ Fax #:
Reason for call: Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For: P An k. 3 S, °n 5:41 os, Lee t4 kv
Block I S Lot g 1 Space 3 �- 4
Date: 3 / ;3 5'/ ,) 0 / 7 Time:
(Send email to P &R)
Verifying Burial space
Other reason:
M:2 r1,
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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
$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
LaCosse, Judith
From: Tokar, Mark
Sent: Thursday, March 23, 2017 10:57 AM
To: LaCosse, Judith
Cc: Wells, Alexis; Bruce, Larry; Vaughan, Karen
Subject: RE: Cemetery Staking - Placement of a double marker
Green flags.
From: LaCosse, Judith
Sent: Tuesday, March 21, 2017 11:28 AM
To: Tokar, Mark
Cc: Wells, Alexis; Bruce, Larry; Vaughan, Karen
Subject: Cemetery Staking - Placement of a double 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 double marker in the following spaces:
Spaces 3 and 4 of Block 15, Lot 87
James Sutton is buried in Space 3 and Ann J. Sutton is buried in Space 4
Staking is needed by this coming Saturday, March 25th in the morning.
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
March 23, 2017
Attn: Kevin Cantrell / Cycadia Monument Co.
Fax: 727 - 785 -0856
Block 15, Lot 87, Space 3 & 4
James Sutton — Space 3
Ann J. Sutton — Space 4
Gravesite marked with Green flags
Note: No fee for monument staking
If you have any questions please give me a call at 727 - 562 -4093.
(cemetery map attached)
Thank you,
dith LaCosse
Official Records & Legislative Services
City of Clearwater