Griffin, Lloyd AubreyDate: 11 / ( / c-o /1
Cemetery CaII Work Sheet
Funeral Home / Monument Company: �o Ss reef_ S��'r
Contact Name: PA-L X4- 4 rein Tel. #: %��-� �' ° 7° Fax #: S4 -
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) ✓ S Ikkt� ` -*L it
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Verifying Burial space
Other reason:
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Interment: (One full burial and one urn, or two urns per space)
Full Burial '� Urn Space
Owner of Plot: L /old V, « f:0
Deceased Name: Ltold A4j rey tsrif() K,
Block 1 Lot a Space /5
Date of Birth: 1 / 1 / 41 l i' Date of Death
U /e h-? Opm Date of Burial 11 / l a/ a n 17 Time:
1 1 1 ' / . c ( 7 7
$30.00 Staking Fee (Funeral Home) — received on: I) / / 3 / ot°
R -ft 11n Q Ls o .
Copy of permit emailed to Mark Tokar, cc: C-h /P &R on: 11 / IL / t)on
"151-7 /Moss
f;‘,5-ter
******************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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: Tuesday, November 7, 2017 8:56 AM
To: LaCosse, Judith
Subject: Re: Cemetery Staking Request - Full Burial
Green flags. Could you please remove Larry Bruce and add Tim chaplinsky.
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On Mon, Nov 6, 2017 at 9:30 AM -0500, "LaCosse, Judith" < Judith .LaCosse @myClearwater.com> wrote:
We received a call from Paul from Moss Feaster requesting a staking for full burial in the following space for:
Lloyd Aubrey Griffin - Space 15 of Block 1, Lot 2 DOB: 1/1/1918 - DOD: 11/4/2017
Burials Nearby:
Space 7 = Lillian B Griffin (full burial)
Space 8 = Mildred I Griffin (full burial)
Space 13 & 14 = Vacant
Space 16 = Barnes (Infant)
Staking is needed by this Wednesday. November 8th for sometime in the morning.
Please advise me with the color of the flags used for staking so we could notify the funeral home.
Thank You.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 -562 -4093
1
November 7, 2017
Attn: Paul MacLaren
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: Lloyd Aubrey Griffin
Gravesite: Block 1, Lot 2, Space 15
Full Burial
Gravesite flagged with Green flags.
Nearby Burials in Block 1, Lot 2:
Space 7 = Lillian B Griffin (full)
Space 8 = Mildred I Griffin (full)
Space 13 & 14 = vacant
Space 16 = Barnes (infant)
** 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,
L& fc,c1A,L_
'J 1dith LaCosse
Official 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
BANK OF AMERICA
64- 1278/611
100(
11/9/2017
PAY TO THE
ORDER OF
City of Clearwater 60.00 DOLLARS
-- -Sixty And 0 /100 --
MEMO Gje4>6i0t/
—w– C--1 a r- l- -Sta1d .ng --Fee
04E7300 1567o ':06 L L L 2788': 0033598/005L0
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
TWO SIGNATURES NEEDED IF OVER $5,000.00
AUTHORIZED SIGNATURE
Comments
Clark Staking Fee
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
L# Comments
1 Staking Fee
9 Staking Fee
Total forClark Staking Fee
7oE.UXE CORP' 1 +800- 328 -0304 www.deluxeforms.com
881064/03-16
1567
Amount
60.00
60.00
1567
Amount
30.00
30.00
60.00
BURIAL PERMIT
CLEARWATER CARETAKER PERMIT # 1466
CLEARWATER. FL November 14, 2017
Permission is hereby granted for burial of:
Name of Deceased: LLOYD A GRIFFIN Burial Type: FULL
Owner of Property: LLOYD V GRIFFIN &
Block : 1 Lot: 2 Space: 15 Date of Birth: January 1, 1918
Date of Death: November 4, 2017 Date of Burial: November 12, 2017
Funeral Home Director: PAUL MACLAREN/MOSS FEASTER
Time: :
Staking Fee: 30.00 Date Paid: November 13, 2017
Clearwater Cemetery
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