Errickson, DorisCemetery Call Work Sheet
Date: (/ / 7 /
Funeral Home / Monument Company:
Contact Name:Nr"t5 Errick S Tel. #: - Sg5 -1"C) Fax #:
JJc C� .oti5 C .-Q-
Reason for call: Staking Request (Interment7Disinterment) ej u 1, cL c.9_ e , ve-i"i zon .nL�
Affidavit (Burial Rights)
Interment:
Full Burial
Owner of Plot:
Deceased Name:
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: '146A 4QD AQ)'t";ws 5G'")
°"G.nrct, k
�LvC- K-sGyk. , WoJS 3�F -e +a k-KDcif
i
(One full burial and one urn, or two urns per space)
Urn Space /
cJ � wt.t., H £ r r � 4` oh ( O Lc) iA e�
r i c
Block Lot 3 5 Space
Date of Birth: / / Date of Death / /
yf i 41,Q 41.1 s /14, uJ
8144uS Itt:ts
5r_ I- ka
Date of Burial: / / Time: am /pm
$30.00 Staking Fee (Funeral Home) — received on: / /
Copy of permit emailed to Mark Tokar, cc: Matt Anderson /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 11/15/17
9/25/2018 Mail - Judith.LaCosse @myClearwater.com
Block 6 Lot 35 - Owner: James Errickson
LaCosse, Judith
Fri 9/7/2018 4:17 PM
To.ardaghchalice @verizon.net <ardaghchalice @verizon.net >;
g 1 attachments (640 KB)
Block 6 Lot 35 - James Errickson.pdf;
Attn: Doris Errickson
Ms. Errickson,
Attached you will find printouts showing the status of Block 6 Lot 35. Spaces 2, 3, 4, 5 have full burials and the
rest are vacant.
The last sheet shows the layout of the spaces.
Please give me a call if you have any other questions at 727 - 562 -4093.
I work from 8:00 to 4:30 p.m.
Thank you.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727 - 562 -4093
https : / /outlook.office365.com /owa/ ?path= /mail /search/rp 1/1
Good Afternoon! Today is Wednesday, September 5, 2018
Cemetery
8 File
Transaction
View Lot Profile
Reports
Print Burial
Permit
Search Names
and Notes
Search Old
Locations
Print/View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List
of Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Permits List by
Location
PRBurial
C� Maintenance
Control Data
Valid Locations
Security
[ Previous Paae ]
Cemetery Tracking System - View Lot Profile
Block: 6 Lot: 35
Profile Summary
Home 1 Feedback I
You are logged in as Judith.LaCosse
Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on the
second grid to view the interment details of that individual.
EAST SIDE OF MYRTLE AVENUE
Space
Owner Last
Owner First
Owner Middle
Max Interred
Total Assigned
Interred
'1
ERRICKSON
JAMES
H
1
0
0
View Assigned
2
ERRICKSON
JAMES
H
1
1
1
View Assigned
3
ERRICKSON
JAMES
H
1
1
1
View Assigned
4
ERRICKSON
JAMES
H
1
1
1
View Assigned
5
ERRICKSON
JAMES
H
1
1
1
View Assigned
6
ERRICKSON
JAMES
H
1
0
0
View Assigned
7
ERRICKSON
JAMES
H
1
0
0
View Assigned
18
ERRICKSON
JAMES
H
1
0
0
View Assigned
9
ERRICKSON
JAMES
H
1
0
0
View Assigned
110
ERRICKSON
JAMES
H
1
0
0
View Assigned
I 12
Updated on Tuesday, January 6, 2009
Home 1 Feedback 1 Departments 1 Contacts 1 Forms
[TOD of Pane]
MGM Good Afternoon! Today is Wednesday, September 5, 2018
e Cemetery
File
Transaction
View Lot Profile
8 Reports
Print Burial
Permit
Search Names
and Notes
Search Old
Locations
Print /View Lot
Status
Monthly Memo
Disinterments
Deceased by
Location
Alphabetical List
of Deceased File
List of Owners
File
Reinterments
Permits List by
Deceased
Permits List by
Location
PRBurial
Maintenance
Control Data
Valid Locations
Security
[ Previous Page ]
Home 1 Feedback
You are logged in as ludith.LaCosse
Cemetery Tracking System - View Lot Profile
Block: 6 Lot: 35
Profile Summary 1
Click 'View Assigned' to view interment details. If more than one individual is interred in a space, a
second grid will appear below, displaying all of the individuals assigned to the space. Click 'View' on the
second grid to view the interment details of that individual.
EAST SIDE OF MYRTLE AVENUE
j Space
Owner Last
Owner First
Owner Middle
Max Interred
Total Assigned
Interred
11
ERRICKSON
JAMES
H
1
0
0
View Assigned
12
ERRICKSON
JAMES
H
1
0
0
View Assigned
12
Updated on Tuesday, January 6, 2009
Home 1 Feedback 1 Departments 1 Contacts 1 Forms
[ Too of Pale ]
Status of Block: 6 Lot: 35 as of 09/05/2018
II
INTERMENTS:
SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED
2 FULL ERRICKSON ALBERT W 1/7/1890 03 / 09 / 1974 5/12/1974
3 FULL ERRICKSON ETHEL 7/6/1900 11 / 11 / 2000 11/14/2000
4 FULL ERRICKSON WILLIAM E 9/20/1830 02 / 29 / 1924 2/29/1924
5 FULL ERRICKSON HELEN L 3/23/1862 09 / 09 / 1930 9/9/1930
DISINTERMENTS FROM SPACE:
No Matching Records
REINTERMENTS:
No Matching Records
Page 1 of 1
PERMIT
1023
2464
0
33333
la-
HELEN L. ERICKSON
1862 -1930
WM. E. ER CKSON
1830 -1924
4
KS 6,-J.
'2 -(, -/q o o- doe
ALBERT WILLIAM ERRICKSON
• 3- ,�l1 -74
11 •