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Padgett, EdnaCemetery CaII Work Sheet Date: g / / a42181 Funeral Home / Monument Company: r��t. Ron�r�en-t Contact Name: re V ` r Tel. #: 4:1° - a---711'8' Fax #: Reason for call: Staking Request (Interment/Disinterment) Affidavit (Burial Rights) Monument (Marker) being placed (No fee for staking of monument) For: C)91.4. Pea Co, Block 1 a- Lot 3 `' Space Date: °I / I / a° le Time: (Send email to P&R) +� Verifying Burial space Other reason: g06 /18 P-eA_ t4 pkce ta�� +k ice a WdLU L.) Lie .,6 12.414 N4+, Kevin•.. c 1.4 a nu.frt.eirt- Co •� ******************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **/ 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: 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 Status of Block: 12 Lot: 34 as of 08/28/2018 INTERMENTS: SPACE BURIALTYPE DECL DECF DECM BIRTH DEATH INTERRED PERMIT 1 FULL PADGETT VERNIE L 10/21/1927 05 / 19 / 1962 5/21/1962 188 2 FULL PADGET EDNA G 4/10/1927 07 / 16 / 2000 7/19/2000 2449 3 FULL LAURIN MARIE L 1/1/1888 09 / 28 / 1963 9/28/1963 310 4 FULL LAURIN EDWARD 1/1/1893 11 / 22 / 1965 11/22/1965 465 DISINTERMENTS FROM SPACE: No Matching Records REINTERMENTS: No Matching Records Page 1 of 1 Re: Cemetery Staking Requests for Monument Placements (3) Tokar, Mark Tue 8/28/2018 11:50 AM To:LaCosse, Judith <Judith.LaCosse @myClearwater.com >; cc:Anderson, Matthew < matthew .anderson @myclearwater.com >; Vaughan, Karen < Karen .Vaughan @MyClearwater.com>; Amon jr- orange flags Padgett- white flags Sowell- blue flags Mark Tokar Get Outlook for iOS From: LaCosse, Judith Sent: Tuesday, August 28, 2018 10:31:23 AM To: Tokar, Mark Cc: Anderson, Matthew; Vaughan, Karen Subject: Cemetery Staking Requests for Monument Placements (3) We received a staking request from Kevin of Cycadia Monument Co. for staking requests for Monument Placements for the 3 Spaces below in red: Block 11, Lot 28, Space 3 = Charles R Amon, Jr - (full burial) Other burials nearby in this plot: Space 1= Herbert R Fredrickson (full) Space 2 = Bertha E Fredrickson (full) Block 12, Lot 34, Space 2 = Edna G Padgett - (full burial) Other burials nearby in this plot: Space 1 = Vernie L Padgett (full) Space 3 = Marie L Laurin (full) Space 4 = Edward Laurin (full) Block 12, Lot 97, Space 2 = Carolyn Sowell - (full burial) Other burials nearby in this plot: Space 1= John L Spears (full) Space 3 = Hattie M Cribbs (full) Space 4 = Luther J Cribbs, Jr (full) Staking is needed by this Saturday, September 1st Please advise me of the color of the flags being used so that we could notify the monument company. Thank You !! Judith LaCosse Staff Asst City of Clearwater ORLS Dept. 727- 562 -4093