Anderson, DeniseDate: (t / I `f / 61°17
Cemetery Call Work Sheet
Funeral Home / Monument Company:
C.
Tel. #: Fax*
Contact Name: DeiA-i-Se.
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)
Verifying Burial space
Other reason: LIK'n 5p �r�� .nece.i--Qy ,bcct J-,
�wS�cKdl) <ler np 5�� leu- h f,ts2lt Siz P4•M-0? cc")4 I`1
f\Av, S.ec}� {%�$ �1A Stets 1.1 ��L C t ` (n� _"� ��` cmc1lM--' (�cT�dol�.
Interment: (One full burial and one urn, or two urns per space) Ce "^e -{e7 5 , - Z 5 M.,'Q.(J
Full Burial Urn Space 6 ✓
Owner of Plot:
Let
Deceased Name:
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
CITY OF CLEARWATER
August 9, 2017
Mr. Jerald E. Anderson
Mrs. Denise Anderson
1309 Lakeview Road
Clearwater, FL 33756
Oi! Ll R:, & 1.1(,i,i nni_Sir,v;rr�
Cris F1 . 1125„i �n ..,(.1.(,1 1 zAvi yt i, CI v.1;1OR]Dv 33-56
i (727) 562-4(1911 F1N (T2) 562-41156
Re: Clearwater Municipal Cemetery - Block 14, Lots 395 & 396, Spaces 00
Dear Mr. Anderson:
We received your check #7025 in the amount of $262.10 for the payment of the two
urn spaces ($125.00 x 2) mentioned above. This check also includes the cemetery
deed recording fee ($10.00) and doc stamps ($2.10). Our receipt No. 448938 is
enclosed with this letter.
The Contract to Purchase Cemetery space document is being routed for city officials
signatures along with the Cemetery Deed document. The Cemetery Deed document
will be sent to the Pinellas County courthouse for recording.
Once the recorded Cemetery Deed document is returned to us I will mail you the
original recorded document along with a copy of the completed/signed Contract to
Purchase Cemetery Space document.
We will update our cemetery program to reflect that you and Mrs. Anderson are the
current owners of these two urn spaces.
If you have any questions please give me a call at 727-562-4093.
Sincerely,
; udith LaCosse
itaff Assistant
C 1 T Y OF C L E A R w A T E R
( )IIIA I A' IZI
}jr. 11? sf O,,„ I
i � :�� r�� i , C�i gra � i i I'i , JRu> , 33�.�-
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i'i I(vi ?) 562-4090 1' v (7 562-4086
August 28, 2017
Mr. Jerald E. Anderson
Mrs. Denise Anderson
1309 Lakeview Road
Clearwater, FL 33756
Re: Clearwater Municipal Cemetery - Block 14, Lots 395 & 396, Spaces 00
Dear Mr. Anderson:
Enclosed you will find the original Cemetery Deed that has been recorded with the
Pinellas County Courthouse along with a copy of the completed/signed Contract to
Purchase Cemetery Space document.
Our cemetery program has been updated to reflect that you and Mrs. Anderson are
the current owners of these two urn spaces.
If you have any questions please give me a call at 727-562-4093.
Sincerely,
udith LaCosse
Staff Assistant
Encl.
JERALD E ANDERSON DBA
ANDERSON ASSOCIATES
1309 LAKEVIEWRD
CLEARWATER, FL 33768.3647
BankofAmerica'V
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CLEARWATER CEMETERY
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CLEARWATER CEMETERY
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CEMETERY DEED
KEN BURKE, CLERK OF COURT
AND COMPTROLLER PINELLAS COUNTY, FL
INST# 2017258119 08/17/2017 at 03:22 PM
OFF REC BK: 19745 PG: 669-669
DocType:DEED RECORDING: $10.00
D DOC STAMP: $2.10
THIS INDENTURE made this 1 sr day of R"' "'it , 2017, between the City of
Clearwater, Florida, a municipal corporation as Grantor and Jerald E. Anderson &
Denise Anderson , whose mailing address is 1309 Lakeview Rd., Clearwater, FL 33756 ,
County of Pinellas, State of Florida, as Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of $250.00 in hand paid by the said Grantee, the
receipt whereof is hereby acknowledged, has remised, released and quit -claimed unto the said Grantee, and their heirs forever, all the
right, title and interest, which the said Grantor has in and to the following described parcel of land, lying and being in Pinellas County,
State of Florida, to wit: Spaces zero (00), Lot Three Hundred Ninety Five & Three Hundred Ninety Six (395 & 396),
Block Fourteen (14) , Clearwater Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas County, Florida.
This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written consent
of the Grantor, and to the further condition that said property shall be used only for cemetery purposes as human burial sites and is
subject to such other rules and regulations the City of Clearwater may adopt pertaining to use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and their heirs and assigns
forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor, by its City Manager,
and to be attested and its corporate seal affixed by the City Clerk on the day and year first above written.
Countersigned: CITY OF CLEARWATER, FLORIDA .1
�orLtrIQr CICO By:ttW L • 0.11%4A -air
George N. Cretekos, Mayor William B. Horne, II, ity Manager
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared George N. Cretekos, the Mayor of the City of Clearwater,
known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be her fre
for the use and purposes herein set forth.
WITNESS my hand and official seal this /•• day of
, 2017.
nt/typec?.€
name:4LJAfA0b'�NPubic,
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared William B. Horne, ll, the City Manager of the City of Clearwater, Florida, to me
well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free act and
deed for the use and purposes herein set forth.
WITNESS my hand and official seal this day of
Pamela K. Akin, City Attorney
CEMETERY DEED.DOC
RETURN TO: Official Records & Legislative Services
P. O. Box 4748, Clearwater, FL 33758
, 2017.
rint/type name: Sk
Notary Public
j•e_C-
9700-0026
Rev. 7/17
CONTRACT TO PURCHASE CEMETERY SPACE
HIS CONTRACT, made and entered into this 1 Sf day of
P''�y"nk , 20 17 between the City of Clearwater as "GRANTOR" and
derak Andeon &I Bnlae Anderon , whose mailing address is 1309
Lakeview Rd. , Clearwater, FL 33756 , of the County of
Pinellas, State of Florida, as "PURCHASER":
WITNESSETH: That in consideration of the mutual promises and
covenants herein contained, and other valuable considerations, the Grantor
agrees to sell and the Purchaser agrees to buy the following described space:
Block 14. Lots 395 & 396 (Urn Spaces) , Clearwater
Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas
County, Florida.
PURCHASE PRICE
RECORDING FEE
DOC STAMPS
$ 125.00 x 2 = $250.00
$ 10.00 (+ $8.50 add'I page)
$ 2.10
Total balance due is $ 262.10 . In the event of default in the balance due, the entire sum may be immediately declared due
in full. Failure of the purchaser to make said payment shall entitle the Grantor to retain all proceeds theretofore paid, as liquidated
damages, and may also retain title to any part or portion of said property which has not been used for grave space, and thereupon this
contract shall become null and void.
NO SPACE SHALL BE USED AS A BURIAL SITE UNTIL THE CONTRACT HAS BEEN PAID IN FULL.
THE PURCHASER FURTHER AGREES to abide by all rules and regulations governing the use and maintenance of space(s)
in Clearwater Cemetery. This contract shall not be assigned nor shall any grave space sold hereunder be transferred without the
written consent of the City of Clearwater.
The obligations and benefits under this contract shall extend to the personal representatives and heirs of the Purchaser and
the successors of the City.
IN WITNESS WHEREOF, said parties have set their hands and seals the day and year first above written.
44w
raid E. Anderson & enise Anderson
PURCHASER(S)
(Witness as to Purchaser)
4-41V Ct
_Grz 3c cZ_ h
(Wi ss as to Pum6aser) 620
.2s1S- GN
CONTRACT TO PURCHASE CEMETERY SPACE
HIS CONTRACT, made and entered into this si day of
P'ty'a t , 20 17 , between the City of Clearwater as "GRANTOR" and
,19taldAnderion & benlae.An on , whose mailing address is 1309
Lakeview Rd. Clearwater. FL 33756 , of the County of
Pinellas, State of Florida, as "PURCHASER":
WITNESSETH: That in consideration of the mutual promises and
covenants herein contained, and other valuable considerations, the Grantor
agrees to sell and the Purchaser agrees to buy the following described space:
Block 14. Lots 395 & 396 (Urn Spaces) , Clearwater
Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas
County, Florida.
PURCHASE PRICE
RECORDING FEE
DOC STAMPS
$ 125.00 x 2 = $250.00
$ 10.00 (+ $8.50 add! page)
$ 2.10
Total balance due is $ 262.10 . In the event of default in the balance due, the entire sum may be immediately declared due
in full. Failure of the purchaser to make said payment shall entitle the Grantor to retain all proceeds theretofore paid, as liquidated
damages, and may also retain title to any part or portion of said property which has not been used for grave space, and thereupon this
contract shall become null and void.
NO SPACE SHALL BE USED AS A BURIAL SITE UNTIL THE CONTRACT HAS BEEN PAID IN FULL.
THE PURCHASER FURTHER AGREES to abide by all rules and regulations governing the use and maintenance of space(s)
in Clearwater Cemetery. This contract shall not be assigned nor shall any grave space sold hereunder be transferred without the
written consent of the City of Clearwater.
The obligations and benefits under this contract shall extend to the personal representatives and heirs of the Purchaser and
the successors of the City.
IN WITNESS WHEREOF, said parties have set their hands and seals the day and year first above written.
4
Le
raid E. Anderson & enise Anderson
PURCHASER(S)
(Witness as to Purchaser)
Nicole Sprague, D-puty
arto ed es to for .
Rob Surette, Asst. City Attorney, II
STATE OF FLORIDA )
COUNTY OF PINELLAS)
4(Wi ss as to P . 6to
a, "i --61.4K o
e2 I S t.fN )ni 3710
address (please print) ec - ��jr (.�(, 3
CITY OF CLEARWATER, FLORIDA
►1e. Blvd , 5fa-G
By: W1-4.40. A144440-2"
William B. Horne, City Manager
COUNTERSIGNED:
By:,109(10gt,\010,
George N. Cretekos, Mayor
Before me personally appeared William B. Horne, the City Manager of the above named city, who acknowledged that he
executed the foregoing instrument. He is personally known to me d did not take an oath.
WITNESS my hand and official seal this a7' day of Jc[..s t< , 20/7 .
(SEAL)
Notary Public State of Florida
Patricia A Kuligowski
Ir.0
My Commission GG 131393
Expires 10/20/2021
Print na
Before me personally appeared George N. Cretekos, the Mayor of the above named city, who acknowledged that he executed
the foregoing instrument. He is personally known to me and did t take an oath.
WITNESS my hand and official seal this=19 " day of , 20/7 .
(SEAL)
CONTRACT.DOC
N.Pa Weis AiKuligite of owskii onda
4a ti
My Commission GG 131393
Expires 10/20/2021
9700-0027
Rev. 4/17