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Errickson, James HLaCosse, Judith From: LaCosse, Judith Sent: Thursday, March 5, 2020 10:11 AM To: Chaplinsky, Timothy; Brigman, Nathan Cc: Anderson, Matthew; Vaughan, Karen Subject: RE: Cemetery Staking Request for Placement of a marker Thank you. I notified Kevin from Cycadia Monument Company. Judith LaCosse Staff Asst City of Clearwater ORLS Dept. 727-562-4093 From: Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com> Sent: Thursday, March 5, 2020 8:51 AM To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com> Cc: Anderson, Matthew <matthew.anderson@myclearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com> Subject: Re: Cemetery Staking Request for Placement of a marker Burial plot is marked in yellow flags east side of cemetery Get Outlook for iOS From: LaCosse, Judith <Judith.LaCosse@mvClearwater.com> Sent: Wednesday, March 4, 2020 2:56:33 PM To: Brigman, Nathan <Nathan.Brigman@MvClearwater.com>; Chaplinsky, Timothy <Tim.Chaplinskv@MvClearwater.com> Cc: Anderson, Matthew <matthew.anderson@mvclearwater.com>; Vaughan, Karen <Karen.Vaughan@MvClearwater.com> Subject: RE: Cemetery Staking Request for Placement of a marker Thank you for letting us know this information. From: Brigman, Nathan <Nathan.Brigman@MYClearwater.com> Sent: Wednesday, March 4, 2020 2:46 PM To: LaCosse, Judith <Judith.LaCosse@mvClearwater.com>; Chaplinsky, Timothy <Tim.Chaplinskv@MvClearwater.com> Cc: Anderson, Matthew <matthew.anderson@myclearwater.com>; Vaughan, Karen <Karen.Vaughan@ MvClearwater.com> Subject: Re: Cemetery Staking Request for Placement of a marker Judith, 1 Mark Tokar is no longer with the city. Please direct these emails to Tim Chaplinsky, as he is the lead worker for this site. Continue to copy me as well. We will be hiring a new foreman in the next month and I can notify you once we have someone in that seat for us. Tim will go out tomorrow to take care of the staking request and notify you once completed, as well as, color of flags. Thank You, Nathan Brigman City of Clearwater Parks and Recreation Department Landscape Manager B.S. Ornamental Horticulture ISA Certified Arborist Office - (727) 562-4270 ext 7808 From: LaCosse, Judith <Judith.LaCosse@mvClearwater.com> Sent: Wednesday, March 4, 2020 12:25 PM To: Tokar, Mark <Mark.Tokar@mvClearwater.com> Cc: Anderson, Matthew<matthew.anderson@mvclearwater.com>; Brigman, Nathan <Nathan.Brigman@MvClearwater.com>; Vaughan, Karen<Karen.Vaughan@MvClearwater.com> Subject: Cemetery Staking Request for Placement of a marker Hello, We received a staking request from Kevin from Cvcadia Monument Co. for placement of a marker for: James H. Errickson in Block 6, Lot 35, Space 12 Other burials nearby in this plot: Space 6 = Warren Errickson - (urn burial) Staking is needed ASAP. Please advise me of the color of the flags being used so that we could notify Cycadia Monument Co. Thank You !! 2 IgPI`#MET Good Afternoon! Today is Wednesday, March 4, 2020 Home 1 Feedback ® Cemetery ® File Transaction View Lot Profile IS 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 G� Maintenance Control Data Valid Locations Security [ Previous Page ] Cemetery Tracking System - Interment Detail Block: 6 Lot: 35 Space: 12 Rights Granted: 12/02/2019 You are logged in as Judith.LaCosse Interment Processed: 12/02/2019 Burial Type: First Name: Date of Birth: URN (JAMES 04/24/1928 Owner of Space? MI: © Last Name: Date of Death: IYES ERRICKSON 11/21/2019 Interment Date: Interment Director: Staking Fee $ 12/03/2019 R. BLAIR KRIEVER/VETERANS ,^ FUNERAL CARE v 30 Time of Service: Permit: Date Paid: 13 : 00 1474 11/26/2019 Interment Notes: RECEIVED $30.00 CASH FOR STAKING FEE/VETERANS FUNERAL CARE v Updated on Tuesday, January 6, 2009 Home 1 Feedback 1 Departments 1 Contacts 1 Forms [Too ofPaoe] Forma OMB Na 2900.0222 Dale: Dar., $1,1020 �1 -,CLAIM FOR STANDARD IMPORTANT: Foam tad rte Georg lakemtalia Mad Werecompleting gis ram. Type or pint clearly ail ittfansation except fbrsiptataret Iliccible Iridin could amok in m incorrect badtlone a maker or ddiray. Flaunt to complete ash bock mq malt is delayed processing. Blocs oohed in bolder GOVERNMENT DD 1. VA FIIEVIOUILY HEADSTONE OR MARKER ' _ ' AT A VA • ERDAL REQUEST Our ' ■ REPLACEMENT , +teas. PLEASE INCLUDE MILITARY DMCDARGE DOCUMENT& • YES • NO UNSURE resetits dtALL 3. NAME OF DECEASED TO BE INSCRIBED ON HEADSTONE OR MARKER (NoNkkaraw orOdespadtlw(1 �' ' ` t FIRST (OrkMgop MIDDLE �: t - (Okra) LAST , ; S 6 SUFFIX (Sr..Jr..11. /I ams) ■ CURRMe ENTLYMARsssNsatrftsy .� NOTMAIMED S. RA (♦ ■ E 0 - N (Yea argaka icon oar. iybrworkw will be ..., srarlrl., presses only.) AMERICAN INDIAN OR ALASKA NATIVE ■ NATIVE HAWIJIAN OR OTHER PACIFIC ISLANDER BLACK OR AFRICAN AMERICAN r • WHITE HISPANIC OR LATINO • OTHER ii),) /. 0--N • lad wl/be weal jotstmvstk+al pwposf!1ulyJ a. MSE r FEMME •,r ' = OF DEATH ...r. , -ti. _ .:,,,• B.VETERAN's8 •,'4.t i 1.` .:.,. 1.e,. l :ry) ,., . ft ..,,1 / SOCIAL SECURITY NO. 0. ANDIOR SERVICE NO. 9. PLACE OF BIRTH IC kyend Rote orCow 10A. DATE OF BIRTN NU X TTJ � AND/OR SVC. NO.: SSN: 558-3C-se)..- [ Q ' d J O QQ C' G7� �l )' f // MONTH DAY I• PL- i MON . t / 1 ' _ L Tri ::-i:��i1 A 1 12. RANK ATTAINED IT ?- 1- . MONTH MI YEAR MONTH DAY YEAR PO' rags) 13. BRANCH OF SERVICE (Check owelkoble boa(rt) MARINE COAST AIR ARMY ARMY CARPS GUARD FOLE FORCESMARINE • . naso be comes, AIR MERCHANT wet cask to &u 12) OTHER SpeN� 14, VALOR OR MEDAL OF DST HONOR CR PURPLE HEART AWARDS) (Deemamoutati a antragda8 SVC SILVER DST FLYING PURPLE AIR SRi STAR C- HEARTM +)I/ :: • 1 • • 15. TYPE • F HEADSTONE OR MARKER REQUESTED (Check one FLAT FIAT UPRIGHT FLAT BRONZE UPRIGHT SMALL FLAT BRONZE GRANI MARBLE MARBLE NICHE GRANITE GRANITE 6. "r WORLD KOREA r- --rr.« Kaidgmotabk, WAR 11 ETNAM t- A moo PERSIAN GULF AFGHANISTAN j IRAQ 17. EMBLEM OP SOUfF (Optimat0 EMBLEM NUMBER 1 y fee e ease n ❑ B ir, G I U ❑ F •Z My IL III OTHER ( c(&) u ■ N, E 18. ADD '7 n' , SC ,, OF ENDEARMENT (Optima° (Space WI wry accord/$$ re ops gjworker) 0 19s. NAME AND MAILING ADDRESS OF APPLICANT (No., Street, Co, State. Cody b VCk S 1Ci K C''•t' s u '7Q -tropic, p1UD qGt 6 19b. DAYTIME OR CELL PHONE NO. OF APPLICANT ry r` - (Melee Area Code J 19c. E-MAIL ADDRESS (Optional) 19d. FAX NO. (Optional) 20. E YOU - _ (''"� CEMETERY MANAGEMENT FAMILY MEMBER (Speen relalanddp) 51 OU 1�'� 0 VETERANS SERVICE OFFICER ❑ (wkm dw eerdalseed resahnr are IwtiaO EPR SB ENTATIVE (Penna resent %%decider FUNERAL HOME MANAGEMENT OTHER areaawa atstwar written aadto>tsorlanl ❑ the rrniwd thr racldwed naabu 0 (9Y) 21.1 WOULD U A PRESIDENTIAL MEMORIAL CERTIFICATE 22. IF "YES' HOW MANY? n YES 1il 0 C • RTIFIC : By signing below I certify the headstone or marker will be installed in the cemetery luted in block 21 at no expense to the Oovanmcer Illtd all information enter .. on this forth is true and correct to the best of my knowledge. I also certify, to the best of my knowledge, that the decedent hes never committed a serious crime, such as murder or other offense that could have resulted in imprisonment for life. has never been convicted of a serious crime. and hu never been convicted of a sexml offense for which he or she was sentenced to *minimum of life imprisonment PENALTY: The Naw provides severe penalties, which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, 23. SIGNATURE OF APPLICANT 26. E AND DELIVERY ADDRESS OF BUSINESS (CONSIGNEE) THAT WILL ACCEPT PREPAID DELIVERY (No.. Sind. CNA State, and VP Code; P.O. BOX eSNOT ACCEPTABLW MUST [N.00g(( 1s : C.''(-4Alit M i iec-ri CERTIFICATION: B tie bdOw roe to ' t •REPRE 20. PRINTED NAME AND 8 ATION: s CERTIF 30. PRINTEICIAL DOF 33. REMARKS r QX & VA FORM 40.1330 DEC 2017 I • r: elive + ;441'1 i. i ,, lT ;+r- 1- z .771 3 PHONE NO OF CEMETEBY (/$code Area Cade) 32. DA7E , Q . CHECK BOX BELOW IF REMAINS ARE NOT BURIED AN • 35. EXPLAIN BELOW (s.g., hued a sea renew red eft) (Rate Cawwry, 0 REMAINS NOT BURIED 25. DAYTIME OR CELL PHONE NO. OF CONSIGNEE (Include Area Code) 92 PS of the headstone or cher. 24. DATE (MM/DD/YYYY) 27. NAME AND ADD OF CEMETERY FAN/LY o PLOT WHERE GRAVE IS LOCATED (Mt. area w Stow. tad LP Cmti) MUST SIGN IN BLOCK 30 Casa p.,w k- M uAc+f Nitoe_Avt, 29. DA (h/lf/DD'»1)7 Pu" t rule/ f 1 - OF THIS FORM ARE OBSOLETE LaCosse, Judith From: Tokar, Mark Sent: Tuesday, November 26, 2019 10:27 AM To: LaCosse, Judith Cc: Anderson, Matthew; Brigman, Nathan; Vaughan, Karen Subject: Re: Municipal Cemetery Staking Request for Urn Burial Pink flags. Mark Tokar Get Outlook for iOS From: LaCosse, Judith <Judith.laCosse@myClearwater.com> Sent: Tuesday, November 26, 2019 9:02:46 AM To: Tokar, Mark <Mark.Tokar@myClearwater.com> Cc: Anderson, Matthew <matthew.anderson@myclearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Vaughan, Karen<Karen.Vaughan@MyClearwater.com> Subject: Municipal Cemetery Staking Request for Urn Burial Good Morning, We received a staking request from Blair Kriever from Veterans Funeral Care for a staking request for an Urn burial for: Decease Name: James H. Errickson in Block 6, Lot 35, Space 12 Other burials nearby in this plot: Space 2 = Albert W Errickson - (full) Space 3 = Ethel Errickson - (full) Space 4 = William E Errickson - (full) Space 5 = Helen L Errickson - (full) Space 6 = Warren L Errickson — (urn) Vacant spaces = 1,7,8,9,10,11,12 Staking is needed by next Tuesday, December 3rd at 1:00 p.m. Please advise me of the color of the flags being used so that we could notify the funeral home. Judith LaCosse Staff Asst City of Clearwater ORLS Dept. 727-562-4093 Date: i 1 / 0.6 / a° (`( Cemetery Call Work Sheet Funeral Home / Monument Company: VCterans �Q C Contact Name: R- Blar k'riever Tel. #:/a-1- 5aq- -`►200 Fax #: C-'.Ia7- go -8-)1,3 Reason for call: L Staking Request (Interment/Disinterment) Affidavit (Burial Rights) Qwir. V of ar.S oer_a:t.12.coaw Monument (Marker) being placed (No fee for staking of monument) For: Block Lot Space Date: / / Time: (Send email to P&R) ✓4f Verifying Burial space Other reason: +0 4-Le.Ikc itut 4As a. . 1-a6-19 Interment: (One full burial and one urn, or two urns per space) Full Burial Urn Space V Owner of Plot: j&r e N err eek 5 Oh. Deceased Name: Z&►..es -4. err i 4, o Block 6, Lot 3 5 Space (a - Date of Birth: `f / a -`f / 1901 Date of Death It / 0 t / d-0( Date of Burial: ia- / / D ( l Time: ( - p° a j� $30.00 Staking Fee (Funeral Home) - received on: it /al, /a01/ 13O-' Copy of permit emailed to Mark Tokar, cc: Matt Anderson/P&R on: 0-- / a- / ao19 ************************************************************************************************** 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 1 LaCosse, Judith From: Tokar, Mark Sent: Tuesday, November 26, 2019 10:27 AM To: LaCosse, Judith Cc: Anderson, Matthew; Brigman, Nathan; Vaughan, Karen Subject: Re: Municipal Cemetery Staking Request for Urn Burial Pink f a . Mark Tokar Get Outlook for iOS From: LaCosse, Judith <Judith.LaCosse@myClearwater.com> Sent: Tuesday, November 26, 2019 9:02:46 AM To: Tokar, Mark <Mark.Tokar@myClearwater.com> Cc: Anderson, Matthew <matthew.anderson@myclearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com> Subject: Municipal Cemetery Staking Request for Urn Burial Good Morning, We received a staking request from Blair Kriever from Veterans Funeral Care for a staking request for an Urn burial for: Decease Name: James H. Errickson in Block 6, Lot 35, Space 12 Other burials nearby in this plot: Space 2 = Albert W Errickson - (full) Space 3 = Ethel Errickson - (full) Space 4 = William E Errickson - (full) Space 5 = Helen L Errickson - (full) Space 6 = Warren L Errickson — (urn) Vacant spaces =1,7,8,9,10,11,12 Staking is needed by next Tuesday, December 3rd at 1:00 p.m. Please advise me of the color of the flags being used so that we could notify the funeral home. Judith LaCosse Staff Asst City of Clearwater ORLS Dept. 727-562-4093