Skeen, EstelleCemetery Call Work Sheet
Date: 5 / 19 / ao ao Vella Funeral Home / Monument Company: v ellarakt,ta C� Contact Name: €r' c. Tel. #: 1 a7 - 5.1Y -1,107. Fax #:
PI, P >rk kti sp4ce
W if or.ha,C .r,1 4.24 .
v 5/a %v 10
Reason for call:
V. 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:
Interment: (One full burial and one urn, or two urns per space)
Full Burial ✓ Urn Space
Owner of Plot: £s -t -S S%ecn
Deceased Name:
Es-ta,Skee-v% HK.siOat* 1: 011CX.464- S .
,ri $ of". 5.134 e"e 1 .
Block l 4 Lot 5 S (' Space el-
Pe.1-n,,1+ E a
Date of Birth: g' /3° / 1%-`4 Date of Death
S/19/�oa.a
Date of Burial: 5 / a a / a ? o Time: N% am/pm
$30.00 Staking Fee (Funeral Home) - received on: 6 / I / )""ad
Copy of permit emailed to Mafk-eekafrec: Matt Anderson/P&R on:
**************************************************************************************************
cLjc koa,L 91�.
fev4K x c4A-P
C 441.
azo )o
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
•
LaCosse, Judith
From: Chaplinsky, Timothy
Sent: Wednesday, May 20, 2020 9:37 AM
To: Brigman, Nathan; LaCosse, Judith; Anderson, Matthew
Cc: Vaughan, Karen
Subject: Re: Rush Cemetery Staking Request - Full Burial
West side orange flags.
Get Outlook for iOS
From: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Sent: Tuesday, May 19, 2020 11:23:54 AM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>
Cc: Chaplinsky, Timothy <Tim.Chaplinsky@MyClearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com>
Subject: Re: Rush Cemetery Staking Request - Full Burial
Thank you we will handle.
Tim,
Please handle as soon as you are able today or tomorrow am.
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@myClearwater.com>
Sent: Tuesday, May 19, 2020 11:20:50 AM
To: Anderson, Matthew <matthew.anderson@myclearwater.com>
Cc: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>; Vaughan, Karen <Karen.Vaughan@MyClearwater.com>
Subject: Rush Cemetery Staking Request - Full Burial
Good Morning,
We received a rush cemetery staking request this morning from Eric of Veterans Funeral Care for a full burial.
Please stake Block 14, Lot 556, Space 2 for a full burial.
Deceased Name: Estelle Skeen - DOB: 8/30/1924 DOD: 5/19/2020 — (her husband is buried in Space 1)
The space needs to be marked by this Thursday, May 21st , burial might be on Friday, May 22"d, not sure of the
time.
1
Other burials nearby in Block 14, Lot 556:
Space 1= William A. Skeen (husband) - full burial
Space 3 = Mary L. Lewis — full burial
Please let me know the color of the flags being used so that I could notify Eric at Veterans Funeral Care as soon as
possible.
If you have any questions please give me a call at 727-562-4093.
Thanks !!
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727-562-4093
2
e0269L20" :`263 L9L38?': 000242 LO20370
Veterans Funeral Care Inc./15381 Roosevelt Blvd
05/26/2020 City of Clearwater
Date Type Reference Original Amount Balance Due
05/26/2020 Bill Skeen -#20214 30.00 30.00
Check Amount
10029 BANK AND CA
026912
Payment
30.00
30.00
30.00
State of Florida, Department of Health, Bureau of Vital Statistics
�• BURIAL TRANSIT PERMIT
DATE PRINTED: May 22, 2020 TRACKING NUMBER: 2020089037
1. DECEDENT INFORMATION
Name of Deceased Date of Death
DAILY ESTELLE SKEEN May 19, 2020
AKA: ESTELLE D SKEEN
Place of Death - County City, Town or Location Name of facility, or street address If not a facility
PINELLAS PINELLAS PARK SUNCOAST HOSPICE CARE CENTER MID PINELLAS
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
VETERANS FUNERAL CARE INC F040002 F040002 (727) 524-9202
15381 ROOSEVELT BLVD
CLEARWATER, FLORIDA, 33760
Funeral Director/Direct Disposer Fla. Lic. No./Reg. No.
RICHARD B. KRIEVER SR. F043611
Medical Verification Statement
Christopher at the certifying physician's office, was contacted on 05/19/2020 by the funeral director listed above; he/she indicated
that JUAN A ESCOBALES, certifying physician, will complete and sign the medical certification of cause of death within 72 hours.
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2020-F040002-5204
Date Issued: May 19, 2020
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: CLEARWATER MUNICIPAL CEMETERY
Method of Disposition: BURIAL Date of Disposition:
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V-1.011, Florida Administrative Code