Eubanks, GervaseDate: '7 /)-`t / )o -v
Funeral Home / Monument Company:
Contact Name:
Reason for call:
Cemetery Call Work Sheet
Se re "';t7 fui e tiJ T1
Tel. #:.7cri - S-°g°Fax #:
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) 7
Verifying Burial space
Other reason:
14'41d.° L()lfL J4) f e --V-•
F .
,A-ksi Ce / S.) 0+
*************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial ✓ Urn Space
Owner of Plot:
Deceased Name:
er vet_ se
Block IS Lot 8L2 Space .3
Date of Birth: 1 / Id / (q a`t Date of Death -7 / a-3 / ?.v;. °
Date of Burial: `1 / a8/
iV ooh
Time: am/pm
$30.00 Staking Fee (Funeral Home) - received on: 7 / / o: o
Copy of permit emailed to Nathan Brigman, cc: Matt Anderson/P&R on:
ctiu C. 4 14' 3 3 (t got,
**************************************************************************************************
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 6/2/2020
Status of Block: 15 LOT: 86 as of 7/24/2020
INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PERMIT
SP TYPE
1 FULL KRESS JULIE 1/4/1938 1/25/1986 1/29/1986 1646
2 FULL EUBANKS ELBERT F 11/26/1926 6/28/1991 7/2/1991 1999
4 FULL JONES BERTHA 12/1/1895 7/17/1992 7/22/1992 2066
DISINTERMENTS
REINTERMENTS
LaCosse, Judith
From: Chaplinsky, Timothy
Sent: Monday, July 27, 2020 7:25 AM
To: LaCosse, Judith; Brigman, Nathan
Cc: Anderson, Matthew; Vaughan, Karen
Subject: Re: Cemetery Staking Request - Full Burial
Westside of cemetery, south end area. The flags are yellow.
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From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Friday, July 24, 2020 1:43:40 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Cc: Anderson, Matthew<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>; Vaughan, Karen<Karen.Vaughan@MyClearwater.com>
Subject: Cemetery Staking Request - Full Burial
Good Afternoon,
We received a cemetery staking request this afternoon from Brittany of Serenity Funeral Home for a full burial.
Please stake Block 15, Lot 86, Space 3 for a full burial.
Deceased Name: Gervase Eubanks - DOB: 1/18/1924 DOD: 7/23/2020
The space needs to be marked by next Tuesday, July 28th. Time of burial is around Noon.
Other burials nearby in Block 15, Lot 86:
Space 1= Julie Kress - full burial
Space 2 = Elbert F Eubanks — full burial
Space 4 = Bertha Jones — full burial
Please let us know the color of the flags being used so that we could notify the funeral home.
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
1
Serenity Funeral Home
13401 Indian Rocks Road
Largo, FL 33774
PAY Thirty and 00/100 Dollars
Amegy Bank, N.A.
Porter, TX
35-1125
1130
PAY TO THE City of Clearwater
ORDER OF CITY CLERKS DEPT
'600 CLEVELAND ST
CLEARWATER FL 33755
Memo._.____.46.6_tQ.100Z_Q_4__.__Eubanks_ Genaase.______.___�_
14334806
07/28/2020
****$30.00
Void After 180 Days
II' 1 4 3 3 4130 611' 1:1131 L05861: 414.4070720