Fitch, Helen LouiseCemetery Call Work Sheet
Date: 7 / 3L)-
Funeral Home / Monument Company: ,to
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Contact Name: - A r Tel. #: �J7-Lt`t4:" —3'55 -
Fax #:
.1a7 _3105-- Y353
Reason for call: 1/ Staking Request (Interment/Disinterment)
Affidavit (Burial Rights)
Monument (Marker) being placed (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
c0H•
(Send email to P&R)
Verifying Burial space
Other reason:
**************************************************************************************************
Interment: (One full burial and one urn, or two urns per space)
Full Burial
Owner of Plot: ° �c
Urn Space
Le. -S
Deceased Name: rf02,c h ,tt 5 e. tc_1„
Block 8 Lot 12 3 Space
Date of Birth: I / (8 / 1`c.) 3 5 Date of Death 1 / `( /
Date of Burial: / 4 / O G Time: °t' am//
$30.00 Staking Fee (Funeral Home) — received on: ( / 1 / 01-C )-63
Cr)0r K Sob, 1✓l.c,.
Copy of permit emailed to Nathan Brigman, 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 6/2/2020
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Orange flags,West side of cemetery, North area. I figured I'd include the photo of the name stone that we discussed
over the phone.
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Thursday, July 30, 2020 8:28 AM
To: Brigman, Nathan
Cc: Anderson, Matthew; Chaplinsky, Timothy; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Good Morning,
We received a cemetery staking request yesterday from Bob Grant of Rhodes Funeral Home for a full burial.
Please stake Block 8, Lot 63, Space 2 for a full burial.
Deceased Name: Helen Louise Fitch - DOB: 10/18/1935 DOD: 7/29/2020
The space needs to be marked by sometime early next week. (Day and time not known at this time — funeral home
checking with the family)
Other burials nearby in Block 8, Lot 63:
Space 1= Joyce Lewis - full burial
Space 2 = vacant
Space 3 = vacant
Space 4 = vacant
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.
Judith LaCosse
Staff Asst
City of Clearwater
ORLS Dept.
727-562-4093
2
Status of Block: 8 LOT: 63 as of 7/29/2020
INTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED PERMIT
SP TYPE
1 FULL LEWIS JOYCE 7/10/1930 5/27/1993 5/27/1993 2103
1 FULL LEWIS JOYCE 7/10/1930 5/27/1993 6/2/1993 2103
DISINTERMENTS
BURIAL DECL DECF DECM BIRTH DEATH INTERRED
SP TYPE
1 FULL FREEZE, JR WALTER H 1/1/1928 7/12/1946 7/12/1946
1 FULL FREEZE, JR WALTER H 1/1/1928 1/1/1946 1/1/1946
HFALTH
State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
DATE PRINTED: July 30, 2020
1.
Name of Deceased
HELEN FITCH
TRACKING NUMBER: 2020139284
DECEDENT INFORMATION
Placa of Death - County City, Town or Location
PINELLAS CLEARWATER
Name and Address of Funeral Home&Dlrect Disposal Establishment
RHODES FUNERAL DIRECTORS INC P041686
800 EAST DRUID Rb
CLEARWATER, FLORIDA, 33756
Funeral Director/Direct Disposer
ROBERT 3 GRANT JR Fla. tic. No/Reg. No.
Medical Verification Statement F043193
Wendy at the can $fyhp Physician's office, waa contacted on 07130/2020 by the funeral director Listed above; helahe Indicated that
SONtYA SNAILESR PATEL, certifying physician, will complete and sign the medical certification of cause of death within 72 hours.
Date of Death
July 29, 2020
Name of faclIlhr, or 4trset address If not a facility
MORTON PLANT HOSPITAL
FIa. Lac. No/Reg, No.
F041686
Phone Number
(727) 446.3055
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants pormisaion to dispose of this body in accordance with Chapter 382, Florida Statutes.
State Registrar
Permit Number: 2020•F04188&d0o5
Date Ittsued; July 30, 2020
• AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District
4.
Approval Number:
CEMETERY OR CREMATORY
Place of Disposition: CnY OF CLEARWATER CEMETERY
Method of Disposition: BURIAL Date of Disposition:
EDRS maintains all statutorily required information regarding the death record and related
burial transit permlt, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their flee they may do so.
DR 326E, 10/12
64V-1,011. Fterida Administrative Co
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HI ON NIVd 'IVAou €E:ZT OZOZ'OE'Tnr
PAY TO THE
ORDER OF
WORK & SON INC.
DIP ACCOUNT
(727) 577-0599
2600 GANDY BLVD
PINELLAS PARK, FL 33702
MEMO 6TA.VZ&I
000/3790 4063/075L34 755238 9560
WELLS FARGO BANK, N.A.
WELLSFARGO.COM
1379
63-751/631
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$ 3cs
DOLLARS 6
THANK YOU FOR YOUR SERVICE
m,
07/24/2006 00:22
7274430253
RHODES
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