Lugo, GilbertoDate: ' / f?/ 01-°J/
Funeral Home / Monument Company:
Contact Name: ``°S 5
Email:
Cemetery CaII Work Sheet
Reason for call:
**
Tel. #:-°`t9iFax#:
Sc)c;Efy
Staking Request — Interment
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
Full Burial
Urn Burial
(One full burial and one urn, or two urns per space)
Owner of Plot: G.� Qipar`f c y I,C•tr
Deceased Name:
Block 15- Lot l o `1 Space +
Date of Birth: la / I' / I`1 Date of Death /
Date of Burial: b d / / Time: )1:0O am�/pm
**
Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space
Date: / / Time:
Affidavit (Burial Rights) Verifying Burial space
Other reason:
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✓ Send email to P&R to stake the space
Notify funeral home/monument company with color of the flags used to mark the space -5/d',AAA re 146 cjA-
f
Staking fee received on: / ' /`'1 From: NJ. °n.,.Q cty
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Jarvis Sheeler in P&R on: 3 / /90=4- /
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9°4-
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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
ORLS/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 9/4/2020
LaCosse, Judith
From: LaCosse, Judith
Sent: Wednesday, February 17, 2021 2:15 PM
To: Brigman, Nathan; Sheeler, Jarvis; Anderson, Matthew; Chaplinsky, Timothy
Cc: Vaughan, Karen; Horsely, Christopher
Subject: Cemetery Staking Request for Urn Burial - Gilberto Lugo
Attachments: Block 15 Lot 109.pdf
Tracking: Recipient Read
Brigman, Nathan
Sheeler, Jarvis
Anderson, Matthew
Chaplinsky, Timothy
Vaughan, Karen Read: 2/17/2021 3:18 PM
Horsely, Christopher Read: 2/17/2021 2:17 PM
Good Afternoon,
We received a cemetery staking request this afternoon from Matt Moss from National Cremation Society for an
urn burial.
Please stake Block 15, Lot 109, Space 4 for an urn burial.
Deceased Name: Gilberto Lugo - DOB: 12/16/1919 DOD: 2/1/2021
Note: His wife, Guadalupe Lugo, is buried in space 4 (urn burial).
The space needs to be marked by next Wednesday, February 24th at around 11:00 a.m.
(See attached burial status for Block 15, Lot 109)
Please let us know the color of the flags being used so that we could notify National Cremation Society.
If you have any questions please give me a call at 727-562-4093.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
i
Colorado Crematory Services
8578 W 32nd Ave
Wheat Ridge, CO 80033
Crematory License Number
CM.0000529
Certificate of Cremation
I hereby certify that the cremation for
Gilberto Cintron LUGO
who passed away on
February 1, 2021
occurred on
February 5, 2021
at
Colorado Crematory Services
Metal Identification Disc Number 58534
National Cremation Society Denver Buck, Cory
Contracting Funeral Home Crematory Representative
Colorado Depanmem
of Public Holth
and F ironmem
AUTHORITY FOR FINAL DISPOSITION
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
• It is unlawful for any person in charge of a burial place or crematory to permit burial or other disposition of a dead human body or fetus until a
final disposition permit has been issued.
• A final disposition permit may be issued only upon registration of a completed death certificate.
• A final disposition permit is required for any type of disposition of a dead human body or fetus.
• This permit may be used for transporting by common carrier.
• This permit meets all the requirements of C.R.S. 12-54-307(2)(a)(IX).
• This permit does not supercede other legal requirements for burial and/or cremation on private property (meaning not an established cemetery or
crematory), such as city/county ordinance, land use regulations, convenants, etc.The landowner and/or
funeral director is responsible for determining if such requirements or restrictions exist, prior to final disposition.
This final disposition permit, when completed and bearing the required signature, constitutes authority for burial, interment, cremation,
removal from the state, or other authorized disposition of the deceased named below, in accordance with Section 25-2-111 C.R.S. 1982.
This permit must accompany the remains to their destination.
Name Of Decedent GILBERTO CINTRON LUGO
Date of Death 02/01/2021
Sex MALE Age 101 YEARS Date of Birth 12/16/1919 Place Of Death LITTLETON ARAPAHOE
Name of Funeral Establishment NATIONAL CREMATION SOCIETY
City County
Address of Funeral Establishment 5060 E HAMPDEN DENVER COLORADO 80222
Type of Disposition CREMATION
Place/ Cemetery/ Crematory COLORADO CREMATORY SERVICES
City WHEAT RIDGE
State COLORADO
Additional information regarding transport and/or disposition (if needed):
I have examined the completed death certificate for the decedent named above, and authorize final disposition of the remains. (To
be signed by the office designated or established pursuant to section 25-2-103 C.R.S. 1982 in the county where death occurred.)
Signature
4300 Cherry Creek Drive South, Denver, CO 80246
State Registrar
Title
02/04/2021
Address
Date
REV: OCTOBER 2015
•
National Cremation Society - Denver
5060 East Hampden Ave
Denver, CO 80222
PAY Thirty and 00/100 Dollars
PAY TO THE
ORDER OF
Bank of America
CITY OF CLEARWATER UTILITY
100 SOUTH MYRTLE AVENUE #210
POST OFFICE BOX 4748
CLEARWATER FL 33758
Memo: 507301000831 Lugo Gilberto
1666
1220
50115833
02/24/2021
****$30.00
Void After 180 Days
wisp L l 58 3 all' is l 2 200066 Li: 0668 2D000 2ll'