Hancock, MaryDate: S / a 5 / d-°
Cemetery Call Work Sheet
Funeral Home / Monument Company: NA ss Ft
1 7
Contact Name: /\ Tel. #: S t a - 7 -' Fax #:
Email:
Reason for call:
**
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: M °' 11.12 m-cr
Deceased Name: MCrr 4'tr cock
Block a Lot t( Space I°
Date of Birth: 4 / -/ 1931
Spkce 11 = 14-4(r7 (46(11.(--bck
Date of Death S / aa/ god-/
Date of Burial: C, / S / Time: /D :00
**
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:
Send email to P&R to stake the space
19-9
Notify funeral home/monument company with color of the flags used to mark the space
Gr -z: - ���,� Sd� o. Ct►„���r�.
Staking fee received on: ' / g•- / c o)-) From: R�"� ss �e 5 -1;'A -F. t.
c� e Gtr- . ;} s 1 = $ 30. ot)
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in P&R
on: (o / 3 /
**************************************************************************************************
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 4/21/2021
LaCosse, Judith
From: LaCosse, Judith
Sent: Tuesday, May 25, 2021 2:54 PM
To: Brigman, Nathan; Anderson, Matthew; Chaplinsky, Timothy; Peterson, Erick
Cc: Horsely, Christopher; Vaughan, Karen
Subject: Cemetery Staking Request - Full Burial
Attachments: Block 2 Lot 11 burials.pdf
Importance: High
Tracking: Recipient Read
Brigman, Nathan Read: 5/27/2021 6:38 PM
Anderson, Matthew
Chaplinsky, Timothy
Peterson, Erick
Horsely, Christopher Read: 5/25/2021 2:56 PM
Vaughan, Karen Read: 5/25/2021 3:02 PM
Good Afternoon,
We received a cemetery staking request from Alex of Moss Feaster Funeral Home for a Full burial.
Please stake Block 2, Lot 11, Space 10 for a full burial for Mary Hancock.
DOB: 4/2/1931 DOD: 5/22/2021
(See attached burial status for Block 2, Lot 11) — Note: Harry Hancock, husband, is buried in space 11 (full burial).
If possible, this space needs to be marked by next week. The service is scheduled for Saturday, June 5th at around
10:00 a.m.
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.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
1
LaCosse, Judith
From: Peterson, Erick
Sent: Friday, May 28, 2021 6:35 AM
To: LaCosse, Judith
Cc: Mack, Paul
Subject: cemetery staking
Judith the grave is mark with Orange flag on the east side of Myrtle Ave
Ru -Mary 601Coc h
aka ,k /a)
MOSS FEASTER FUNERAL HOME
AND CREMATION SERVICES
693 SOUTH BELCHER ROAD
CLEAR WATER, FL 33764
(727) 562-2070
PAY TO THE
ORDER OF
City of Clearwater
---Thirty And 0/100 ---
MEMO
BANK OF AMERICA
64-1278/611
U
2
5/24/2021
g
m
30.00 DOLLARS
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
TWO SIGNATURES NEEDED IF OVER $5,000.00
. Bancock__Staking_.w_Fee.__.n111,6730022510 ':061LL2788': 0033598 LOOS Le
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
Comments
Hancock Staking Fee
AUTHORIZED SIGNATURE
2251
Amount
30.00
30.00
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2251
L# Comments
Amount
1 Hancock Staking Fee 30.00
Total forHancock Staking Fee 30.00
■)DELUXE CORP- 1+800-328-0304 www.deluxeforms.com
881064 / 03-16
2565058700
'3,91E CHIK0K03 01/13/20201L54 -26-
CITY OF CLEARWATER
POST OFFICE Box 4748, 01.kiVIVATER, FLORIDA 33758-4748
• %
600 CLEVELAND STREE1, SUITE 600, CLEARM ATER, FL 33755
TELEPHONE (727) 562-4090 FAx (727) 562-4086
OFFICIAL RECORDS AND
LEGISLATIVE SERVICES
June 2, 2021
Moss Feaster Funeral Home
and Cremation Services
693 South Belcher Road
Clearwater, FL 33764
Attn: Alex
Dear Alex:
We received the Cemetery Staking Fee check #2251 in the amount of $30.00 for the interment
of Mary Hancock in Block 2, Lot 11, Space 10.
Attached you will find our receipt No. 452097.
Thank you,
,
IA
dith LaCosse
.-'Staff Assistant
Mark Bunker, Councilmember
Kathleen Beckman, Councilrnember
Frank V Hibbard, Mayor
David Allbritton, Councilmernber
Hovt Hamilton, Councilrnember
"Equai Employment and Affirmative Action lEmplover”