Nickelson, Hazel M (2)Date: � / `I / )--°11
Funeral Home / Monument Company:
,3-?
Contact Name: Tel. #: 5 < -Ila (, Fax #:
`aX-t- )13
Cemetery Call Work Sheet
R or,J t -k
Email:
h.e
Reason for call:
**
r.
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:
Deceased Name:
Block Lot Space
Date of Birth: / / Date of Death / /
Date of Burial: / / Time: am/pm
**
Monument (Marker) being placed - (No fee for staking of monument)
For: 'i2„?.. 1 iceek Sc,�z
Block PS- Lot I I Space Date: / / Time:
Affidavit (Burial Rights) Verifying Burial space
Other reason:
**************************************************************************************************
✓Send email to P&R to stake the space
V Notify funeral home/monument company with color of the flags used to m
arkthe space
\-1(\ Staking fee received on: / / From:
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in 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
ORLS/Cemetery/FormsPermitsTemplates/Cemetery Call Work Sheet -20
Revised 4/21/2021
LaCosse, Judith
From: Peterson, Erick
Sent: Wednesday, June 16, 2021 7:51 AM
To: LaCosse, Judith; Brigman, Nathan; Anderson, Matthew; Chaplinsky, Timothy
Cc: Horsely, Christopher; Vaughan, Karen
Subject: Re: Cemetery Staking Request - Placement of a marker
Grave mark with hot pink flags thanks
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From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Tuesday, June 15, 2021 3:53:46 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: RE: Cemetery Staking Request - Placement of a marker
Thank You !!
From: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>
Sent: Tuesday, June 15, 2021 3:47 PM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Placement of a marker
Judith,
We will have this staking done first thing Wednesday morning 6/16/21. My apologies. We have been under emergency
response for Red Tide.
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.LaCossePmyClearwater.com>
Sent: Tuesday, June 15, 2021 3:29:07 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Peterson, Erick <Erick.Peterson@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
1
Cc: Horsely, Christopher <christopher.horsely@MyClearwater.com>; Vaughan, Karen
<Karen.Vaughan@MyClearwater.com>
Subject: FW: Cemetery Staking Request - Placement of a marker
Good Afternoon,
We have not yet received your response regarding this staking request.
Please advise,
Thank You.
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: LaCosse, Judith
Sent: Thursday, June 10, 2021 1:45 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@myclearwater.com>; Peterson, Erick
<Erick.Peterson@myclearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: FW: Cemetery Staking Request - Placement of a marker
Importance: High
Good Afternoon,
I just received an email from Laura Vinci of Memorial Park. She's requesting that Space 1 (Harvey Nickelson -full burial)
in Block 15, Lot 11 also be staked with space 2 (Hazel Nickelson -full burial) for marker placement.
Thanks !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: LaCosse, Judith
Sent: Thursday, June 10, 2021 9:51 AM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@myclearwater.com>; Peterson, Erick
<Erick.Peterson@myclearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
2
Subject: Cemetery Staking Request - Placement of a marker
Importance: High
Good Morning,
We received a cemetery staking request from Laura Vinci from Memorial Park for placement of a marker as soon as
possible.
Please stake Block 15, Lot 11, Space 2
Deceased Name: Hazel M. Nickelson — (full burial)
(See attached printout of burial status for Block 15, Lot 11)
Please let me know the color of the flags being used so that I could notify Memorial Park.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
3