Shea, MellaneeDate: / 30 / 9-0)-1
Funeral Home / Monument Company:
Cemetery Call Work Sheet
n55 1-124-51er r H.
Contact Name: A Q2,/ Tel. #:1? --7 -SL )° 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)
P r L. Pc J QA (_t to Lr
Owner of Plot:
Deceased Name: e. a ve e S k2
Block 7 Lot 6 S Space 3
Date of Birth: 11 / / 1'0 Date of Death
Date of Burial: 9 / `f' / I Time:
**
J..seri-t.Ste&(14 142
�Xvck: 7, Lci± (,C) S� 4
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
VNotify funeral home/monument company with color of the flags used to mark the space l P(hk)
Staking fee received on: 9 / 13 / a-1 From: Muss Fe 1-2\-
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in P&R on: 1 / 1 `f / '?-°)-1
Disinterment: 4 `fct
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, August 31, 2021 8:15 AM
To: Peterson, Erick
Cc: Vaughan, Karen; Horsely, Christopher
Subject: RE: Cemetery Staking Request - Full Burial
Good Morning Erick,
I'm assuming you meant flags.
I will notify the funeral home.
Thank You !!
Judith LaCosse
StaffAssistant
ORLS Dept.
727-562-4093
From: Peterson, Erick <Erick.Peterson@MyClearwater.com>
Sent: Tuesday, August 31, 2021 7:02 AM
To: LaCosse, Judith <Judith.LaCosse@myClearwater.com>; Brigman, Nathan <Nathan.Brigman@MyClearwater.com>;
Anderson, Matthew <matthew.anderson@myclearwater.com>; Chaplinsky, Timothy
<Tim.Chaplinsky@MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Re: Cemetery Staking Request - Full Burial
Judith mark with pick flags Resized_Resized_20210831_065740.jpeg
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From: LaCosse, Judith <Judith.LaCosse@mvClearwater.com>
Sent: Monday, August 30, 2021 12:15:03 PM
To: Brigman, Nathan <Nathan.Brigman@MyClearwater.com>; Anderson, Matthew
<matthew.anderson@myclearwater.com>; Chaplinsky, Timothy <Tim.Chaplinsky@ MvClearwater.com>; Peterson, Erick
<Erick.Peterson@MyClearwater.com>
Cc: Vaughan, Karen <Karen.Vaughan@MyClearwater.com>; Horsely, Christopher
<christopher.horsely@MyClearwater.com>
Subject: Cemetery Staking Request - Full Burial
Good Afternoon,
We received a cemetery staking request this afternoon from Alex of Moss Feaster Funeral Home for a Full burial.
1
Please stake Block 7, Lot 65, Space 3 for a full burial.
Deceased Name: Mellanee Shea - DOB: 11/29/1934 DOD: 8/28/2021
Note: Joseph Shea (husband) is buried in Block 7, Lot 65, Space 4 — (full burial)
The date of burial is set for this Saturday, September 4th, for sometime in the afternoon
(See attached burial status for Block 7, Lot 65)
Please let us know the color of the flags being used so that we could notify the funeral home before the end of the
week.
If you have any questions please give me a call at 727-562-4093.
Thank You !!
Judith LaCosse
Staff Assistant
ORLS Dept.
727-562-4093
2
INTERMENTS
BURIAL DECL
SP TYPE
1 FULL PARKER
2 INFANT PARKER
2 FULL PARKER
3 FULL SHEA
4 FULL SHEA
DISINTERMENTS
REINTERMENTS
Status of Block: 7 LOT: 65 as of 8/30/2021
DECF
DECM BIRTH DEATH INTERRED PERMIT
THOMAS A
UNKNOW
N
ANNA L
MELLANE
E P
JOSEPH R
1/31/1896 3/27/1944 3/27/1944 0
4/30/1958 4/30/1958 4/30/1958 0
11/28/1903 9/3/1985 9/6/1985 1629
1/1/1901 1/1/0001 1/1/0001 0
5/23/1928 2/14/1995 2/18/1995 2196
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
Shea Staking Fee
II' 4 6? 300 2 2 9011' 1:0 6 1 1 1 2 4881: 00 3 3 5 98 100 5 1n'
GG�U
BANK OF AMERICA
64-1278/611
1
9/1/2021 •
g.
30.00
DOLLARS
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00 n
TWO SIGNATURES NEEDED IF OVER $5,000.00 `
AUTHORIZED SIGNATURE
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES
Comments
Shea Staking Fee
2290
Amount
30.00
30.00
MOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2290
L# Comments
1 Shea Staking Fee
Total forShea Staking Fee
-)DELUXE CORP' 1+800-328-0304 www.deluxeforms.com
Amount
30.00
30.00
881064/ 0316gra