Hubbard, Cora JeanDate: n l / 9'O
Cemetery Call Work Sheet
s1ConFuneral Home / Monument Company: Mo S 5 P -e (-4-tet-
Contact
tact Name: � Tel. #: Fax #:
Email: F --J. P C Qui C2 hs m j-com.
Reason for call:
**
Staking Request — Interment
$30.00 staking fee (Weekdays) - $50.00 staking fee (Saturday, Sunday & Legal Holiday)
Urn Burial '/
Full Burial
(One full burial and one urn, or two urns per space)
Owner of Plot: 1re "tib &( Lux., Rit,
Deceased Name: -jectn H LAI C.A.C1
44,1/h Pcv‘e ty)
Block a Lot ;-t-t Space /3
Date of Birth: 5 / � / (939'
Date of Burial: /0 / d -c)
**
Date of Death (a- / 1-7 / )-019
Time: 1r 30
_ Monument (Marker) being placed - (No fee for staking of monument)
For:
Block Lot Space
Affidavit (Burial Rights)
Other reason:
Date: /
Verifying Burial space
/ Time:
Peke df *14 9 g
Send email to P&R to stake the space iVris/ 2 i
Notify funeral home/monument company with color of the flags used to mark the space (0/'
netyl-
Staking fee received on: (° / /12, / 3 ( From: R o S sFt %5 kr 1+.
Copy of permit emailed to:
Nathan Brigman, cc: Matt Anderson, Tim Chaplinsky, Erick Peterson in P&R on:
**************************************************************************************************
lc -1/
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
INTERMENTS
BURIAL
SP TYPE
1 FULL
2 FULL
3 FULL
4 FULL
5 FULL
7 FULL
8 FULL
9 URN
11 FULL
12 FULL
14 FULL
15 FULL
15 URN
16 URN
16 URN
DECL
ACKERMAN
ACKERMAN
BISHOP
BISHOP
WAGNER
MAXWELL
ARMSTRONG
HELSLEY
FUSSELL
FUSSELL
WILLS
HUBBARD
HUBBARD
HUBBARD
HUBBARD
DISINTERMENTS
REINTERMENTS
Status of Block: 2 LOT: 24 as of 10/6/2021
DECF
JOHN
DOROTHY
LUCY
JOHN
SYLVIA
THOMAS
NINA
ELINOR
TIMOTHY
CORA
MARY
JOHN
MARGARE
T
LUCILE
FREDERIC
K
DECM BIRTH DEATH INTERRED PERMIT
L
B
T
A
L
S
M
M
0
A
R
S
F
R
5/25/1902 10/9/1954
7/30/1903 5/2/1986
11/18/1880 9/5/1968
6/11/1856 6/17/1933
1/1/1901 5/12/1955
12/17/1846 9/16/1935
9/14/1872 1/19/1934
2/1/1896 1/25/1985
1/1/1880 1/1/1933
1/1/1881 10/5/1956
9/2/1926 4/20/1975
1/1/1868 1/1/1937
10/9/1954
5/6/1986
9/7/1968
6/17/1933
5/12/1955
9/16/1935
1/19/1934
2/1/1985
1/1/1933
10/5/1956
4/25/1975
1/1/1937
1/1/1875 1/1/1966 1/17/1967
4/9/1901 6/24/1974 6/28/1974
11/21/1901 3/31/1992 4/22/1992
0
1659
651
0
1148
0
0
1594
0
1237
1082
0
546
1036
2053
LaCosse, Judith
From: Peterson, Erick
Sent: Tuesday, October 19, 2021 8:04 AM
To: LaCosse, Judith; Brigman, Nathan; Anderson, Matthew; Chaplinsky, Timothy
Cc: Vaughan, Karen; Horsely, Christopher
Subject: Re: Cemetery Staking Request - Urn Burial
Blue flags East side of cemetery South end close to Lakeview
Get Outlook for iOS
From: LaCosse, Judith <Judith.LaCosse@myClearwater.com>
Sent: Monday, October 18, 2021 1:40:20 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: Cemetery Staking Request - Urn Burial
Good Afternoon,
We received a cemetery staking request from Paul at Moss Feaster Funeral Home for an Urn burial.
Please stake Block 2, Lot 24, Space 13
Deceased Name: Cora Jean Hubbard - DOB: 5/24/1934 DOD: 12/17/2019
Other burials nearby in Block 2, Lot 24:
Space 12 = Cora Fussell — (full burial)
Space 14 = Mary A Wills — (full burial)
Space 15 = John R Hubbard — (full burial) & Margaret S Hubbard — (urn burial)
Space 16 = Lucile F Hubbard — (urn burial) & Frederick R Hubbard — (urn burial)
The burial is scheduled for Wednesday, October 27th at around 11:30 a.m.
Please let me know the color of the flags being used so that I could notify the funeral home.
Thank You.
Judith LaCosse
Staff Assistant
ORLS Dept.
727-562-4093
1
�frrrt��
oi ti-Lre- CITY OF CLEARWATER
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
,,� 600 CLEVELAND STREET, SUITE 600, CLEARWATER, FL 33755
=-IITaBLI`,,1���•TELEPHONE (727) 562-4090 FAx (727) 562-4086
OFFICLAL RECORDS AND
LEGISLATIVE SERVICES
October 14, 2021
Moss Feaster Funeral Home
and Cremation Services
693 South Belcher Road
Clearwater, FL 33764
Attn: Paul
We received the Cemetery Staking Fee check #2312 in the amount of $30.00 for the urn burial
of Cora Jean Hubbard in Block 2, Lot 24, Space 13.
Attached you will find our receipt No. 452126.
Thank you,
udith LaCosse
Staff Assistant
Mark Bunker, Councilmember
Kathleen Beckman, Councilmember
Frank V. Hibbard, Mayor
David Allbritton, Councilmember
Hoyt Hamilton, Councilmember
"Equal Employment and Affirmative Action Employer"
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
Hubbard. Staking_ Fee
BANK OF AMERICA
64-1278/611
GO1G
1
10/8/2021
30.00
DOLLARS
U
VOID AFTER 180 DAYS
CHECK CANNOT EXCEED $10,000.00
TWO SIGNATURES NEEDED IF OVER $5,000.00
v G�
AUTHORIZED SIGNATURE
II' 4 6 7 300 2 3 1 211' I:0 6 i 1 L278131: 00 3 3 5 98,L00 5 LII'
iIIOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2 312
Comments
Hubbard Staking Fee
Amount
30.00
30.00
IIIOSS FEASTER FUNERAL HOME AND CREMATION SERVICES 2 312
L# Comments
1 Hubbard Staking Fee
Total forHubbard Staking Fee
'DELUXE Cone- 1+800-328-0304 www.deluxeforms.com
Amount
30.00
30.00
881064/ 0316
6082120000M