HomeMy WebLinkAbout4-03-26CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9927
Name.Jo� &Mcm LI Cash
Date U �.� heck #
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501362100 Taxable Rent -
001501362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
C a Zd
o�
Total Paid
'als
White - Dept. of Origin - Yellow - Finance • Pink - Applicant
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
1�osme-n
Name(s) I -
7 ( -8"j
Address
Are Code & Phone umber , cc
Name & Residence Address of In4ended Occupant if Other Than Purchaser
Receipt is
6"
owledged in the
on this �dy/� day of
Cemetery Lot(s) and/or Niche(s
OFFICE USE ONLY
of:
bo Dollars ($ )
/oov )a&` def
O -,20 for the purchase of the following described
Unit T , Block �1-3 , Lot(s) 026
Niches)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20) Opening & Closing �,� /W O H
Circle One
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Uri
,'fiof ,
Interment
Disinterment
TOTAL ,$
City of Se dstian
The following documents were provided as Proof of
Residency:
I:1WW-DATA\Ms-Cernetery\RECEIPT.doc I and
Name
Unit_
Block
Lot _
Date of Mark -out lfl�/ 5� peZ>O 14
Date of Burial /Z2__ 5 Time l• a
Name of Funeral Homg —+ �AI n S
Authorized by W, "
CRY OF
SEBAS-T11V
HOME OF PELICAN ISLAND
Certificate No. 2473
CITY OF SEBASTIAN_
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Judy L. Bosmeny
709 Beard Avenue
Sebastian, FL 32958
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 3, Lot 26
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 10th day of August, 2015.
CITY OF SEBASTIAN, FLORIDA
Joseph F. Grif in
City Manager
ATTEST:
Sally A. io, MMC
City Clerk
State of Florida, Department of Health, Bureau of Vital Statistics
— BURIAL TRANSIT PERMIT
HEALTH DATE PRINTED: August 11, 2015 TRACKING NUMBER: 2015120499
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ORVIS EUGENE COURSEY August 7, 2015
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER VERO BEACH GRACE REHABILITATION CENTER OF VERO BEACH
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
Funeral Director/Direct Disposer Fla. Lic. No./Reg. No.
DAVID W. WALLACE F046853
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2015-FO73380-5183
Date Issued: August 7, 2015
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY QQ
Method of Disposition: BURIAL Date of Disposition:
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V-1.011, Florida Administrative Code