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HomeMy WebLinkAbout4-03-25Name�/1t� Unit Block Lot Date of Mark -out Date of Burial rr,,// 3 /// �n Time Name of Funeral Ho%Q S k t9 Authorized by &,Y, -0/l'.O0A.C.. CI CITY OF SEBASTIAN 10932 ADMINISTRATIVE SERVICES RECEIPT Name 911,U -MK /vt�-' Ill OCash Date ld /It,� 7 Check# 37 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees CZI s'e i 3"Rcs ©� C `4 aC, co Ilrui r q 811< 3 Lc -r A _q9k9" L Total Paid ISO. Initials White - Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ��ItO City Clerk's Office – Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 For information contact: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 Office (772) 388-8215 or 388-8214 ctesta(a)cityotsebastian.org FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIM Lot-25—Block 3 Unit 4 Lot—Block—Unit Niche Block Unit N S E W Friday, October 13, 2017, 11:00 AM – St. Sebastian CC FOR DECEASED: Theresa Marie McParland Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Patricia A. Durkin Patr'gLci A. Auri6o. 10/10/2017 Name Signature Date 6201 S. Mirror Lake Drive, Sebastian, Florida, 32958 1 certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Gary D. Evans Name Gang -D. F=Ks 10/10/2017 Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. \try State of Florida, Department of Health, Bureau of Vital Statistics O BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: October 10, 2017 TRACKING NUMBER: 2017161563 1. DECEDENT INFORMATION Name of Deceased Date of Death THERESA MARIE MCPARIAND October 9, 2017 Place of Death - County City, Town or Location Name of facility, or $"at address If not a facility IND" RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral HomelDlrect Disposal Establishment Fla. Lie. N.Ae9. No. Phone Number STRUNK FUNERAL HOME. SEBASTIAN FW1870 FNIS70 (]]2)589-1000 1623 N CENTRAL AVE SEBASTIAN. FLORIDA. 32958 Funeral DlrectorMireel Disposer Fla. Lie. NO.IReg. No. GARY D. EVANS FW5074 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. 2m]-Fo4f07]J Dale Issued: Omober 10,, 2 2011 ] 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 Fir-, CI�1 Method of Disposition: BURIAL Date of Dispaeltlon: 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 328E. 10112 64V-1.011, Florida Admimsdahes Code 10/10/2017 14:30 #7124 P.001/001 FUNERAL DIRECTOR'S FOR BURIAL OPEh REQUEST TO ING IN SEBASTIAN IV CTY OF SEBASTIAN L NICIPAL METERY For information contac : S Up Kelso, .Cemetery Se Bastian Municipal Cam Phone: (772) 589-254 a on a cry Fax: (772) 228.9927 City Clerk's Office – Cathy Testa City Hall, 1225 Main Sf t Sebastian, FL 32958 Office (772) 388-8 15 or 388-8214 ctesta i ofseb s an.or FUNERAL HOME: Strunk Funeral H me and Cremato ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 3295 PHONE* 772-589-1000 Check One XXXX OPEN BURIAL LOT Lot-25._BI k 3 Unit OPEN CREMAINS LOT Lot—Block Unit OPEN COLUMBARIUM NICHE Niche Ick Unit 11:00AM–Si BURIAL DATE AND SERVICE TIME: { iday, October 13, 2017, Sebastian CC FOR DECEASED: Name NAME AND SIGNATURE OF LOT OWNER (Must provide proper documentation of o OR REPRESENTATI ership) Patricia A. Durkin Name 6201 S. Mirror Lake Drive, Sebastian, Florida, 32953 1 certify that I have determined the owners fees have been paid and authorize openin NAME AND SIGNATURE OF LICENSED Rat-rWy A. pLtrIqLVL.Rat-r'' Signature ip of the above describe of same. UNERAL DIRECTOR: I site that als /10/2017 to fees and administra Gary D. Evans Name D. EIX,1hS /10/2D17 to Signature Cemetery Sexton Certification: I certify that I have checked the ownership office and that all fee have been paid: information by viewing th owner'sdee rd upon c o nd confirming with C letion. Ce ate exton / This form to be provid6d to Clerk's Office b Date Sexton for permanent ri tive :lerk's Certificate No. 2501 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: Owen & Theresa McParland In and for consideration of the sum of $4,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 3, Lots 24 & 25 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 15th day of April, 2016. CITY OF SEBASTIAN, FLORIDA 4� r Joseph F. Griffin City Manager ATTEST: anette Williamsm-JNtC`-:.ti' ity Clerk cm or 77 - GO a HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Owe. Th ere-Sa. MC 106-r laeid Name(s) 7 & �( AW 13y f'" 5tree-+ , 5aaZ tlo-4 F(- 32-252 Address (-7-7Z) Z2-9 % Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: tJu� ae-d 'I�4 �o-o �J�oilars ($ 4000. UO ) on this -5day of &Irl ( 20� for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 41 , Block 3 , Lot(s) Zq ZS Niche(s) 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 - Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser Opening & Closing Interment /W O H Circle One Disinterment TOTAL $ ,ILAO(). City of Sebastian The following documents were provided as Proof of Residency: I:\W W-DATA\Ms-Cemetery\RECEIPT.doc and CITY OF SEBASTIAN 10073 ADMINISTRATIVE SERVICES RECEIPT Name me-19arland FOJYLit4 UCash Date 4 -15 —i & ❑ Check # 4 16redh Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees teiowlo 3y3k0o UUO.I)U u v 83 Lots Lyr-Z Total Paid 000- oD I 'tials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant