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Home My WebLink About3-72-05Nema�glD �i_ ! ;trEK2 Unit 3 Block%4 Date of Mark -out 3 /.'Z5i19 • Date of Burial_Li'Z�Q Name of Funeral Ho/me �� ✓ '� Authorized by I_ jVDf Time :f � Strunk Funeral Home - Sebastian ( January 13, 1947 - March 22, 2019 ) Mr. Richard C. Camey, 72, died March 22, 2019 at Sebastian River Medical Center in Sebastian, FL. A Mass of Christian burial will be held at 11.00 AM on Thursday, March 28, 2019 at St. Sebastian Catholic Church, Sebastian, FL. Interment will follow the Mass at Sebastian Cemetery, Sebastian, FL. Arrangements are by Strunk Funeral Home and Crematory, Sebastian, FL. A guest book is available at www.strunkfuneralhome.com. �Of sE� aroa3 HOME OF PELICAN ISSLIHND 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. ��r�JA M.Ca,zN�y Name(s) 1 '+IC CLt4-,,- 6L- s � . �t�3a-srrA,S , t -l. 3-;� 4 Address Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($ .-7� Cho 1 on this day of 20_ for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 3 Block %A , Lot(s) i -H 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 - $20) Opening & Closino 15� • c c /W O H Circle One Vase and Ring for Niches (cost) Interment Disinterment Temporary Marker Preparation & Installation & RureK Signature of Purchaser TOTAL $ ) 00• co �� , � City,of Sebaet' n The following documents were provided as Proof of Residency: 1AW W-DATA\Ms-CemetegARECEIPT.dac and FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, .Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office – Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta0chttofsebastian.ora 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 Lot -5 -Block -72 -Unit 3 Lot—Block—Unit Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 11:00 am THURSDAY, 3/28/2019, Mass at St. Sebastian CC – then burial FOR DECEASED: Richard C. Carney Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Donna Camev nom 3/25/2019 Name Signature Date 410 Columbus Street, Sebastian, Florida, 3958 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: Tim Marvin Name Tia MooK Signature 3/25/2019 Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owners 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. State of Florida, Department of Health, Bureau of Vital Statistics P i7a BURIAL TRANSIT PERMIT rHIDf IE�LTMUG DATE PRINTED: March 25, 2019 TRACKING NUMBER: 2019049631 1. DECEDENT INFORMATION Name of Deceased Data of Deem RICHARD C CARNEY March 22, 2018 Place of Death - Count, Cly, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral Home/Direct Disposal Establishment Fla. Dc. NoAeg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN FNI870 F041B70 (7/2)589-1000 1623 N CENTRAL AVE SERASTUW, FLORIDA 32858 Funeml DimcbeeDlract Disposer Fla. Llc. NoJReg. No. TIMOTHY W MARMN F022709 Medical Verification seasonal DR. DEPUTRON M me cerdying physician's ofnce, was contacted on OWN2019 by the funeral director listed above; hefahe Indicated Mat DAVID DEPUTRON JR, certifying physician, will complete and sign Ne medical ceNBratlon of cause of death within 72 houre. 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: 2019-1`0,1Manch2S M195053 �— Date lSaUetl: Martl125, 2018 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 Method of Disposition: BURIAL Date of Disposidori �117LJIoV�q 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 Use permit for their file they may do so. DH 3WE.10112 "V.1.011, FIaMa Adminiseaum Code MYOF SEBASMA 4 c - HOME OF PELICAN ISLAND Certificate No. 2623 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: Donna Carney 410 Columbus Street Sebastian, FL 32958 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 3, Block 72, Lots 4 & 5 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 27th day of March, 2019. CITY OF SEBASTIAN, FLORIDA ATTEST: Paul E. Carlisle City Manager �in4tife l c.)[X&Mor 316hnette Williams, MMC__ _ _ ,- City Clerk = -- Lift If SEBAST,N HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772)589-5330 Phone April 1, 2019 Mrs. Donna Camey 410 Columbus Street Sebastian FL 32958 RE., Interment Rights to Unit 3, Block 72, Lots 4 & 5, in the Sebastian Municipal Cemetery. Dear Mrs. Carney, Enclosed is City of Sebastian Certificate 2623 entitling you to full interment rights in Unit 3, Block 72, Lots 4 & 5 in the name of Donna Carney. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy la Records Clerk Enclosure CITY OF SEBASTIAN 11672 ADMINISTRATIVE SERVICES RECEIPT Name VTr\CINE /OA42,I`4� / OCash Date �/� F' I -I / Check # �G O Credit Amount Paid 001001208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 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 acre cl 3432 5 O I L I .O° 6olaln 3�+3goo Lors ��,2.r L)JIt 3 SLACYLIA LArs 4+6 t �— Total PAi'y1/� c�-0 Initials White - Dept. of Origin - Yellow -Admin. Svcs. - Pink - Applicant