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Home My WebLink About3-73-15Name ySA�Bi{iGB a '6.44rN 9XA Unit .*/ Block Y 3 Lot Date of Mark -out Date of Burial 3/.4b? 3/z, / ,4. Name of Funeral Home s / UN A. Authorized by - Time "1'oV,4.(�!%tQ�G 03/18/2019 8:09 PM FAX 7725892583 STRIINR 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 cteslai FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY I I44 I M.01 For information contact: Kip Kelso,. Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax. (772) 228-9927 UPCity Clerk'sOtfice — Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 OfFce (772) 388-8215 or 388-8214 ctesta0citvotsebastian.ora FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian. Florida. 32958 PHONEM 772-589-1000 (Check One) XXXX OPEN BURIAL LOT _OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot 15 Block 73 Unit 3 Lot_Block Unit Niche Block Unit N 9---F 77- - BURIAL DATE AND SERVICE TIME- 9:00 AM on Friday, 3/22/2019, Direct Burial at Sebastian Cemetery FOR DECEASED: Lawrence George Barton Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Joann and Marshall Bruce 11atn,4, awd Marshall Srucg 3/18/2019 Name Signature Date 346 Main Street, 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: Tim Marvin Name TM Mowta Signature 3/18/2019 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. State of Florida, Department of Health, Bureau of Vital Statistics O BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: March 18, 2019 TRACKING NUMBER: 2019045654 7. DECEDENT INFORMATION Name of Deceased Date of Death LAWRENCE GEORGE BARTON March 16 2019 Place of Death - County Cay, Town or Location Name of facility, or street address if nota facility INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE Name and Address of Funeral HomeMbect Disposal Establishment Fla. Uc. No.laag. No, Phone Number STRUNK FUNERAL HOME- SEBASTIAN FNI870 F041810 (!]2)509-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Dim lcuVirect Disposer Fla. Uc. NodReg. No. TIMOTHY W MARVIN F022769 Medical Verification Statement Paige at Me CeNlying physiclan's office, war contacted on 0311812019 by the funeral director listed above; helshe indicated that MICHAEL ANTHONY VENA210, certifying Physician, will complete and sign the medical certification of cause of death within 72 boom. 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. March1,201900e �— Date Issued: March 18, 2019 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 ^ Placa of Disposition: SERASTWI CEMETERY r c � a �I -Lit. q Method of Disposition: BURIAL Data of DisPpo�alrtion: I awl OV �_I 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 se. DH 326E. 10112 64V-1.011. Fisher Administrative Code CITY OF SEBASTIAN 11671 ADMINISTRATIVE SERVICES RECEIPT NameTkunic / ` Jell] ❑Cash Date 3 jAIl /"check#y o� ❑ Credit Amount Paid 001001 208001 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 1 Oin(sn 3-3405 OIG w[ ,E,3 �-'"13 LcTIS .-911> Total P I'd a L Initials White - Dept. of Origin • Yellow -Admin. Svcs. - Pink -Applicant