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Home My WebLink About3-68-06Name Unit Block PJ LM 69 Date of Mark -out Date of Burial 6 /fig/ , 4 Name of Funeral Hom Authorized by i — Tim= i'OOp.�,ed✓Es�n�� . —_ Strunk Funeral Home - Sebastian JACQUELYN BAKER DEVANE ( July 29, 1933 - June 24, 2019 ) Mrs. Jacquelyn Baker DeVane, 85, died June 24, 2019 at Palm Bay Community Hospital in Palm Bay, FL. Survivors include daughters, Joyce Mallory of Micco and Roxanne E. DeVane Mackey of Sebastian, son John W. DeVane Jr. of Sebastian, brothers Thomas R. Baker, Jr. of Satellite Beach and Michael D. Baker of Green Castle, Indiana, 5 Grandchildren, 2 Great Grandchildren. Memorial contributions may be made to Sebastian Area Historical Society, 1235 Main Street, Sebastian, FL 32958. Visitation will be held 11:00 AM to 12:00 PM on Friday June 28, 2019 at Strunk Funeral Home Chapel followed by a Celebration of her life at 12:00 PM with Rev. Grant Foster of Riverside Church Assembly of God, officiating. Interment will follow at Sebastian Cemetery, Sebastian, FL. Arrangements are by Strunk Funeral Home and Crematory, Sebastian, FL. CITY OF SE�T�A1V HOME OF PELICAN ISLAND Certificate No. 2638 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: Jacquelyn B. DeVane 8520 US Highway 1 Micco, Fl. 32976 Are entitled to full interment rights in the following Lot: Unit 4 Block 31 Lot 34 In even exchange for the following Lot: Unit 3 Block 68 Lot 6 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 26th day of June, 2019. CITY OF SEBASTIAN, FLORIDA P Paul E. Carlisle/� City Manager ATTEST: (Jeanette Williams, Mf4£ - City Clerk 08/28/2019 11:14AM FAX 7725892585 STRUNK 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 ice (772) 388-8215 or 388-8214 ctesta(Mcitvofsebasdan.oroi FUNERAL HOME: Strunk Funeral HmmP. and Crematory ADDRESS- 1623 North Central Avenue. Sebastian. Florida. 32958 PHONE* (7721589-1000 (Check One) XXY.OPEyBUMALLOT,. ..... Lot 8 Blokk68 nit 3 _OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot—Block Unit Niche Block Unit N S F_ W [a 0001/0001 BURIAL DATE AND SERVICE TIME: 1:00 PM Friday, 6/28/2019, Committal service at cemetery FOR DECEASED: Jacquelyn Baker DeVane Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Jovice Mallory Jrdl.pe Mallow 6/26/2019 Name Signature Date 3700 Church Street, Micro, Florida, 32978 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 some. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Marshall Voyles Name MCLUP4 Q CvOyges 6/26/2019 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: CerP eieexton / Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: 0 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 ctesta(ftitvofsebastian.ora FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida. 32958 PHONE#: (7721589-1000 (Check One) MM OPEN BURIAL LOT _OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot -6 -Block -68 -Unit 3 Lot—Block—Unit Niche Block Unit N --S--F 77 - BURIAL DATE AND SERVICE TIME: 1:00 PM Friday, 6/28/2019, Committal service at cemetery FOR DECEASED: Jacquelyn Baker DeVane Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Jovice Mallory )VOe MaUory 6/26/2019 Name Signature Date 3700 Church Street, Micro, Florida, 32976 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: Marshall Voyles Name Jv10ASRallt NOY&S 6/26/2019 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. State of Florida, Department of Health, Bureau of Vital Statistics O� BURIAL TRANSIT PERMIT 14EALTH DATE PRINTED:June 25, 2019 TRACKING NUMBER: 2019105011 1. DECEDENT INFORMATION Name of Decessed Date of Death JACQUELYN BAKER DEVANE June 24, 2019 Plateof Death - County Cdy,Townor Location Name ofMosey, or street address N not a facility BREVARD PALM BAY PALM BAY COMMUNITY HOSPITAL Name and Address of Funeral Home/Direct Disposal Establishment Fla. LIc. NoJReg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F0418]0 F041870 (]72)589.1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral DlrectorlDirect Disposer Fla. LIc. No./Reg. No. R MARSHALL VOYLES JR FU3488 Medical Vermcation statement or Abbod at the certifying physician's office, was contacted on 0812512019 by the funeral director listed above; Eelshe Indicated that RYAN ANTHONY ABBOTT, outlying physician, will complete and sign the medical certification of cause of deem within 72 hours. 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 -F041870 -51m �-- Date Issued: June 25, 2019 Stale 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 rr1/ l,�I �/y''I'.lI 1 _ ��y Method of Disposition: BURIAL Date of DlspoaNIon: I it 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, 10112 SIVA 011, Flodda Administrative Cade CITY OF SEBASTIAN 11698 ADMINISTRATIVE SERVICES RECEIPT Name DEvftlr�55 )(Cash Date 6 ab 1 UCheck # U 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 69-- (cot (-,)t) 3 -39oo L --ye ani6¢ 0.4 6-11-Le734 roR V -3B— Total pa-if l& -60— initials White - Dept. of Origin - Yellow - Admin. Svcs. • Pink -Applicant CITY OF SEBASTIAN 11700 ADMINISTRATIVE SERVICES RECEIPT NamevW1�C. /-bl'c V1'Nf3 OCash Daterod �q _, y Check # IL 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 001501347557 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 Ob(S-01.34390;5" 6%G ° t 3 81k 68 Lo -r b �'�� C�0 -&9- Total Pai ✓L Initials White - Dept. of Origin - Yellow -Admin. Svu. - Pink -Applicant