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Home My WebLink About3-67-15Name ` oCQ (y' • p 'yX» Unit Blo,i. d, "r Lou Is - Date of Mark -out :7-/1 /iq Date of Burial 4/9/9" Name of Funeral Ho e Authorized 1,11 4 gC5 Strunk Funeral Home - Sebastian GEORGE ELSON DOUGLAS ( September 05, 1941 - July 03, 2019 ) Mr. George Elson Douglas, 77, died July 3, 2019 at VNA Hospice House in Vero Beach, Florida. He was born in Meigs County, Ohio and lived in Roseland, Florida since 1979 coming from Ohio. George worked for Local Union 189 in Columbus, Ohio as a Plumber having worked there since 1961 beginning at age 18 years old. George received his Certificate and Pin for being a Mason for 50 years in American Union Lodge 189 of the Grand Lodge of Ohio. He was also a member of the Loyal Order of Moose, #1767, Sebastian, Florida. Survivors include his wife of 35 years, Edna E. Douglas of Roseland, FL; son, James Douglas and his wife, Beverly of Melbourne, FL; daughter, Janet Deyette and her husband, Jeffrey of Sebastian, FL; stepdaughters, Debbie Carter of Libby, Montana, Carol Frye of Micco, FL and Rebecca Cain of Mount Clemons, Michigan; stepsons, Edward Cain, Jr., of Tampa, FL Mike Cain of Micco, FL and Scott Cain of Micco, FL; brother, Derald Douglas; sisters, Barbara Currier and Betty, 14 Grandchildren, 8 Great Grandchildren. He was preceded in death by his daughter, Linda Douglas and brother, John Douglas. Visitation will be held 11:00 AM — 12:00 PM on Tuesday, July 9, 2019 at Strunk Funeral Home, Sebastian, Florida followed by a Celebration of his life at 12:00 PM in the Funeral Home Chapel. Burial will follow the service at Sebastian Cemetery, Sebastian, Florida. Arrangements are by Strunk Funeral Home and Crematory, Sebastian, Florida. CHYOF HOME OF PELICAN ISLAND Certificate No. 2641 CITY QE SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Edna Douglas 7935 129th Place Roseland, FL 32957 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 3, Block 67, Lots 15 & 16 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 5th day of July, 2019. CITY OF SEBASTIAN, FLORIDA ATTEST: maul E. Carlisle City Manager �Ax&te Gvja. Janette Williams, MMC City Clerk 07/05/2019 10:39AN FAT 7725892581 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 Nall, 1225 Main Street Sebastian, FL 32958 Office (772) 388.8215 or 388-8214 ctesta0citvofsebastian.om, FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida. 32958 PHONE#: 772-589-1000 (Check One) OPEN BURIAL LOT _ .. Lot 75_Block 67 Urrft 3 _OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot Block Unit Niche -Block-Unit N 5 E W [a cool/0001 BURIAL DATE AND SERVICE TIME: 12:00 PM Tuesday, 7/9/2019, Chapel Service -IPM Committal Service FOR DECEASED: Georee Elson Douelas Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Edna E. Doualas 6dwa 6. Dnua_Las 7/512019 Name Signature Date 7935129th Place, Roseland, Florida, 32957 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 Tial M=K Signature 7/5/2019 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 ave been paid: Cem toryeon Date � This form to be provided to Clerk's Office by Sexton for permanent record upon completion L'Mot SE�T�N HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772)589-5330 Phone July 9, 2019 Mrs. Edna Douglas 7935 129' Place Roseland, FL 32957 RE Interment Rights to Unit 3, Block 67, Lots 15 & 16, in the Sebastian Municipal Cemetery. Dear Mrs. Douglas: Enclosed is City of Sebastian Certificate 2641 entitling you to full interment rights in Unit 3, Block 67, Lots 15 & 16 in the name of Edna Douglas. If you have any questions, please contact our office at 388-8209. Sincerely Cathy Tgsta Records Clerk Enclosure CRY (A SEW'kSrIAN�i��i "s'".� ` HOME OF PELICAN UAM 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. EDMA 1ot,talas Name(s) --7g35 laqA YIA.CE ts>rLvnrD.Ft. �a9,5'1 Address Area Code & Phone Nu er �s*6c- E . Jbou1aS Name & Residence Address of Intended Occupant' they Than Purchaser OFFICE USE ONLY Rece'�iipt is acknowledged in the sum of: ((FOLLC fnovSA fh find Dollars ($45boo.cc' ) on this 5 day of -Tk l y 2020 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). /J Unit -3, Block (ci , Lot(s) 1,5+1(o 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: Comer Markers (set of 4 -$20) Opening & Closing I�� •/ W O H Circle One Vase and Ring for Niches (cost) Interment Disinterment Temporary Marker Preparation & Installation ��4-Lmx(c- Signature of Purchaser TOTAL $ 4, 15-0 • 00 , City oiSebastl The following documents were provided as Proof of Residency: I:NWW.DATA\Ms-CemelerARECEIPT.doc 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 0401— City Clerk's Office – Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or -388-8214 ctestaftcitvofsebastian.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_15_Block_67, Lot—Block—Unit Niche Block Unit N S E E— BURIAL DATE AND SERVICE TIMF- 12:00 PM Tuesday, 7/9/2019, Chapel Service– SPM Committal Service FOR DECEASED: George Elson Douglas Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Edna E. Doualas Edna E. 150" Las 7/5/2019 Name Signature Date 7935129th Place, Roseland, Florida, 32957 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 Trt Mwwht Signature 7/5/2019 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 WPM BURIAL TRANSIT PERMIT 14FAITH DATE PRINTED: July 5, 2019 TRACKING NUMBER: 2019109469 7. DECEDENT INFORMATION Name of Deceased Data of Death GEORGE ELSON DOUGLAS July 3, 2019 Place of Death -County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER VERO BEACH "A HOSPICE HOUSE Name and Address of Formal Home/Direct Dlspmal Establishment Fla. Lic. NOJfi No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN FMI870 FNI870 (n2)$89.1000 1623 N CENTRAL AVE SERASTAN, FLORIDA. 32958 Funeral DbectoolDlrect Disposer Fla. Lie. NoMea No. TIMOTHY W MARVIN F04789 Medical Vermeer.. Statement Paige at Ne ceditying physician's office, was contacted on 0710312019 by the Natural director listed above; he/she Indicated that MICHAEL ANTHONY VENAVO, certifying physician, will complete and sign the medical ceMficamon of cause of death 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 2019-1`04187 6 5111 � — Datelssued: July3.2019 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 Place of Disposition: SEBASTIAN CEMETERY TIILsdl(�I Method of Disposition: BURIAL Data off�Dispositic ll `-IG 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 W4.01 1. Floods Adminantrabre Cade 'SIAW, Ic. CITY OF SEBASTIAN 11710 ADMINISTRATIVE SERVICES RECEIPT Name�gU Cash Date �L�19 KCheck# �w 1 U Credit Amount Paid 001001 208001 Sales Tau 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non-Texable 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 I— (cototo 3438CC WIS 4 coo.c0 r?clScl :f°i3Sos OIC �� lSC.°i ()n1iT 3 Blv b -i L -CTS tS+Ib ,Qe, Total Pei ,4 S6. Indials White - Dept. of Origin • Yellow -Admin. Svcs. • Pink -Applicant