Loading...
HomeMy WebLinkAbout4-33-12CRY OF SEBASTIAN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772)589-5330 Phone (772) 589-5570 Fax November 4, 2016 Kristie M. Woodward 677 Forster Avenue Sebastian, FL 32958 RE: Interment Rights to Unit 4, Blk, 33, Lot 12 Sebastian Municipal Cemetery Dear Ms. Woodward, Enclosed is City of Sebastian Certificate 2522 entitling you to full interment rights in Unit 4,13Ik 33,Lot 12 in the name of Kristie Woodward. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy sta Records Clerk Enclosure CITY of SEBAST ,r HOME OF PELICAN ISLAND Certificate No. 2522 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: Kristie M. Woodward 677 Forster Sebastian, FL 32958 In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 33, Lot 12 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 1st day of November, 2016. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: anette Williams M,44C- - City Clerk = Unit ` Block Lot Date of Mark -out Date of Burial!l �J OL6 Name of Funeral Home Authorized by Time !' Osin- IF 10/31/2016 16:32 96115 P.001/001 FUNERAL DIRECTOR'S REQUEST TO FOR PURIAL OPENING IN SEBASTIAN I FUNERAL HOME: S1 ADDRESS: 1623 Nort PHONE* 772-SR9-7 (Check One) XXX OPEN BURIAL OPEN CREMAI OPEN COLUMI BURIAL DATE AND SE FOR DECEASED: CI NAME AND SIGNATURE (Must provide proper docs For information contact Kip Kelso .Cemetery Sex Sebastian Municipal Cem (772) 589-2545 City Clerk's Office City Hall, 1225 Main Sin Sebastian, FL 32958 Office (771) 388-8215 or 381 Fax; (772) 589.5570 Funeral Home and Crematorv- LOT :IUM NICHE H. 1:00 OF SEB StIAN :IPAL CEMETERY 4 4STIAN Lot _12�B14 _33_Unif -'h Niche ok U it i Thursday, No mber 3, 2036r- GRAVESIDE SERVICE LOT OWNER OR REPRESENT station of ownership) Name Signature I certify that I have determined the ownership of the above describe ite that all fees have been paid and authorime opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Gary D. Evans Name Cemetery Sexton Cerl I certify that I have chi office and that all fees Gary al rEyans Signature the ownership information by viewing been paid: Cemetery S xton Date This form to be provided t4 Clerk's Office by Sexton for permanent r rd deet upon fees and administrative 10131/2016 Date confirming with Clerk's State of Florida, Department of Health, Bureau of Vital Statistics — -- — BURIAL TRANSIT PERMIT HFALTH DATE PRINTED: November 1, 2016 TRACKING NUMBER: 2016168109 1. DECEDENT INFORMATION Name of Deceased Date of Death CLEO H WOODWARD October 30, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN 677 FORSTER AVENUE Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. NodReg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041 B70 F041870 (772)589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No, GARY D. EVANS F065074 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: October 1, 2016 Date Issued: October 31, 2016 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 Disposition: 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 64V-1.011, Florida Administrative Code FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY `fit • �V t For information contact: Kip Kelso Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: Strunk Funeral Home and Crematory—SEBASTIAN ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE* 772-589-1000 (Check One) XXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE Lot-12—Block-33—Unit 4 Lot—Block—Unit Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 1:00 pm, Thursday, November 3, 2016 — GRAVESIDE SERVICE FOR DECEASED: Cleo H. Woodward Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Kristie M. Woodward IJlnisae to CLUoodwand 10/31/2016 Name Signature Date I 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 Cjary (D. Evans 10/31/2016 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. arc OF 5 �TIM �asaa 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. IL\cT)M VJWr)Vj+2-b Name(s) " Address Area Code & Phone Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: A-f\,(A D 00h o0 Dollars ($ on this I day of 1Vwe.rn4u2. , 20 16 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit_ `�, Block 3 3 , Lot(s) 9a-'+ 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 & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc Interment /W O H Circle One Disinterment TOTAL $ , 1)(00o. °O City of The following documents were provided as Proof of Residency: CITY OF SEBASTIAN 10449 '' IAD''MINISTRATIVE SERVICES RECEIPT Name W©OOU2*19L) JCash n Date < < J 1 1 6 YCheck # ❑ 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 4I (,,oiolo 3432co oa®.°0 /% X_ Total Pal �� 00 I ials 2� Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant CITY OF SEBASTIAN 10394 ADMINISTRATIVE SERVICES RECEIPT Name�T unI ZI)JCash Date l 1 r b Check # 7S a ❑ 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 d� � SV 0 ©O I 13020S IL 1 . Total PAM 1 i6als Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant 01/18/2017 13:23 Mug 24 2011 Lrlpal Do$Crlp! u e7 t Squvoi Appfneed cnockoci "IIA f ExemP/e I( 133Rm HP LRSERJET FAx Oft, of Seba I *rim �rnllul.0 rroMme P6►It$771 Au., ! 12 1�f�111177;t 71F•Y hl IF far IR(OM1011PFyl purpn,v, re�evainf nbmumral Yl 1Chi�11:IP l'c, I. 11 r, ,b If fur SIN%If llsruvrp undfr I ❑•.e our ! w(r,v,r in. I IM w,d folvjlj4jjr n F ro w city 0440414141111 Seb 9lllan Crolflfrl Il7!1 hnrlh <'rnlral orf. rvQ'/Ull_T�a 2-0 u 1-0 x L)-4 D VVW W1 D ILIA I-'1 xr TM !o lit: c, of 3y: 3Y., STRUNK FUNERAL HOME &CREMATORY 1623 No. Central Ave, SEBASTIAN, FL 3295 (772) 589-1000 #6367 P.001/002 c Dry Mix S•lruua7li�rn u��urra 6y fotfN - dFl� ,I,�1.1•,�..I:.IIra ,��/r-