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Home My WebLink About3-61-14Name Unit 3 Block 61 Lot ! Date of Mark -out /+ 2 77ZSJ Date of Burial 7 / 2' S— Name of Furneral Home Authorized by �_ %f State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: June 24, 2025 TRACKING NUMBER: 2025118394 1. DECEDENT INFORMATION Name of Deceased Dale of Death KATHLEEN MARIE NORMAN June 20, 2025 Place of Death - County City, Town or Location Name or facility, or street address if not a facility ORANGE ORLANDO ORLANDO REGIONAL MEDICAL CENTER Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No.IReg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041670 (772) 589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. NoJReg. No. MARYA. KOPCHAK F486444 Medical Vedflcation Statement Jennifer at the certifying physician's office, was contacted on 06/24/2025 by the funeral director listed above; he/she Indicated that LAUREN NICOLE LOFTIS, certifying physician, will complete and sign the medical certification 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: 2025-FO41670-5099 �---- Date Issued: June 24, 2025 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. OH 326E, 10112 64V-1.011. Florida Aoministradve Code Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctestana,citvofsebastian.org Funeral Home: Strunk Funeral Home Address:1623 North Central Avenue, Sebastian ,Florida 32958 Phone: 772-589-1000 (Check) n Open Burial Lot Unit 3 Block 61 Lot 14 Open Cremains Lot Unit Block Lot ❑ Open Columbarium Niche Unit Block Niche_ Burial Date and Service Time: Tuesday 7/1 11:OOAM Deceased Name: Kathleen Marie Norman Name and Signature of Lot Owner or Representative: (Must provide propel- documentation of ownership) Print Name Signature Date Address Phone Number I certify that I have determined the ownership of the above -described site that all site fees and administrative fees have been paid and authorized opening of same. Name and Signature of Licensed Funeral Director: Sandy Mastrando 06/23/2025 Print Name Signature Date 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 Certification: /emeteFf Date This form is to be provided to Clerk's Office for permanent record upon completion. CITY OF Sf]3ASTJ�N HOME OF PELICAN ISLAND Certificate No. 2986 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: Brad Norman 473 Perch Lane Sebastian, Florida 32958 In and for consideration of the sum of $2,850.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 3, Block 61, Lot 14 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 23,d day of June, 2025. CITY QF SEBASTIAN, FLORIDA Brian Been City Manager ATTEST: �4d'v-t�' �Us&"Iz ganette Williams, MMC City Clerk - ; - CITY OF SEBASTIAN 17054 FINANCE DEPARTMENT RECEIPT Name Q nj Unnon ,-I Cash Date loTr � r XCheck # ❑ Credit 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001 208001 Sales Tax 450010 369900 Airport Badge 450010 362521 AP Shade Hangar Rent 450001 208045 Airport Sales Tax 001501 347557 Community Center Revenue 001501 341920 General Fund Copies 001501 354100 Code Enforcement Fines 601010 343800 Cemetery Lot Sales 001501 343805 Cemetery Fees 480010 341920 Bldg Dept Copies PD Shop with a Cop PD COPE PD Cadets PD SRT Amount Paid Es. •_, Total Paid Jept s Whlteigin •Yellow -Finance Dpt. •Pink -Applicant CrrY OF SIE ST HOME OF PELICAN ISLAND 1225 Main Street,SSeba�stian, FL 32958 772-388-8209 City of Sebastian Mun cipa Cemetery Purchase Order /7,,,, All,, LAN Name(s) Address 77,;2-ol26 -1175� Area Code & Phone Numb /P,r ( // /.I 'iName & Residence Address of Intended Occupan Than'�/ Purch�aser Receipt is acknowledged in the sum of: on this _23_day of Cemetery Lot(s) and/or Niche(s). OFFICE USE ONLY Dollars ($,3 I5�S6 o) 20_25_ for the purchase of the following described Unit 3 Block _61 Lot(s)_14 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: Opening & Closing fee for ceremony after hours or on holiday Disinterment Fee TOTAI E� E N IN City 0f Sebastian r5a6vks 017YOF S N HOME OF PELICAN ISLAND Sebastian Municipal Cemetery Artificial and fresh flower, blankets. No more than two bouquets of artificial or fresh flowers will be allowed at any gravesite. Artificial flower arrangements will be permitted to remain until they become faded or unsightly. Fresh flowers will remain until unsightly. No glass or ceramic flower containers or ornaments shall be allowed, however, a plastic flower container no more than six inched deep, six inches wide and 24 inches long may remain in place unless broken or in decrepit condition. No wires shall be allowed to hold flower arr gements permanently in place at the interment site. Blankets are allowed to be placed prior to any holida t must be removed within ten days following the holiday. Initia Sod placement. Sod will be placed after the ground has settled following the burial to ensure a level surface and proper a tablishment of the grass. This process helps maintain the overall appearance and integrity of the cemete ounds. Initial Permanent Markers. All markers shall be installed within 120 days after burial. Where this regulation renders a hardship or presents any special problems, such as an estate not settled, special consideration will be given. equest for special consideration should be make in writing to the Sebastian Parks and Recreation Direc 25 Main Street, Sebastian, Florida 32958. Initia'( Unlawful Conduct. Our Ordinance states that it shall be unlawful for any person to possess or consume any type oholic beverage within the cemetery grounds. Init� Violations of article; penalties. A violation of any of the rules and regulations contained in this article shall be considered a iolation of the ordinances of the city, and any person adjudicated in violation of such rules and regula' all, in addition to any penalty imposed by court not exceeding $500.00 fine and/or not exceeding 90 prisonment, be denied the right to do further business in the cemetery of the city. Initial I acknowledge hat I r tl and understand the contents on this form. Signatur Date CITY OF N SE$ASTj)k HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 388-8216 beakins@cityofsebastian.org June 23, 2025 Mr. Brad Norman 473 Perch Lane Sebastian, FL 32958 RE: Interment Rights in the Sebastian Municipal Cemetery Dear Mr. Norman, Enclosed is City of Sebastian Certificate 2986 entitling you to full interment rights in Unit 3, Block 61, Lot 14. I have also enclosed a copy of the Sebastian Municipal Cemetery Rules and Regulations Booklet. If you have any questions, please do not hesitate to contact me at (772) 388-8216. Sincerely, Bridget Executive Assistant Enclosures