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Home My WebLink About3-60-08Name 11 Ale, /', (.2111 Unit_ 7 1311^1' LD Date of Mark -out Date of Burial l/A ?VA / Tin - Name of Funeral Home Sj;,7,-� ✓�C Authorized by ��k��'��li •N� CInOF 5E12ASTN HOME OF PELICAN ISLAND Certificate No. 2733 CITV 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: Mrs. Billie Singleton 439 Basking Ridge CT Ocoee, FL 34761 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 3, Block 60, Lot 8 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 25th day of January, 2021. CITY OF SEBASTIAN, FLORIDA ATTEST: Paul E. Carlisle J'0anette Williams, MMC City Manager City Clerk an icf SEBASTIAN RWAN _7 HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax February 1, 2021 Mrs. Billie Singleton 439 Basking Ridge CT Ocoee, FL 34761 RE., Interment Rights to Unit 3, Block 60, Lot 8 in the Sebastian Municipal Cemetery. Dear Mrs. Singleton: Enclosed is City of Sebastian Certificate 2733 entitling you to full interment rights in Unit 3, Block 60, Lot 8 in the name Billie Singleton. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy to Records Specialist Enclosure dn« ROME OF PEUCAN 14%MD City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) T69 &Sk1V6 kid6c-c?' 0Q7---* R 34761 Address 67.7*-8 - 9a so S R N1 ;( so (5 /Ael_ , eon) Area Code & Phone Number 2� cSro) Name &Residence Address of Intende/Ocuapan Iif Other ThanPurcraser OFFICE USE ONLY Receipt is acknowledged in the sum of: -Tt )4 WugtSArt Dq AA-b' Oct/ICY Dollars ($ Ar Od v , W on this 1s day ofjz[kAV 20A I for the purchase of the following described Cemetery Lot(s) and/or Niche(s). r Unit J , Block 420 , Lot(s) g 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: 00 Corner Markers (set of 4 - $20) Opening & Closing I� I W O H Circle One Vase and Ring for Niches (cost) Interment Disinterment Temporary Marker Preparation & Installation TOTAL S1 _pIS�•oD Signature of Purchaser City oeba a The Following documents were provided as Proof or Residency: l.%WW-DATAWs-CemeterylRECEIPT.doc FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, Cemetery Sexton / F a4/FLF Sebastian Municipal Cemetery� u Phone: (772) 589.2545 .b- Wel Fax: (772) 228-9927 ® City Clerk's Office - Cathy Testa City Ball, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or388.8214 ctesta0citvolsebastian.ora FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) MM-OPEN BURIAL LOT _OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot 8 Block 60 Unit 3 Lot —Block —Unit — Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME. 2:00 PM - Wednesday, 1/27/2021 - Graveside Service FOR DECEASED: Gary Herbin Singleton Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Billie Sinaleton S_LLLb, SLIna_I.ebwn 1/25/2021 Name Signature Date 439 Basking Ridge Court, Ocoee, Florida, 34761 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 MaASIZOR CV04kS 1/25/2021 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: CemdterV 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 BURIAL TRANSIT PERMIT I HEALTH GATE PRINTED: January 25, 2021 TRACKING NUMBER: 2021017I66 1. DECEDENT INFORMATION Name of Deceased Dale of Beam GARY HEREIN SINGLETON Janwry23.2021 Place of Death, -County City, Town or Location Name of facility, or street address if not a facility ORANGE OCOEE 439 BASKING RIDGE COURT Name and Address of Funeral Homelturect Disposal Establishment Fla. Uc. NoJReg. No. Phone Number STRUNK FUNERAL HOME. SEBABTIAN F011870 F041870 (r72)589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral DlredorMleact Disposer Fla. LIc. NoAeg. No. ROBERT M. VOYLES JR F043488 Medical Venficallon Statement DR. PRAM M the certifying physician's office, was connected on 0112512021 by We funeral director listed above; helshe Indicated Net ANNE PHUONG PHAM, cenllying physician, will complete and sign lee medical certification of cause of deem w"In 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: 2021-FJanuary 2520-5018 21 Date 16eeetl: January 25, 2021 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATOR`,Y�� Place of Disposition: SEBASTIAN CEMETERY V V o Method of Disposition: BURIAL Data of Disposition: 1 IL' (2A ERRS 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 84V-1.011, Floods Administrative Code CITY OF SEBASTIAN 12603 ADMINISTRATIVE SERVICES RECEIPT S Name NH4.E'7-Orj ❑ Cash Date ❑ Check # XCredit Amount Paid 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001208001 Sales Tax 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501220030 PDSHOP 001501366602 PD SAFE 001501 366603 PD COPE 4201010 343 ACO C 015bf -7 3265 Lo-T �sa,vbo. � Jtjf t 3 &-K= w 10r 8 GJ Totalai�x �.� Initials While - Dept. of Origin • Yellow - Admin. Svcs. • Pink -Applicant offff SEBASTLAN QMW HOME OF PELICAN ISLAND Sebastian Cemetery Ph# 772-589-2545 Fax# 772-228-9927 Site Plan for Marker Installation Funeral Home: Type & Size of Marker: I . o X �,o Yo.61 15TWX His Gory W. 5:^Ctm- n Hers DOB: Val IS I L 3 DOB: DOD: 1 1 a3 / 31 DOD: Unit: 3 Unit: Block: L o Block: Lot: T Lot: Size Foundation Material P x 2............................................. Dry mix, consisting of a bag of concrete (only) includes flat grass marker. Larger than 1' x 2................................Formed and poured concrete including base. Approvedby: 36e V Date3h&/;-I Marked out by: 3uK v Date )l'0sl;l Foundation Poured by: H ec-r k Date 31 a,t 1 7 7 Foundation Material S ur-- Cr. c Date 31 �a171