HomeMy WebLinkAbout3-25-16Name TC �+'T , L' F
1 W1 t
Unit .3
Block
Lot /
Date of Mark -out
Date of Burial
Name of Furneral Homa v�Ir uv-.., "`,
Authorized by .�
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
ctestancitvofsebastian.orf;
Funeral Home: Strunk Funeral Home
Address:1623 N. Central Avenue, Sebastian, Florida 32958
Phone:772-589-1000
(Check)
F71 Open Burial Lot Unit 3 Bloc Lot
Lot 16
Open Cremains Lot Unit Block Lot
_F1 Open Columbarium Niche Unit Block Niche_
Burial Date and Service Time: 10/29/2025 @ 11:30 AM
Deceased Name: Patricia J. Waters
Name and Signature of Lot Owner or Representative:
(Must provide proper 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 ' rized opening of same.
Name and Signature of Lic�nsed ral actor:
Sandy Mastrando / 10/27/2025
Print Name (Zigna_tuire 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:
Z-
Xmetery / Date
This form is to be provided to Clerk's Office for permanent record upon completion.
BURIAL TRANSIT PERMIT
TRACKING NUMBER:
1.DECEDENT INFORMATION
Name of Deceased Date of Death
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No.Phone Number
Funeral Director/Direct Disposer Fla. Lic. No./Reg. No.
BURIAL - TRANSIT PERMIT2.
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:
State Registrar
Date Issued:
AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION3.
Authorization given by Medical Examiner District Approval Number:
CEMETERY OR CREMATORY4.
Place of Disposition:
Method of Disposition: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.
DH 326E, 10/12
2025194678
PATRICIA J WATERS October 25, 2025
INDIAN RIVER SEBASTIAN
STRUNK FUNERAL HOME- SEBASTIAN F041870
1623 N CENTRAL AVE
SEBASTIAN, FLORIDA, 32958
(772) 589-1000
SANDRA ASSUNTA MASTRANDO F764131
SEBASTIAN CEMETERY
BURIAL
2025-F041870-5150
64V-1.011, Florida Administrative Code
State of Florida, Department of Health, Bureau of Vital Statistics
PELICAN LANDING ASSISTED LIVING AND MEMORY CARE
DATE PRINTED:October 27, 2025
F041870
October 27, 2025
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
Staff at the certifying physician's office, was contacted on 10/27/2025 by the funeral director listed above; he/she indicated that
MICHAEL ANTHONY VENAZIO, certifying physician, will complete and sign the medical certification of cause of death within 72
hours.
Medical Verification Statement
CITY OF
SF]3ASTJ�N
HOME OF PELICAN ISLAND
Certificate No. 2993
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:
Kathleen A. Bogan
13630 N. Indian River Drive
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 25, Lot 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 51h day of August, 2025.
CITY OF SEBASTIAN, FLORIDA
Brian Be rh
City Manager
ATTEST:
c I� e etc G�-�c arwa
J nette Williams, MMC
City Clerk
Credit
Amount Paid
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 of.�
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
01'
3"T14NN
ICAN ISLAND
n Street
FL 32958
8-8216
'sebastian.org
netery
} g you to full interment rights in Unit 3,
Total Pai
als
White - Dept. of Origin • Yellow - Finance Dpt. • Pink - Applicant
fat Cemetery Rules and Regulations Booklet.
If you have any questions, please do not hesitate to contact me at (772) 388-8216.
Sincerely,
Bridget Eakins
Executive Assistant
Enclosures
0 -._,
HOW Of PF LICAN ISLAN111
12.25 Mh n Sirret. Se4)asiran, 'FL 3295E 772 3158 8209
City of Sebastian Municipal Cemetery Purchase Order
}{2 rc I 1 LA
++i a 1t
NI�t�Ri 1) -� llr_ilf�"aA V' R i/11
Arai Cade & Phone Nurntiet
Narrw
Rcceiat is actk+iuMudged in the suns or.
on this day of _
Cemetery LAt(s) andlor Niches)
d Occupant r1 Other than Pvcheser
OFFICE USE ONLY
Dol`ars (S -'
20 for the purcha"c of the faklvnnng descrebed
Unit Block _ Labs} Nreheis)
for use to accordance w1h the conditions, ordinances, resoluLons, rules and fegulations pfeFsC000c
Irweforet by the City of Sebastian
Addrtionar Fees pald at time of purchase:
Opening & Closing foe for ceremony after hairs or on holiday S
Disinterment Fee S
Vase and Ring for Niches �curremt market price) $
TOTAL s _
00 r-4
® ture of Purchaser
City o'f Sebastian
Tt N
tk?AAt CAI Pi I K AN 191 .A,%"
Sebastian Municipal Cemetery
Artificial and V*sh ltowrf. btenkets. %--' 'ro'o than t ro tKkA PRx & arlA naI c+ fresh fl, rs vwb pP ssra roe
V nny gravosrro Anrhord rkhw arnargem►nrc Will be Crrnvded 10 rtnwei urv- they become laded v
Vnsr9htPi t rest flTssys We iernem r.nt+l veyrphtly No piss a ceramic tower coninrws Lv ornlnMntt skis
be allowed. hawever, a Plastic flasver conNlner no more than sin birched deep, six inches wide and 24
inchn tong may ranwon M pact ynlass broken of Ir decsep-t con,"oe, No vnres shall be allrA"d to hold
mow,,, arra rpenrr+ts pnr n inenMt n piece at the vhlermen! ve FAwikris are allowed to be placed PrXW to"
hnl>dwy tut rtwsl bp rd'rn�w+y wort ten days toeowin0 the h84dfre
tvau
Sod placement sal wet be placed aver the graLwA hips wired 1101110M1nif the bund to ensure a level surface
and f+r4w a stabhshmenl or the pass iNs process hags mentan aN &AWO eppearerxhw snd V447dy of tee
Ow"" voli-AXIS.
brit
Pern%arrent Waffims. Ail rnarkrv-s shall be installed within 120 days SIPW burial. V*we " ntq*aycm
r[m;krs a ha *shp or presents any Wienai prohlerns. such as an oslate not settled. speaal wnt+dsrahm wnt
be gven Regrwst liar ape ial convdetakor shuuld be make in vnw,nq to the Sebastian Parks and RecrvabOn
Directw, 1229 Man Street, Sebastian Flonda 32V,8
9
WN'
Unlawful Conduct Our 0-dinarc states that it "I be ualawral to my Purwn to pas:sr:ss a *nwr*o ar+y
type d a},c�nrr.c 6evoragn avCr'S OM CameRery grra.�C�c
Ntotabons of arWit; penotbes, A nalabon ill any of the notes and requlabons contained n vws artale shill be
oonsidered a wolalon of the wdrnances of the city, and arty parson adp6caled in VxA"w of such rues erJ
requ[atona;hat, in addition to any penalty Imposed by court not exeaed rya S'MDO Ana an*'or not exceel6nq
SO days urhtnsonmant be denied Ure right td do Further busnwss in the aerrmlery of the city
I ackIaWledge that I have r ad and I deratand the contents on this form.
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