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Home My WebLink About3-COL-20DnBName Unit Block vv A. Lot /1( �� '0 Date of Mark -out Date of Burial iC-� Time Name of Fune Authorized by CITY OF SEBASTIAN 10930 ADMINISTRATIVE SERVICES RECEIPT Name 19,4ZISKJ6 ❑Cash Date )1Check#'�9 ❑ 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 OOlso i - 3 q38os Vo r Rf%�G 9c, `o UMtz 3 8IK COL NlcH6 dooN3 Total Paid 10, 16itials White - Dept. of Origin • Yellow - Admin. Svcs. • Pink -Applicant Vero Beach Crematory, LLC 1830 Wilbur Avenue Vero Beach, Florida 32960 We hereby cer iffy thar rhese are the cremored 'human remains of. Mary D. Briskie July 13, 2017 (Date of Death) Strunk Funeral Home and Crematory (Funeral Home in Charge) 5174 (Cremation ID Number) July, 18 2017 (Date of Cremation) Sebastian, Florida (City and State) By: Cremoto n ture) 07/20/2017 15:28 FUNERAL OR'S REQUEST OF STIAN FOR BURIALDOP NING IN SEBAST ANOMI�ig PAL CE , E7 RY For information contact: P Kelso, .Cemetery Seattc in astian Municipal Cemetery Phone, (772) 589-254 Fax: (772) 228-9927 Ci Clerk's Office – Cathy ity Hall, 1225 Main Str Sebastian, FL 32958 Office (772) 388-8;15 or 388-8214 ctestal #6953 P.001/001 FUNERAL HOME: Strunk Funeral Home ana taemaT ADDRESS: 1623 North Central Avenue. Sebastian, Florida, 3295 PHONE#: 772-589-1000 (Check One) OPEN BURIAL LOT Lot Block Unit OPEN CREMAINS LOT Lot—Block Unit_ XXOPEN COLUMBARIUM NICHE XX Niche 20 D/ Block_!mL Unit -3 :)O NOON at 5pbastian BURIAL DATE AND SERVICE TIME: 7 27/2017, Thursday @ 1 Cemetery Gazebo FOR DECEASED: Mary D. Briskie Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATI : (Must provide proper documentation of ownership) Ronald E. Briskie 7;?-pV,.4W E % apri Avenue,ebastian, site that all /20/2017 I ate FL 32958 i,te fees and administrative Name 2035 blue Ridge Avenue, Melboume, Florida, 329 1 certify that I have determined the owns Signature 35 PEED BarrettBriskie, l2 hip of the above describ fees have been paid and authorize openi g of same. NAME AND SIGNATURE OF LICENSE FUNERAL DIRECTOR: Marshall Voyles Iv=Rdt CYo 3 /20/2017 ate Name Signature Cemetery Sexton Certification I certify that I have checked the ownershi information by viewing owner's de � and confirming with Clerk's office and that a)l fees have been paid: 4 t – I I IL ee ery on S dDate m This form to be provided to Clerk's Office by Sexton for permanenj r cord upon 0 MY Lf HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax July 20, 2017 Mr. Barrett Briskie 125 Capri Avenue Sebastian, FL 32958 RE: Interment Rights to Unit 3, Block COL, Niche 20DnB, Sebastian Municipal Cemetery Dear Mr. Briskie, Enclosed is City of Sebastian Certificate 2544 entitling you to full interment rights in Unit 3, Block COL, Niche 20DnB, in the name of Mary D. Briskie and Barrett Briskie If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Testa Records Clerk Enclosure CITY OF SE T" Wno HOME OF PELICAN ISLAND Certificate No. 2544 p Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Mary D. Briskie Barrett Briskie 125 Capri Avenue Sebastian, FL 32958 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: Unit 3, Blk COL, Niche 20DnB of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 20th day of July, 2017. CITY OF SEBASTIAN, FLORIDA b Joseph F. Griffin City Manager ATTEST: anette William',. MMC City Clerk _ — uIr OF UbAs `M HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Qk! l,I kC-_ CSctJ --ro D I,jJiu-h Nlw-it�rLL_ Address Area Code & Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: d `t vt SA Iy+� Dollars ($ CROOL - ) on this 40 day of (SN 2017 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 3 Block 0 -CL , Lot(s) Niche(s) cQC 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 4 1S U OD Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc Interment City /W O H Circle One Disinterment TOTAL EE The following documents were provided as Proof of Residency: 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 ' I Fax: (772) 228-9927 C City Clerk's Office –Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(&citvofsebastian.orp FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) OPEN BURIAL LOT OPEN CREMAINS LOT XXXX OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI FOR DECEASED: Mary D. Briskie Name Lot Block Unit Lot—Block—Unit Niche 20 D/N/B Block COL Unit 3 N S E W 7/27/2017, Thursday @ 12:00 NOON at Sebastian Cemetery Gazebo NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Ronald E. Briskie 1z0waL01 a 1' ,KsleLe 7/20/2017 Name Signature Date 2035 Blue Ridge Avenue, Melbourne, Florida, 32935 DEED Barrett Briskie, 125 Capri Avenue, Sebastian, FL 32958 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 JvmkauNoglls 7/20/2017 Name 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. State of Florida, Department of Health, Bureau of Vital Statistics Oil d BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: July 17, 2017 TRACKING NUMBER: 2017112719 1. DECEDENT INFORMATION Name of Deceased Date of Death MARY D BRISKIE July 13, 2017 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN 125 CAPRI AVENUE Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. 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. NodReg. No. R. MARSHALL VOYLES JR F043488 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: 3041870.5131 July 1 �— Date Issued: July 13, 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: C17-19-07-232 4. CEMETERY OR CREMATORY Place of Disposition: VERO BEACH CREMATORY —TI-) Method of Disposition: CREMATION 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, 10/12 64V-1.011, Florida Administrative Code CITY OF SEBASTIAN 10732 ADMINISTRATIVE SERVICES RECEIPT NametJ" (Z ( 41�- l i= ❑ Cash Date —7 A0 —I-1 Check#50, UtiT3 6fk cot Lcr Acb/A; fig 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent r ❑ Credit 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 Amount Paid 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 6oi cto - Lor O ob '441— t Total Pal _CO nitials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant