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Home My WebLink About4-28-14Date of Burial 0' Time Name cxFuneral Homo Authorized by � CEM Iex: City of Sebastian, FL — Cemetery Lots Last Name Razzini First Name John L.& Evelyn Address 1 Address 2 City Sebastian Deed # Interred 03-07-02 Date Unit # 4— Block # Lot Number 14 Interred Lot Number iS Interred Lot Number Interred Lot Number Interred Comment See Comment State F1 Amount 28 Evelyn Razzini John L. Razzini vet Zip Record:1878 32958— Dte Interred 03-07-02 Dte Interred 07-13-98 Dte Interred Dte Interred <F>tard <B>ack <E>dit <D>elete <N>ext <P>rev <R>e—search <L>abel <T Tuesday, Apr 26, 2005 03:11 PM <Esc> Z Q Q ~ o: a �m W W Wm MF, F CTZN Q0 a x cc (,) ZW qoa ®MU YQ 00 �Q w Q CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT y ❑ Cash Name CheckX� Date AmountPald 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501 362100 Community Center Rent 001501 362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010343600 Cemetery Lots 1/, Block �• Unit LoVNiche � �•„�, 001501369400 Interment Fee �7 001501369400 Weekend SeNice 680800 220681 Yacht Club Security Deposit 68080022M2 Community Center Security Deposit fi80800 220683 Riverview Park Security Deposit Total Paid .J1ZLtu-- / Initialslicant White-Oept. of llri8in• Yallaw- Finance •Pink - APP > €kms sa> ❑ I ❑ II• m II . IU Z �II( 0 ° ` IIS >ro cc a°0 LL re .e•a••a•+�wo uairs u xruar CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT y ❑ Cash Name CheckX� Date AmountPald 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501 362100 Community Center Rent 001501 362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010343600 Cemetery Lots 1/, Block �• Unit LoVNiche � �•„�, 001501369400 Interment Fee �7 001501369400 Weekend SeNice 680800 220681 Yacht Club Security Deposit 68080022M2 Community Center Security Deposit fi80800 220683 Riverview Park Security Deposit Total Paid .J1ZLtu-- / Initialslicant White-Oept. of llri8in• Yallaw- Finance •Pink - APP FLORIDA DEPARTMENTOF HEALT A r PFI State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of Evelyn Catherine Razzini Death March 2 2002 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or I Indian River Vero Beach Inst. Palm Garden of Vero Beach 3. Name of Medical lAddress Phone Number Certifier Rociter Mittleman 2500 I S. 35th Street 1 Medical Examiner Physician Fort Pierce, FL 772-464-7378 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian FL 1228 772-589-1000 5. Check Appropriate Box a. The medical certification has been completed and signed. A completes ceruncate or ceain accompanies inls application. b. R C. F1 He/she verified that this and that certification of cause of was contacted on was from natural causes, that there was no accident nor other external cause of death, will complete and sign the medical death within 72 hours. was contacted on of death within 72 hours. . He/she verified that Medical Examiner, will complete and sign the 6. Funeral Director/Si tyre F.E. No./Reg. No. Date Signed .,.-_-. / s 1862 3/4/02 B. C. Ga BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-02-0096 �A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. F-1Noextension of time for filing the death certificate has been requested. pgibti., 01 Date Date Cert'rf1'cate Subregistrar Signature .�A. %1 Issued: 3 I �- I O 2.. Due: 31 % / O ]„ Approval Number. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Date Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. Method of Disposition: ISBURIAL CREMATION Signature of Sexton 1 or Person -in -Charge 1} FISTORAGE ❑ OTHER (Specify) i/ - CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition rv, This permit must be endorsed by the Sexton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the county where disposition occurred. Disafbubcn: While: Cemetery or crematory DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 574e4D004)326-2) Pink: Local Registrar INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION FOR BURIAL -TRANSIT PERMIT FORM APPLICATION FOR PERMIT Section A. 1. Type name of deceased and date of death. 2. Indicate place of death: County; City, Town, or Location; Hospital or institution (if not in hospital or institution, give street address). S. Indicate the name, address, and telephone number of the Medical Examiner or physician who is to provide the medical certification of cause of death. 4. Indicate name, address, telephone number, and license number of funeral home or direct disposal establishment. 5. a. Check if a completed death certificate, Including the completed and signed medical certification of cause of death, accompanies the pink copy of the application for Burial -Transit Permit to the Local Registrar of the county in which the death occurred. (If the completed certificate cannot be obtained in sufficient time to be filed with the pink copy of the Application, check 51b.) b. Provide the name of the person contacted in an effort to obtain the name of the physician who is to complete and sign the medical certification portion of the certificate, and the date he/she was contacted. The person contacted must be either the physician or a responsible person who can speak for him/her. C. Check to indicate if this is a Medical Examiner case. Give the name of the person contacted who verified that the Medical Examiner will complete and sign the medical certification of cause of death and the date contact was made. 6. Requires the signature of applicant Funeral Director, FE License number, or Direct Disposer, Registration Number, and the date the Application was signed. BURIAL -TRANSIT PERMIT Section B. If R is anticipated that the certificate cannot be filed within five days from the date of death, five additional days (exclusive of weekends) may be requested and granted by checking the box provided. If no extension of time is requested, check appropriate box. The Registrar or Subregistrar who issues the Burial -Transit Permit will sign and date the Permit Application and assign the permit number. Section 382.006, Florida Statutes, requires that a Burial -Transit Permit be obtained prior to disposition or removal from the State and within five (5) days after death. It shall be mailed or delivered to the Local Registrar of the county in which death occurred within 24 hours after issuance. NOTE: It is not necessary to wait until the Funeral Director/Direct Disposer has custody of the actual body to begin the paperwork. AUTHORIZATION FOR CREMATION, DISSECTION, or BURIAL -AT -SEA Section C. Approval for cremation, dissection, or burial -at -sea must be authorized by the Medical Examiner. Space for his/her approval number and date are provided. In addition, space is provided for the name of the person obtaining telephone approval from the Medical Examiner and the date such approval was obtained. (NOTE: DO NOT HOLD UP FILING THE PINK COPY WHILE AWAITING MEDICAL EXAMINER APPROVAL.) CEMETERY OR CREMATORY Section D. Required: Signature of Sexton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton.); check the appropriate box to indicate the method of disposition; fill in the date and place of disposition in space provided See, , - Euii, P . �g3-4L;n . - 3 (71az _ IIA.M. L ru. )4-, /alk av, J,r /4� s N& s z q4O e �/Ato s L '),