HomeMy WebLinkAbout1-34-20Certificate No. 2154
~~ ~~ ~ ~~
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Thomas &/or Linda Carman 449 Orange Ave., Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit_1_Block_34_Lot_20_
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 19th day of November, 2007.
FLORIDA
ATTE
~_____
Sally A aio, MMC
ity Clerk
11/15/2007 01:16 5615892583 STRUNK FUNERAL HOME PAGE 01
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
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HOME Oi PEIICAN IfIAND
For iniormafign contact:
Kip Kelso -Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clark's 0/(ice
City Hall, 1225 Main Street
Sebastian, FL 32958
Olfice (772) 388-8215 or 388-8214
Fax; (772) 589-5570
~~~~~s~
FUNERAL HOME: Strunk Funeral Home
ADDRESS: 1623 N. Central Avenue, Sebastian, FL
PHONE= #; 772-5B9-1400
(Cl~ck One)
1b~ OPEN BURIAL LOT Lot ~ G L310Ck 3 4' Unit _
OPEN CREMAINS LOT Lot Block ~ Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL BATE AND SERVICE TIME: Nov. 21, 20d~7-"@ tll a.m.T
FOR DECEASED: Thomas Jamcs Carman
Name
NAME AND SIGNATURE OF LOT OWNER OR I~
(Must provide proper d cumentation of ownership,
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Name Signa
RESENTAT
re
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Date
I 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 ICENSEO F NERAL I CT
~-~~~
Narne Si nature 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:
Cemete Sex n Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
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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, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase ~ j n Q(~ CCc.,r-'Yl Q Yl - ~Gt_ Lt9 h tN,r
nt
Name(s)
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Address
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Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
~~ .,~.~/t~-~-~~~.yi~ ~d ~~6-0 ollars ($ ~, yUU~UU )
on this q ~ ~ day of l~c~ ye-~n ber , 20~ for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit ~_, Block 3 ~ ,Lot(s) ~ 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:
~-
Corner Markers (set of 4 - $20) Opening & Closing ! W O H
Circle One
Vase and Ring for Niches (cost) Interment
Signature of Purchaser
Disinterment
TOTAL $ ~ (~C~ , UU
ty of Sebastian
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc
Obituaries ~ Death Notices ~ Newspaper Obituaries ~ Online Obituaries ~ Newspaper D... Page 1 of 1
THOMAS ]AMES "TOM" CARMAN
Thomas James "Tom" Carman, 66, of Sebastian, died Nov. 17, 2007, at Holmes Regional
Medical Center, Melbourne. He was born in Freeport, N.Y., and lived in Sebastian for six
years, coming from Ronkonkoma, N.Y. He was a mail carrier with the U.S. Postal Service
for 35 years in Baldwin, N.Y., and in Ronkonkoma, N.Y. He served in the Army during
Vietnam. He was a member of Loyal Order of the Moose 1767in Micco. He volunteered at
the Keep Indian River Beautiful recycle center on Main Street and the Sebastian Historical
Society. Survivors include his daughter, Linda Carman of Sebastian; sister, Betty Gilroy of
North Merrick, N.Y.; three nephews; and one niece. SERVICES: Visitation will be from 6 to
8 p.m. Nov. 20 at the5trunk Funeral Home, Sebastian. A graveside service will be at 11
a.m. Nov. 21 at Sebastian Cemetery with full military honors conducted by the Sebastian
Area Veterans' Honor Guard.
Published in the TC Palm on 11/19/2007,
Today's TC Palm obituaries and death notices
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http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=9822... 11 /19/2007
LINDA D. CARMAN os-03 647
407 AZINE TER 63-4/630 FL
SEBASTIAN, FL 32958-4539 t~ 1488
Date ~ ~~ ~ 1-
Pay ° `-~,~ lJ~ c~~.-~-~ac'`•' I ~ ~ 1 ~~
to the order of
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BankofAmeric ~~~~ ~ ~~~
ACH R/T 063100277 ~ r/ ~, -
Mento ~ G
x:06 300004 7~: 00 549 34 X96 2 711'064 7
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CITY OF SEBASTIAN ~ O
CITY CLERK'S OFFICE
RECEIPT
Name ~ ~ r mQ, h ^ Cash
I I - t -L' , V ~ Check#~.-
Date
Amount Paid
No.
001001208001 Sales Tax
001501322900 Garage Sales
001501341920 Cop'~eslBid S~•
001501341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees ,_ _ _ O
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Cemetery Lots 1
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001501 343805 Cemetery Fees
Total Paid f f vo 00
Initials 9 hcant
White -Dept. of Ori in • yellow -Finance • Pink • App
FLORIDA DEPARTMENT OF
HEALT State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Thomas James Carman Death Nov. 17 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Melbourne Inst. Holmes Regional Medical Center
3. Name of Medical Address Phone Number
Certifier James Neel, M.D. 200 E. Sheridan Road
Medical Examiner Physician Melbourne, FL 32901 321-725-4500
4. Name of Funeral Home/Dir~Die~eeeF Address1623 N . Central Ave. Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment Sebastian, FL 1228 772-589-1000
Strunk Funeral Home
5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death acxompanies this
Appropriate application.
Box
b, ~ Michelle was contacted on 11 / 19 / 07
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Neel will complete and sign the medical
certification of cause of death within 72 hours.
c, ~ was contacted on He/she verified that
Medical Examiner, wilt complete and sign the
medical certfication of of death within 72 hours.
6. Funeral Director/ ,/ S' F.E. No./Reg. No. Date Signed
nt.a... n,-....--r /' ~~~ _ _ 44048 11 /18/07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-0472
A five (5) day extension of time for filing the death certificate (exGusive 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.
~No extension of time for filing the death certficate has been requested.
~r ~ Date Date Certficate
SubregistrarSignature ~ ~i'x'/I,,, ~ ~~~.4yQ.~tssued: 11/18/07 Due: 11/23/07
c. AUTHORIZATION for CREM/4TION, DISSECTION, or BURIAL-AT-SEA
Approval Number.
Date
Medical Examiner, ,gave authorization by telephone to
Funeral Diredor/Dired Disposer. Date
The Medical Examiners approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is
required for all cremations.
p CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition ,~l / ~ f ~O'~ ,
CREMATION OTHER (Specify)
Signature of Sexton 1
or Person-in-Charge J}
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 returnea
within 10 days to the local County Health Department in.the county where disposition occurred.
Distrilwtion: Whiff: Fumneral D recta ortD~red Disposer
DH' 326, 8197 (Obsoletes all previous editions)
(Stock Numt~er: 5740.000-0326-2) Pink Local Registrar ,~ `~ ~