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Home My WebLink About4-48-38Name a 7-` ` /r l DIe +D d,4,yt - Y X ID ��. � � -s '4!.5 Unit "/ Blocker Lot Date of Mark -out Date of Burial F / I./ Time Name of Funeral Home Authorized by `6,f-� # - :DO tt ,i2.4✓LS1J OTHA FELTON FORDHAM, JR. May 20, 1933 - September 14, 2017 Mr. Otha Felton Fordham Jr., 84, died September 14, 2017 at his residence in Fellsmere, Florida. He was born in Laurens County, Georgia and lived in Fellsmere since 1968. He was a US Army veteran during the 1950's. He was the owner/operator of a lawn equipment maintenance business in Fellsmere. Survivors include son Joel Fordham (Hope) of Kenansville, daughter Wanda Walker (Terry) of Fellsmere, grandson Michael Sellers (Tanya) of Sebastian, sister Joy Smith of Scott, Georgia, 5 Grandchildren and 6 Great Grandchildren. U.S.ARMY He was preceded in death by his wife of 55 years Cynthia and daughter Bom: May 20, 1933 Donna Sellers. Death: September 14, 2017 A Graveside Service will be held 10:00 AM on Thursday September 21, 2017 at Sebastian Cemetery. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: 1�YQ Kip Kelso, .Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax. (772) 228-9927 City Clerk's Office — Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(&citvofsebastian.org FUNERAL HOME: Strunk Funeral Home and CrematorV—SEBASTIAN ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) xxxxxx OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIM Lot-38—Block 48 Unit 4 Lot—Block—Unit Niche Block Unit N S E W 10:00 AM Thursday - 9/21/2017, Graveside service/Sebastian Cemetery FOR DECEASED: Otha Felton Fordham. Jr. Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Wanda Walker Wawda WaLlur Name Signature 162 South Willow Street, Fellsmere, Florida, 32948 1 certify that I have determined the ownership of the above described site that all fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Timothy Marvin Tmotkq Mcau Name Signature 9/18/2017 Date site fees and administrative 9/18/2017 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 BURIAL TRANSIT PERMIT FIEALTFI DATE PRINTED: September 18, 2017 TRACKING NUMBER: 2017146859 1. DECEDENT INFORMATION Name of Deceased Date of Death OTHA FELTON FORDHAM JR September 14, 2017 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER FELLSMERE 162 SOUTH WILLOW STREET Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lie. No./Reg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. NoJReg. No. TIMOTHY W. MARVIN F022789 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: 2017-F -5159 Date Issued: Septemberber 15, 15, 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY-T!,��t�(�CJ Method of Disposition: BURIAL Date of Disposition: II - 3 I, 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 10749 ADMINISTRATIVE SERVICES RECEIPT Name�3+Run)< 1 Ot2a 14A -r -f ❑ Cash Date -1-Ac -1-7 XCheck #Z%1% U 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 00(�5ci J43 gcs o`c_ 1s c LIv, -, 4 aix4q lir 38 109 IX Total Pa Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant 09/19/2017 12:19 97068 P.001/001 FUNERAL DIRECTOR'S REQUEST TO Cl OF SE TIAN FOR BURIAL OPENING IN SEBASTIAN MU ICIPAL C ETERY For information contact: Wp Kelso, .Cemetery Sext Set astian Municipal Came Phone. (772) 589-2545 Fax, (772) 228-9927 CityClerk's Office - Cathy ty Hall, 1225 Main StriN it Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta anyofsebastigh.ora FUNERAL HOME: Strunk Funeral Home and CrenlatQ — BASTIA ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE* 772-589-1000 (Check One) nuu=_ OPEN BURIAL LOT I-ot_38 _ploeR_A L nit 4 OPEN CREMAINS LOT Lot—Block _Unit__. OPEN COLUMBARIUM NICHE Niche ck�it 027, Grav s BURIAL DATE AND SERVICE TIME: 2 :00 AM Thursday 9/21 e service/Sebastian FOR DECEASED: Otha FelIgn-Eord am, Jr. Name NAME AND SIGNATURE OF LOT OWNE ORREPRESENTATIVE: (Must provide proper documentation of ow ership) Wanda Walker VyAyL&1 al 812017 Name Signature Ito 162 South Willow Street, Fellsmere, Florida, 32948 1 certify that I have determined the owners ip of the above describe I site that al s i fees and administr fees have been paid and authorize openin g of same. NAME AND SIGNATURE OF LICENSED 7UNERAL DIRECTOR: Timothy Marvin Tmot4 Maxair! .18/2017 ate Name Signature Cemetery Sexton Certification: I certify that I have checked the ownership Information by viewing tt a owner's d and confirming with office and that all fe s have been paid: g ipletion. Cem ery 9extbnDate This form to be provided Clerk's Office by Sexton for permanent a wrd upon x Cemetery ative Clerk's 1,050 O0 Net Paid $ ........... ." ...... 8/28/87 Lots Block ldextm~m No. liudal Sl~ee~ ............... [3hi t 4 Monnment ~e~mJtted ....................... (Dnt~ .bore Sis line fo~ I~ty Record only) 38 & 39 NO. 1442 O~itg nf ~ebastiatt 1442 emetery No. ................................................................. D ~96 Otha ~. and/or CTnthla A. Fordham ............................................ ~$2"~';"~11'1~ "5't ~'o't ....................................................... ~ll~ore, Florida 32968 ~t the Gr~tot for a~ ~ mnsid~flon of the ~m of $ .~ ;.~ 9. t ~ ............. tO it ~ hand ~ld, the mmi~ whe~f