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Home My WebLink About4-44-02Block Date of Mark -out ,y /I IR .46., / Date of Burial /O 11A.0 //6 Time X41 � re- rt/ ,4IF If L+� Name of Fune Authorized by CITY OF SEBASTIAN 10389 ADMINISTRATIVE SERVICES RECEIPT Name K Y+� ISS UCash �/ � Date ITI �% Checkk sag ❑ 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 001501 3 43 26; i zbb.o' 04,�rr 4 QIK lora ew 60 ( Total Paid *SC I'i s Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink • Applicant State of Florida, Department of Health, Bureau of Vital Statistics M M15 BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: October 17, 2016 TRACKING NUMBER: 2016160446 1. DECEDENT INFORMATION Name of Deceased Date of Death MAGGIE J YATES October 15, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER FELLSMERE 13615103RD STREET Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041370 (772) 589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral DirectorlDirect Disposer Fla. Lic. No.IReg. No. GARY D. EVANS F065074 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: 2016-F041870-5178 — Date Issued: October 17, 2016 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY Method of Disposition: BURIAL 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 k_INkL 4 k- Wf L6T -X / Lot.~ 1 & 2, BLK. 44, UNIT 4 3 _ ~ ~ 9/1/87 No. P~id by CEMETERY Eec¢ipt No .............. va~ea ........................... 350.00 2 L~tPfic~$ .................. Mm~imumNo;Bm~]SP~ce~ ................. Parker S. & Maggie J. Yates 1134 Net Pma $ .....7.0D ,.0~ .... Monument mnmtt~ .... ~ La ~ ............ 11055 S.R. 507 Fellsmere, Fl. 32~48 (D~ above ~m ~r~ for City Record an~,) of ebas ian leme ery Beeh NO. 1134 September .8..7 THIS INDENTURE MADE Tlga., .............. 1st ...... d~y of ............................................ A. D, 1~. .., between the City of ~ebaitl~ & m~lci~ ~rat~n ~ist~g ~r tbe laws of the ~ta~ of F~rM~ as Gr~r ~ Pa~ker S. amd-Maggie J. Yates 11055 S.R. ~07, F~ll~re, Fl~$4a 32948 of the ~unty of ......... ....................... Indian River........... ,n-] State of ........... FLorida ...................... ~ ....... ~ Or~n~ WITNESSE~ 700.00 T~t ~ ~to~ fo~ ~ ~ ~n~a~n of ~e sum of ~ ......................... ~ it ~ ~ p~, ~ ~ipt w~reof ~ ~ewi~ a~ ~w~e~ d~s by t~ ~ent ~t, b~, ~ ~e~, ~n~y ~d ~ ~to ~ Gr~e . .their ~k~ kgm re~e~tafives ~d a~s ~ofLot(s)~..~..2 B~~, ........~4 ,U~T ..~,........... ,ofS~a~m~m~as~rPhiNumberl~ftewtd~Pht Book 2, at p~e 65 of ~e pub~ ~r~ ~ ~e offi~ of ~ ~k ~f t~ ~t Co~ of S~ Lu~ Co~ty of Flo~; ~ ~ now l~t md b~ To Have and to Hold th~ ~im~ fol~v~; provii~i that i/d property/ll~ ami ~ol~ly ~i exclu/vely for the ~ter~nt of ~e hu~ ~d ~d ~ be u~, kept ~d ~ed at ~ ~es ~ ac~ ~ the m~s ~ ~g~fions, or~s a~ re~lufions of ~ City of Szba~ Flofi~ be~ fore, ~w ~ ~er ~opt~ or pro~ for ~e gov~e~ ~ op~a~n of ~ ~w~ry. ~ wn~tion~ re~i~ons ~d ~q~cmen~ ~n~ m~e ~d ~mp~ ~th iu~ ~, ~cg~ ~e~ns ~.or~s ~d t~ ~o~ of ~e d~d of ~n~ t~reof t~n ~ ti~ of su~ ow~r ~ ~d to ~d ~o~y ~ 1or~a~ ~d t~ ~me ~ ~eve~ W t~ City of ~ba~n, Flo~ IN ~SS ~OF, T~ ~d ~y of t~ ~ p~ ~s ~d ~ ~tr~ent to be exe~led ~ its n~ ~ on its be~ by its ~yor ~ a~e~ by i~ ~ty ~k ~d ~s ~rate ~ to be h~eW ~, t~ day ~d ye~ ~ above w~t~m ........ . ................................ ~ttest ~ ~ City Oer~ .B~ Ma~or Signed, Se~ed and Delivered in th~esence of~ ~ .......... STATE OP FLORIDA