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Certificate # 1871
HOME Of PWCAN ISlAND
ern( OF SEBASTIAN
Certificate of Interment Righfs
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Margaret Kamakaris
(name)
821 Doctor Avenue, Sebastian, Fl 32958
(address)
(name)
(address)
(name)
(address)
in and for consideration of the sum of $ 1 , 0 0 0 . 00 , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 . Block 39 . Lot(s) 11 &,12
of the Sebastian Municipal Cemetery,
as maintained on f"Ile 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 16th day of January
2003
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issued to replace original dated 2/23/98 that cannot @
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Name
G&OR6E
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Date of Burial
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Time
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Name of~~"-~ra~,HO~/!f. j ",.". ""/.",.,,/,,/,,', ,;,',", ,)
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STRUNK FUNERAL HOMES, P.A.
tj-.3/ - //Y-~ i
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91617TH STREET
VERO BEACH, FLORIDA 32960
(561)562-2325
1623 NORTH CENTRAL AVENUE
SEBASTIAN, FLORIDA 32958
(561)589-1000
STATEMENT OF FUNERAL GOODS AND SERVICES FOR CASH ADVANCE ITEMS
NAME GeorGe Kamakaris
DATE
8
The charges for these items are made by third parties and are not part of our charges for sevices or merchandise.
YOU MAY WRITE- SEPARATE CHECKS FOR EACH AGENCY OR WE WILL ACCEPT A TOTAL SINGLE
PAYMENT AND DISBURSE PAYMENTS IN YOUR BEHALF,
CASH =--- ~ .
1. Grave Opening/Closing ......~ ~ ((~ , ~ ~~ . . . . . . . . . . . . . . . . . . . . , . . .$
2. Vault Installation ....................~......,..................,........$
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425.!-
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1000. '
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loo.db
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0.00
O.r
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3. MarIriog and Sodding ..a..:..;...... ~ . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .$
4.CemeteryProperty ..... ../.'l. .'f..... ~.I.... ~. 7J..~...........$
5. Air Transportation of Remains (Estimated) ..':../."......................'...$
6.GratuityforClergy ...... ,4-?-!~ ./~/j.".,......",....., ,$
7. Other Gratuity ......'.....".'............"..,.."................,.,.$
8. Organist ."......."..................,.....................,........$
--c:..=. .--......-_... ------.~_-. -""---~_". ,. -.-___ __ _ ___ ___ u.
9. Soloist ...............,.....................................,..".... $
10, Final Date ........"......'....."........,...................,......$
I1.Flowers ....... ~~/~.....,..,......................,....$
12. Certified Copies (6) ,. .J,,/I.:~,. .//4',-:.,.............,....,......$
0.00
r
270'1-
42'r
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of-
ot-
ot-
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Th'~ $
$
$
$
$
ESTIMATEDCASHADVANCES .",............,..,.... ,., .TOTAL $
PAlDT FUNERALHOMEFORDISBURSEMENT ,.....".,.....,....... $
The undersigned hereby acknowledges receipt of this state 'ent.
Funeral Director
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Pers n(s) Responsible for Arrangements
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. Year
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State of F.a, Department of Health, Vital Statistics .
APPLlC N FOR BURIAL - mANSIT PERMIT
A.
1. Name of
Deceased
(Type or Print)
First
Middle
last
Month
Day
2. Place of Death
County
Indian River Roseland
3. Name of Medical Medical Examiner
Certifier }
Nasir Rizwi, M.D. X Physician 13885 U.S. Hi hwa #1, Sebastian, FI 561-589-6844
4. Name of Funeral Home/ Address Fla. Uc. No.lReg. No. Phone Number (Area Code)
Direct Disposer 1623 N. Central Ave.
Strunk Funeral Home Sebastian, FI 1228 561-589-1000
5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application. '
priate !
Box
George J.
City, Town or Location
DATE
OF
Kamakaris DEATH Feb.
Name of (If neither, give street address)
Hosp.or
Inst. Sebastian River Medical Center
Address Phone Number
22
1998
bJt
Jeanette was contacted on 2/23/98 within 72
hours after death. He/she verified that this death was from natural causes, that there was no accident
nor other external cause of death, and that Dr. Rizwi will complete
and sign the medical certification of cause of death.
c 0
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. Place of Sebastian Cemetery
Final Disposition:
7. Funeral Director/
~I _. !._...___r
I ndianRiver
F.E. No.1 Reg. No.
1862
Removal
from state Donation
Date Signed
2/23/98
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228~98-0095
Permission is hereby granted to dispose of this body.
o A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
o No extension of time for filing the death certificate requested.
Re~:.:.l.u. ""'.
Subregistrar Signature
Date
Issued:
01 \~~ \4:1 Ii
~~~ cer.!tl, \q. '
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT-SEA
Signature
or
Medical E~aminer,
, Medical Examiner
Date
, 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.
D.
CEMETERY OR CREMATORY
Methods of Disposition:
W BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition
Date of Disposition
~ t=; ~",:-::r
Signature of Sexton )
or Person-in-Charge )
_;YLm';', ..1.~
This permit must be endorsed by the Secton or person-in-charge (or by the Funeral Director/Direct Disposer when there isn,(1ton>
and returned within 10 days to the local County Health Department in the County where disposition occurred.
DH 326. 10/96 (Replaces HRS Form 326 which may be used)
(Stock Number: 5740-000-0326-2)
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City of Sebastian
1225 MAIN STREET IJ SEBASTIAN, FLORIDA 32958
TREPHONE (561) 589-5330 IJ FAX (561) 589-5570
MEMO
To:
From:
Subject:
Date:
Janet Isman, Finance Director, . ~
Kay O'Halloran, City Clerk ;) D
Check Request
February 10, 1998
Please issue a check as follows:
AMOUNT: $800.00
.J II
PAYABLE TO: Anthony 1. and/or Dorothy M. Bachiocchi
703 W. Fischer Circle
Sebastian, FL 32958
PURPOSE: Repurchase of Cemetery Lots 11 & 12, Block 39,
Unit 4 by City.
SUBMIT TO: Linda Galley
ACCOUNT NO.: 001-30-590-995 $400.00
601-27-539-995 $400.00
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