HomeMy WebLinkAbout4-36-08Certificate No. 1966
CITY OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Janet L. Kendrick
P. O. Box 510177
Melbourne Beach, FL 32951
In and for consideration of the sum of $1,125.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 36, Lot 8
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 26th day of March, 2012.
CITY OF SEBASTIAN, FLORIDA ATTEST:
Al Minner
ity Manager
SallVitly Maio, MMC
Clerk
Name
Unit
Block 'C
Lot t �caS �Q n4—pp- 1
Date of Mark -out z--
Date of Burial— Time
Name of Funeral Home Sy! rC
An .�-� ! i l !! ! a Ov A-- n
CaL1, C ✓�✓� Total Paid
Initials
Whita — nant_ of nrinin • Yellow — Finance • Pink - Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE /,
4
RECEIPT
Name
�K� ! o Cash
Date
'" t Check # 60
No.
Amount Paid
001001 208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDCICode of Ordinances
001501 341930
Election Qualifying Fees
601010 343800
Cemetery Lots
LotfNiche Block . (0- , Unit
001501 343805
Cemetery Fees
j
CaL1, C ✓�✓� Total Paid
Initials
Whita — nant_ of nrinin • Yellow — Finance • Pink - Applicant
JANET LONG KENDRICK
Mrs. Janet Long Kendrick, 80 of Melbourne Beach, FL passed away
Feb.25, 2013 at her home.
Janet, a.k.a. Ma Ma J, was born in Morganton NC. She received a
bachelor's degree at U. N.C. in Chapel Hill N.C. Janet and Ben, Sr.
moved to FL in 1957 to raise a family. She worked at Holmes Regional
Medical Center as supervisor of the Histology lab prior to her
retirement.
She was preceded in death by her husband Ben Kendrick, Sr. and
siblings: Guy Max Jr., Bill, Floyd, Sarah and Joyce. She is survived by
her children Ben Kendrick Jr. and Brenda K. Truesdale, grandchildren:
Hunter and Amanda Kendrick, Grant and Rachel Truesdale.
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
�a
HOME of PEZAN nwv
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax. (772) 589 -5570
FUNERAL HOME:
ADDRESS: v,!M, FL 31958
I °112 589 -1000
PHONE #:
( elFOne)
OPEN BURIAL LOT Lot Block Unit_ �u�r�1�
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME:
FOR DECEASED: �J N IO NCB K e1N) b le--I CL-
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper umentation of ownership)
I yut)jak,� vy
Name Signature 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 LICENSED FUNERAL DIRECTOR:
kctr�, G A au V'[,,q ('� Go.a- I,kw-t Y�,,,Co I I
Name
Signature
Date
Cemetery Sexton Certification:
certify that l 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.
Vero Beach Crematory, LLC
1830 Wilbur Avenue
Vero Beach, Florida 32960
We hereby certify that these are the cremated human remains of.•
Janet Long Kendrick
February 25, 2013
(Date of Death)
Strunk
Funeral Home & Crematory
(Funeral Home in Charge)
03101
(Cremation ID Number)
March 7, 2013
(Date of Cremation)
Sebastian, Florida
(City and State)
(Cremator Signature)
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SEBAS!!AN
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HOME OF PELICAN ISJ.ANI)
Certificate # 1966
CIn( OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Janet L Kendrick
(name)
POBox 510177, Melbourne Beach, Fl32951
(address)
in and for consideration of the sum of $1.125.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plots:
Unit _ 4_ Block _36_ Lots_ 08 _
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 TIllS 21st day of June, 2004.
errenc~oore
City Manager
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Name
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Lot
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Date of Mark-out
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SEBA5!!AN
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/ HOME OF' PELICAN ISLAND
Certificate # 1966
"
ACCORDANCE with p
Sebas an, it is hereby certified that:
of Ordinances of the City of
Janet L Kendrick
(name)
P. O. Box 510177, Melbourne Beach, FI 3295
(address)
for use in accordance with the conditions, ordinances, resolutions, rules and
prescribed therefore by the City of Sebastian.
, FLORIDA
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CONVEYED TIllS 21st day of June, 2004
A(P)T:
~a) ~:J
S A. Maio, CMC
City Clerk
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Te , Moore
City Manager
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HOME. OF PWCAN ISLAND
June 30, 2004
~s.JanetL,Kendrick
POBox 510177
Melbourne Beach, FI 32951
Dear ~s. Kendrick:
Enclosed is a new issue of City of Sebastian Certificate Number 1966 for' the purchase of
Cemetery Lot 8, Block 36, Unit 4. On June 21, 2004, a Certificate was mailed to you with an
incorrect amount in the purchase price ($350.00) line. This error has been corrected on the
enclosed Certificate. I apologize for any inconvenience this may cause you.
I have enclosed a stamped self-addressed envelope, and ask that you return the incorrect
Certificate.
Thanks for your assistance in this matter and if you have any questions, please contact our office.
~lY' a frt ~
Sa1l~. CMC
City Clerk
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SEBAST!AN
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HOME OF 'WCAN ISlAND
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City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
J~rL
Name(s)
~(!'j i3~>t
Address
KQlJ:'A;C,e
'!)/D/77;~,#k/~"UA~E.#F~ n
~~?S7, ~-Y7
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
ll.. ~~ fthl ,,~~_Z,,~,~,Dollars ($~ /..?.>: c e>)
on this ~ a- day of. .~ . 20~ - for the purchase of the following
described Cemetery Lot(s) d/or Niche(s).
Unit Y , Block J6 ,Lot(s) r 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 - $20)
Opening & Closing
W 0 H
Circle One
Vase and Ring for Niches (cost)
Interment
Disinterment
/T
AL$,( /~ () d
Signature of Purchaser
Service fees are to be paid at time of need only
1:\WW-DATA\Ms-Cemetery\RECEIPT.doc
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
2914
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JANET L. KENDRICK
P.O. BOX 510177
MElBOURNE BEACH, FL 32951"()177
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State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
f.l'~;;
A.
(TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Benjamin Jenkins Kendrick, Sr. Death June 12 20011
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Melbourne Beach Ins!. 6600 Floridana Avenue
3. Name of Medical Address Phone Number
Certifier Richard NadolnrR M. D. 200 E. Sheridan Road
nMedical Examiner Physician Melbourne, FL 321-725-11500
4. Name of Funeral Home/~,~L B;"fJu"al-' Address Fla. Lic. No.lReg. No. Phone No. (Area Code)
Establishment 1623 N. Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check
Appropriate
Box
a. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b. I1J Kathy was contacted on 6/111/011
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Nadolny will complete and sign the medical
certification of cause of death within 72 hours.
c.D
.,JJiro,..t ni~pn~\"
ause of death within 72 hours.
F.E. No.lReg. No.
1862
Date Signed
6/13/011
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
6. Funeral Director/
B.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose ofthis body. Permit No. 1228-011-02110
o 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.
ONO extension of time for filing the death certificate has been requested.
Rll8illtra' or r
Subregistrar Signature
Date
Issued:
6/12/011
Date Certificate
Due: 6/17/011
C.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -SEA
Approval Number:
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:
~BURIAL
DCREMATION
Signature of Sexton
or Person-in-Charge
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
D.
DSTORAGE
Date of Disposition
{e //7/o~
DOTHER (Specify)
} "fi' 7- 7f~€>,/
rhis 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
Nithin 10 days to the local County Health Department in the county where disposition occurred.
)H 326, 8/97 (Obsoletes all previous eddions)
Stock Number: 5740-000.0326-2)
Distribution: WIlde: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
1, DECEDENT'S NAME
FIRST MIDDLE LAST
Benjinnin Je"kins Kendrick,
4. SOCIAL SECURITY NUMBER Sa. AGE.Last Birthday
7. BIRTHPLACE (City and State or Foreign Country)
Mt. Holly, North Carolina
~.~c:^
Male
3, DATE OF DEATH (Monlh, Day, Year)
June 12, 200_
6. DATE OF BIRTH (Monlh, Day. Year)
February 20, 1931
7.
9a.
l:lQSfffAl.: Inpatient ER/Out atient DOA
9c. FACILITY NAME (If not instilution, give street and numbel)
6600 Floridana A venue
lOa. DECEDENT'S USUAL OCCUPATION lOb. KIND OF BUSINESs/INDUSTRY
QIliEB:
Home X Residence
Other S eci
9d. CITY, TOWN, OR LOCATION OF DEATH
Melbourne Beach
9b. INSIDE CITY LIMITS? (Ills Of No
No
9a. PLACE OF DEATH (Check on7y one: see inslructions on olher side)
9b.d.e,
ge. COUNTY OF DEATH
B'l'!evard
10. GIVEKlNDOF
WORK DONE
DURING MOST
OF WORKING
LIFE. DO NOT
USE RETIRED,
Postal Clerk
Government
11. MARITAL STATUS - Married,
Never Married, Widowed.
Divorced (Specify)
Married
12. SURVIVING SPOUSE (If wife, give maiden name)
13.
13a. RESIDENCE - STATE
13b. COUNTY
13c. CITY, TOWN, OR LOCATION
Janet Long
13d. STREET AND NUMBER
13e. INSIDE CITY 131. ZIP CODE
L1MITS?IY~s or No)
14. WAS 0 :l\NIC OR HAITIAN ORIGIN?
(SMci . il ~s, speci!Y.Haitian, Cuban,
Mexican, Puerto Rican, etc.) ..x No _ Yes
6600 Floridana Beach
Florida
Brevard
No 32951
Specily.
15. RACE - American Indian.
Black, White, etc.
Specily.
White
ls:lviofl4ER'S NAME (First, Middle. Maiden Surname)
Muriel Jehkins
Part II
20a. METHOD OF DISPOSITION
Burial Cremation
Removal 'rom State
19b. MAILING ADDRESS (Street and Number or Rural Roule Number, City or Town, Stale. Zip Code) 32951
6600 Floridana Avenue, Melbourne Beach, FIOFida
20b. PLACE OF 'DISPOSITION (Name of cemelery. crematory. or 2Oc. LOCATION - City or Town, State
other place)
20a.
Part la.
Sebastian Cemeter bastian, Florida
21b. LICENSE NUMBER 21c. NA'4EJlND AD..~BESS OF FACllI H
(of Licensee) :>'trllnK t'uner ome
1623North ntral Avenue
1862 Sebastian lorida 32958
'" ~ 22a. To the best o. '. my knowledge, death occurred at the time, date and place and due
.c to the cause(s) as stated.
II (Signature and Title) ~
I ~ ~ 22b. DATE SIGNED (Mo., Day. YI) 22c. HOUR OF DEATH
0~6
~ L2d~AME..OF
"19'~
21a. SIGNATURE OF FUNERAL SERVICE LICENSEE OR
PERSON ACTING AS SUCH
Donation
Other (Specify)
a.
~ ffi 23a. On the basis 01 ex ination and/or investigation, in my opinion death occurr
Z at the time, date d place and due to the cause(s) and manner as stated.
-g ~ (Signature and TItle)
!~, 23b. DATE SIGNED Mo., Day, YI)
EW
0....
0<
23c. HOUR OF DEATH
,.,..,...",.".!!I
",,"',
24. NAME AND ADDRESS OF CERTIFIER (PHYSICtAN, MEDICAL EXAMINER) (Type or Prin~
25a. SUBREGISTRAR - SIGNATURE AND DATE
25c. DATE REGISTERED
26. PART I. Enter the diseases. injuries, or complications that caused the death.
or heart failure. list only one cause on each line.
jng, such as cardiac or respiratory arrest, shock Approximate Interval
I Between Onset and
Death
IMMEDIATE CAUSE (Final
disease or condition
resulting in death) ~
Sequentially list conditions,
II any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Diooaoo or injury
that initiated events
resulting in death) LAST
b.
UE TO (OR AS A CONSEQUENCE
c.
DUE TO (OR AS A t:6~l&JllIijJ;:lQ!$;:,~~j;" :
...:".,'.., .'
, ',;~.ll\011;'~fl,r sisJnilicanl condliio'li~ 'cl~'i\ ributing' t,,'d'eath l:1ut nOl .res~1!.!\\1' in the
, . un erlying cause given in Part I. .';" . ..,'....
27a. WAS AN AUTOPSY
PERFORMED?
(Yes or No)
27b. WERE AUTOPSY FiNDlr~GS
USED TO COMPLETE CAUSE
OF DEATH? (Yes or No)
:lB. CASE REPORI Ell
TO MEDICAL
EXAMINER?
(Yes or No) .Yes
3Ob. DATE OF SURGERY (Mo., Day. Yea,
32e,
29. IF FEMALE, WAS THERE A
PREGNANCY IN THE PAST
3 MONTHS? ___ Yes __ No
31. PROBABLE MANNER OF
DEATH (Specify)
Natural, accident. suicide,
homicide, or undetermined.
N,Q
30a. IF SURGERY IS MENTIONED IN PART I or ,ENTER CQNDITION FORV~HICH IT WAS PERFORMED
32a. DATE OF INJURY
(Monlh, Day. Yeal)
32b. TIME OF
INJURY
32c. INJURY AT WORK?
( Yes or No)
32d. DESCRIBE HOW INJURY OCCURRED
M
321.
32e. PLACE OF INJURY - At hori'l~. tarri'l.
street. laclory. etc. (Specify)
321. LOCATION (S/reet and Number or Rural Route Number, City or Town, Stale)
DH 512. 9/96
(Replaces HRS
Form 512)
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