HomeMy WebLinkAbout4-34-22Certificate No. 2349
CITY OF S EBB SSTIA
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Joseph & /or Felicia Lombardino
105 Redgrave Drive
Sebastian, FL 32958
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 4, Block 34, Lot 22
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 30th day of October, 2012.
CITY OF SVBASTIAN, FLORIDA ATTEST:
*1 Minner
ty Manager
f A l
SallyMaio, MMC
ity Clerk
Name
Unit
Block
Lot -
/�
Date of Mark -out
11C Date of Burial Time
Name of Funeral Home
Authorized by
ROSALIE RIOLO
Mrs. Rosalie Riolo, 87, died October 28, 2012 at Palm Garden of
Vero Beach in Vero Beach.
Mrs. Riolo was born November 6, 1924 in Brooklyn, New York and
lived in Sebastian since 1988 coming from Long Island, New York.
She was of the Christian faith.
Survivors include her daughter Felicia Lombardino of Sebastian, five
grand children and five great grandchildren. She was preceded in
death by her husband Neil Riolo and her son Jack Riolo.
I&
E1 ORlD�DFI'ARCSiT qF ,.' State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: October 30, 2012 TRACKING NUMBER: 2012149441
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ROSALIE RIOLO October 28, 2012
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER VERO BEACH PALM GARDEN OF VERO BEACH
Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. 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. No. /Reg. 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: 2012- FO41870 -5075
• 4 G /� Date Issued: October 30, 2012
c[. °7 r 3
Meade Grigg, 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: "
Signa re of p4xtog or person -in -c ge (or by the funeral director /direct disposer when there is no sexton)
DH 326E, 1/11
64V- 1.011, Florida Administrative Code
(2-.-)
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
1.
IAN
ROME V. CFl{C A>r ISUND
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: 5',�"j7VPK_ FU 1)C(Z4 — 1400%,r— Z�wt.4T6!ZX
ADDRESS �(y Z3 ln► C��VTi �- i E� SCds9S i3+'n� EZ,
PHONE #: 77Z--A-332—/04E'2
(Ch a One) Ll
—X —OPEN BURIAL LOT Lot �2- Block
\ OPEN CREMAINS LOT Lot __Block Unit
_-OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME:
FOR DECEASED:
(Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE'
(Must provide proper documentation of ownership)
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 FUNERA DIREC t OR.
W. WtAfWr�j
Name I ig ature D, e
----------------------------------------------- ------------------------------------
- - - - - ------------------------------------------------------------------------ - - - - --------------- - - - - --
Cemetery Sexton Certification:
I certify that I have checked the ownership inforinathon by viewing
with Clerk's office and at all fees have been paid
/O 30 / Z,
Ce tery xto! Date
the owner's deed and confirming
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF
L «; �f 1',� CITY OF SEBASTIAN ������� CHECK NO. 084106
1225 MAIN STREET NATIONAL BANK 84106
"`F* SlEASTIAN. FLORIDA 32950
SEBASTIAN, FL 32958
-- a� GENERAL ACCOUNT
HOME OF PELICAN ISLAND
* * * * * ** *150 DOLLARS AND NO CENTS
PAY Felicia Lombardino
105 Redgrave Dr.
Sebastian
TO THE
ORDER
n3 -515
6;0
VENDOR CHECK DATE CHECK AMOUNT
62 11/09/201 $150.00
I
kf ( V D IF'NOT PAID WITHIN 90 DAYS
FL 32958 �� r�
rWP
TWO SIGNATURES REQUIRED
110084 10611' I:06 700 5 L 5811: 4 3 2 7 i0 388 Lila
84106
ITY OF SEBASTIAN SEBASTIAN, FL 32958
110912 084106
INVOICE DATE INVOICE NUMBER INVOICE DESCRIPTION NET INVOICE AMOUNT PO NO.
11/01/12! Refund Rosal I Overpayment on U -4, Blk 3�,L.22- 150.00
93327
626 Felicia Lombardino 150.00 84106
fflrm-mmici
CITY OF SEBASTIAN
CHECK REQUEST
Accounting Use Only
Input Date Fiscal Period
Document # Entered By
Document Amount # of Lines Total HC Hash
Due Date
To Be Completed By Department
11/9/2012 Single Check YIN Y Vendor Number
LN
TC
Reference
Organization
Code
Object
Code
Project
Code
Amount
601010
343800
$150.00
Description
Number of Lines Amount
The City inadvertently charged the family for the opening and closing
after the funeral home already collected the fee.
Regarding Rosalie Riolo U4, Blk 34, Lot 22
ISSUE CHECK TO
$150.00
NAME
Felicia Lombardino
ADDRESS
105 Redgrave Drive
CITY
Sebastian STATE FL ZIP CODE
32958
DRAW CHECK FR M SEE BELOW
19 4
APPROVED BY
DATE /I -t - ( 7-
BUDGET APP
MAIL ATTACHED DOCUMENATION (Except for remit slips, requesting department should attach
a copy of documentation along with the original)
OTHER INSTRUCTIONS Please give Jeanette a copy of the check
Total Paid 15Q. )o
Initials 9 Applicant
White -Dept. of Ori in • Yellow - Finance •Pink -App
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
4754
RECEIPT
n ►^r I
❑ Cash
Name ,5
1 1- 2 1
7—
l Check
Date
Amount Paid
No.
001001 208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDCICode of Ordinances
001501341930
Election Qualifying Fees
601010 343800
Cemetery Lots
Lot/Niche � , , Bloek ' Unit
001501 343805
Cemetery Fees
�()
Total Paid 15Q. )o
Initials 9 Applicant
White -Dept. of Ori in • Yellow - Finance •Pink -App
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