HomeMy WebLinkAbout4-09-08
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HOME OF PELICAN ISLAND
Certificate No. 2100
Cln( 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:
Thomas Colletti
(name)
7350 129th Street, Sebastian, FL 32958
(address)
in and for consideration of the sum of $700.00 is entitled to full intennent rights in the
Sebastian Municipal Cemetery for the following plot/niche:
Unit_ 4_ Block_09 _ Lot_08_
of the Sebastian Municipal Cemetery,
as maintained on fIle in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 15th day of September, 2006.
~STIAN, FLORIDA
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HOME OF PELICAN ISlAND
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to detennine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for intennent must be
provided at time of purchase
~C~
Name(s) ~ n ~ . j (\ C . r <
l350 I~q ~9itJ ~th()~) FL~:;tq5'X"
Address
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
3~ i-kuJJ(oJ J%~-CDollarS($JOOIOO )
on this ~day of ~ t"k/,^~ Od: lr . , 20lia..- for the purchase of the following
described Cemetery Lot(S)~
Unit~, Block g ,Lot(s) '??
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
$15000
@ 0 H
Circle One
Vase and Ring for Niches (cost)
Interment
Disinterment
Signature of Purchaser
TOTAL$//5I(Jo
Service fees are to be paid at time of need only
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
3584
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Date b
No.
o Cash
~heCk#~
Amount Paid
001001 208001
001501 322900
Sales Tax
Garage Sales
001501341920
CopiesIBid Specs.
LOC/Code of Ordinances
001501341910
001501341930
Election Qualifying Fees
Cemetery Lots t'1 (") 0
LotINiche 8 . Blockl. unitL
601010343800
001501 343805
Cemete:y Fees
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~\.l TotalPaid $7'75~
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White - Oept. of Origin. Yellow - Finlnce . Pink. Appliclnt
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2006-123
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BURIAL-TRANSIT PERMIT
Middle
Last
Name of Deceased First
ALEXANDRIA
PALLE
FLORENCE
Age
Sex
Date of Death
Method of Disposal
Xl Removal
o Burial
o Cremation
o Male lO Female
SEPTEMBER 10, 2006
91
Place of Death
City - County
State
HARRIS
TEXAS
TOMBALL REGIONAL HOSPITAL
TOMB ALL
Name of Cemetery or Crematorium
City
State
SEBASTIAN CEMETERY
SEBASTIAN
FLORIDA
Zip Code
Print Name of Funeral Director or Person Acting as Such
Address City State
14711 FM 1488
KLEIN FUNERAL HOME Y~GNOLIA TEXAS
77354
RAYMOND R. REED #11163
Print - Name of Local Registrar
County
City or Precinct
File Number
DEBBIE K OWENS
HARRIS
TOMBALL
2006-123
A certificate of death having been registered or completed in so far as possible; permission is hereby
given for final disposition, transport, or removal of the body from the state of Texas.
SEPTEMBER 13, 200
Dale
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Vital Statistics 25 Texas Administrative Code Sec. 181.2(b) "If a dead body or fetus is to be removed from this state, transported by common
carrier within this state, or cremated, the funeral director, or person acting as such, shall obtain a burial-transit permit from the local registrar
where the death certificate is or will be filed, or from the state registrar electronically through a Bureau of Vital Statistics electronic death
registration system. The registrar shall not issue a burial-transit permit until a certificate of death, completed in so far as possible, has been
presented."
A file number may be assigned by the Registrar as needed. A copy of this permit is to accompany the body in
transit. There is no fee authorized for the issuance of a Burial-Transit Permit.
If an incomplete death certificate is used to obtain the Burial-Transit Permit, the registrar will validate that the body
is no longer needed by the certifier of cause of death before issuing the permit, to ensure that a completed death
certificate will be received. "Completed in so far as possible" means the information relating to the deceased,
including the name, date of death, place of death and funeral director's information is completed. In a few
instances, the cause of death may not be completed. It is the responsibility of the person presenting the
Certificate of Death, and obtaining the Burial-Transit Permit, to assure that the fully completed Certificate of Death
is filed as soon as possible.
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In accordance with state statute, before a dead body can be cremated, a Cremation Authorization must be signed
and issued by the medical examiner or justice of the peace of the county in which the death occurred showing
that an autopsy was performed or that no autopsy was necessary. If an inquest is being conducted by the
medical examiner or justice of the peace, authorization for cremation from the medical examiner or justice of the
peace is required.
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[HSC ~193.008, 25 TAC ~181.2, ~181.3]
VS-116 Revised 9/2004
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Date of Mark-out
Date of Burial
Name of Funeral Home
Authorized by
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