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HOME OF PELICAN ISLAND
Certificate No. 2361
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Certificate of Interment Rights :
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IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that: _
Howard W. Oliver
` P. O. Box 780580
Sebastian, 'fL 32978
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 29, ,Lots 21, 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 14th day of January, 2013. i
CITY OF SEBASTIAN, FLORIDA
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`� AI Minner
City Manager
Al-f E ST:
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Sall . Maio, MMC
City Clerk
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MARY BETH OLIVER
Mrs. Mary Beth Oliver, 56, died January 10, 2013 at Sebastian River
Medical Center in Sebastian. Mrs. Oliver was born ]une 16, 1956 in
Dearborn, Michigan and lived in Sebastian since 1967 coming from
Texas. She was a graduate of Vero Beach High School Class of 1974.
She was the Owner/Operator of Paradise Hair Designer located in
Sebastian since 1977.
Survivors include her husband, Howard W. Oliver of Sebastian; sons,
Richard Brock Powell and Christopher ). Oliver both of Sebastian;
daughters, Beth Ann Powell of Sebastian and Sharon Marie Oliver of
Boynton Beach; brother, Charles E. Brock of Sebastian; sister, Linda
Trantham of Sebastian; 3 grandchildren.
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FLO�RID�DiPAbLf6iE�inF�, ;' State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: January 14, 2013 TRACKING NUMBER: 2013006013
1. DECEDENT INFORMATION
Name of Deceased Date of Death
MARY BETH OLIVER January 10, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER
Name and Address of Funeral HomelDirect Disposal Establishment Fla. Lic. No.IReg. 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: 2013-F041870-5009
. G� ��r • Date Issued: January �a, 20�3
J „�
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 19 Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: BURIAL Date of Disposition: f{��D I(�
Signa re sex or person-i -charge (or by the funeral director/direct disposer when there is no sexton)
DH 326E, 1/11 �
64V-1.011, Florida Administrative Code
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING !N SEBASTIAN MUNICIPAL CEMETERY
ana
HOME OF fFIICAN KIAtU
For information contact:
IGp Kelso - Cemetery Sexton
Sebastian Municipa! Cemetery
(772) 589-2545
City Clsrk's Oftke
City Hall, 1225 Main Sireet
Sebasfian, FL 32958
�fl`'ice (772) 388-8215 or 388-8214
Fex: (772) 589-5570
STRUNK �UNERAL HOME & CREMA30RY
FUNERAL HOME: 1623 No. Central Ave.
ADDRESS:
SEBASTi ,
PHONE #:
(C eck One�
OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
Lot Z.Z Block Z� Unit �_
Lot Block Unit
Niche Block Unit
BURIAL DATE AND SERVICE TIME: V ��V � J I�p�s —r�.� W�CrC/�i�i�Og� �
FOR DECEASED: M � �'I ���
Name
iJ
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownershi )
.
{�o�r�d In�. �l�v� �- ��-��
Name Signature Date
l 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.
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NAME AND SIGNATURE OF LICENSED FUNE DIRECTOR:
fd`%!�� I,IJ� y1�j,a-ez✓��v '/!� z�o%
Name ignature Da
Cemetery Sexton Certification: ^_��Y
I certify that I have checked the ownership information by viewing the owne�'s deed and confirming
with Clerk's office and that all fees have been paid:
, /y ��.
C m tery exton Date
This form to be provided to Clerk's Office by Sextan for permanent recor+d upon cornpletion.