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HomeMy WebLinkAbout4-09-22crtvoF '~~~,."~ _ - _-- .,tea HOME OF PELICAN ISLAND Certificate No. 2116 ~~ ~~~~~ Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Joan Chatham 945 Louisiana Avenue, Sebastian, FL 32958 (name) (address) in and for consideration of the sum of $1.400.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4 Block 9 Lots 22 & 23 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 28thd day of February, 2007. CITY OF, SEBASTIAN, FLORIDA A' lz~ ,ys'A. Maio, MMC City Clerk t:~31' ~F ~~ ~` ~P~~ ~~ P~~.I ~ a~ March 6, 2007 .~~~ i,~~s~(i tom'! ~"~~'~r ~3R~1~Std~s ; ?`~.. ~~~~~`r Mrs. Joan Chatham 945 Louisiana Avenue Sebasatian, FI 32958 RE.• Interment Rights to Unit 4, B/ock 9, Lot 22 & 23, Sebastian Cemetery Dear Mrs. Chatham: Enclosed is City of Sebastian Certificate 2116 entitling you to full interment rights in Unit 4, Block 9, Lots 22 & 23. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sin : r`e y~, -~ Sally A. ' , MMC City Gerk SAM:ar }s; enclosures Name Unit L Block Lot ark-out ~~~ ~~ Date of M f :..~~: Ci Time ~ ~ ©G~ ~fL ~ ~ Date of Burial Name of Funeral H Authorized by_ t I aIr a SE~s~~AN -~ ~-~ NC-ME C+F PELICAN ISLAND 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 ~ Name(s) 5 Address (~~ ~a Area Code & Phone N ~a ~~ , . ~ ~a~, ~ ~L ~ag5g tuber Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Interment on this o~ b~ day of , 20~ for the purchase of the following described Cemetery Lot(s) and/or Niche s Unit ,Block _~, Lot(s) o~J 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 - $20) Opening & Closing Vase and Ring for Niches (cost) ature of Purchaser Dollars ($ "~~~ • ~(7 ) W O H Circle One Disinterment TOTAL $ a O - f Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-CemeterylRECEIPT.doc ITY OF SEBASTUIN CITY CLERK'S OFFICE ~ 3 7 7 3 RECEIPT Name ^ Caeh ~° Date ~ ~Checkd No. Amount Palo 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopiesBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Ek~ctlon QualNying Fees 601010343800 Cemetery Lots ~~ 1 LotMiche .~~ Bbdc ~, Unit 001501343805 Cemetery Fees ~ ~~~ 0~ Total Paid ~~~--~ r.,- In White -Dept of O~ipin • Yellow - Fiaanq • Piak • Applicant ~ J is cHATHAM OR JOAN CHATHAM 945 Louisiana Ave 772-589-4150 ~ Sebastian, FL 32958 ~ A A ~ ~ WAICHOVI~, ~M Berd4 NA. PDR x:06?00643 2~: i65 30740 i77 5490 ~9~ ~o a, oases ATE -J ~ ~ ~ ~ 0~ r scum. LLARS f v..wr.. O.t.ll. on B.Ck. ~• OX-GIFFORD-SEAWINDS FUNERAL HOME suNTAUSrenraK 927$ 1950 20TH STREET VERO BEACH, FL 32960 VERO BEACH, FL 32960 63-215/631 ~.~~~ PAY TO THE ORDER OF C1lV Of SebaStlan ~ _*', ~: (~i:1 nne Hundred Twenty-Five a_nd 00/100***************'~*******'~**~***************~~~*~*~#*~=y--= a r City of Sebastian j 1225 Main. St. Sebastian, FL32958 ~~ ~~'009 2 78~i' x:06 3 LO 2 L 5 2~: L0000 X 7 3 7 7 7 6 2~~' 7 .3M' N m mO 0 ao • m F I T a v n' m 0 v d n ~~ O 0 0 0 0 0 o S 0 ° o o o a W A f.1 U A W O j O w A O W A O W NNN tD O N O O ~ ~ n ~ ~.C) T r C7 G7 Cn m ~ W ~ ~ ~~ ~ fp ~ 7 O ~ W "'1 v fD ~ ~ G. W ~ obi N x j ~ m N r ~ N '~` ^ ° N ~ N y • v t~ a m ~ ~ R x m ~ ~ a ~ ? A 3 o c °- J\)v__ c:, AV n A -~G n ~mT ~ ~ f/f N m ~Oy T ~ T_ S ~ Z m "-J Cb FLORIDA DEPARTMENT OF ~-IEALT A. 1. Name of First Middle Last Date Month Day Year Deceased J. B, CHATHAM °f FEBRUARY 28, 2007 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER SEBASTIAN Inst. 945 LOUISIANA AVENUE b. ~J ~ ~ ~ a State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external muse of death, and that will complete and sign the medical certification of cause of death within 72 hours. c• ® was contacted on He/she verified that , Medical Examiner, will complete and sign the medical cation of cause of death within 72 hours. 6. Funeral Director/ Ignature F.E. No./Reg. No. Date Signed Direct Disposer ~ 2294 MARCH 1, 2007 i3. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 07-2617-047 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 cert~cation of cause-of-death section of the death certificate within 72 hours. 1 ®No extension of time for filing the Beat cert~ ~ to has been requested. Registrar or Date Date Certificate SubregistrarSignature Issued: 03/01/07 Due: 03/07/07 ~- AUTHORIZATION f®r CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number. Date Medical Examiner, ,gave authorization by telephone to Funeral DirectorlDirect Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for all cremations. ®• CEMETERY OR CREMATORY MethorAof Disposition: Place of Disposition SEBASTIAN CEMETERY ~f3lJRIAL ^STORAGE Date of Disposition ,~~`~ /~ ®CREMATION Signature of Sexton or Person-in-Charge ^OTHER (Specify) This 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 within 10 days to the local County Health Department in.the county where disposition occurred. Distrilwtion: White: cemetery or Crematory DH 326, 81'97 (Dbsoletes ell previous eddions) Yelbw: Funeral Dvector or Direct Disposer +~ `~ ~ (Slodc Number 5740-000-0326-2) Pink: Local Rapistrar 3. Name of Medical Address Phone Number Certifier RENATA RATAJCZAK-DAMBEK,M.D. 7901 RON BEATTY BOULEVARD Medical Examiner R Physician BAREFOOT BAY, FLORIDA 32976 772-664-7532 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958 2617 772-5'89-1933 5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box }^.- -.. c~~_ .,~-. .'~ ~, 1 ~ _ ,~~~ ~ J.B. CHATHAM 70, of Sebastian, FL, went to <ze_with his Lord and, Savior on February'28, 2007, at his home. . _.. Mr. Chatham was born December 26, 1936 in Richland, Virginia and was a resident of Sebastian for 36 years. Before retirement he was a heavX equipment operator for Fischer & Sons. He was a member of the Crossroad. Church and an avid fisherman. Surviving are his wife and best friend of 31 years, Joan; children Karen (Frank) Fletcher of Grant, FL, Kenneth Chatham, Jody Chatham, Jeffery Mark Chatham, Arlene (Jump) Cappelen, all of Vero Beach, FL, Jennifer (Fred) Barkley of Kissimmee, FL, Stanley Gib son of Marlington, W.V., Debbie Gee of Vero Beach, FL, Gregory Gibson of St. Au gustine, FL, Kevm (Karen) Gibson of Sebastian, FL; sis ters Evelyn (Charles) Hall of Bassett, VA, Janice (Bud) Farmer of Bassett, VA, Lu cille (Jimmy) Farmer of Sug ar Grove, VA and Margaret Uim) Salgle of Columbia, SC; sister-in-law Frances Chat ham of Sugar Grove, VA; 18 grandchildren and 2 great grandchildren. He was pre rt`e-ceased by his brother Harold Chatham. Memorial contributions may be made in his name to the VNA & Hospice Founda tion, 1110 35th Lane, Vera Beach, FL 32960 or the ALS Association, 3242. Parkside Center Circle, Tampa, FL 33619. Visitation will be held on Sats:~-day. March 3. 2007 ~cgsst~~n3 at 10:00AM fol vo;~ed by a service at 12:OOPM at the Seawinds Fu neral Home Chapel, 735 Fleming Street, Sebastian, FL. Bur~ai w~~l follow in Se Bastian Cemetery. Arrangements by Seasn'~ds =~neral Home & Crearaa_~~~- Sebastian, Flori da. Cc~c_lences may be -e~gis-=~~ at seawindsfh. ~_r.. ~..-.. ~9aa