HomeMy WebLinkAbout2-50-08Name al
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Date of Mark -out 6 ` '2. U L"/
Date of Burial V o ` `/
Name of Furneral Home
Authorized by
CITY OF SEBASTIAN 17053
FINANCE DEPARTMENT RECEIPT
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❑ Credit
01501 362150 Non -Taxable Rent
01001 220000 Security Deposit
01501 362100 Taxable Rent
)01001 208001 Sales Tax
150010 369900 Airport Badge
t50010 362521 AP Shade Hangar Rent
t50001 208045 Airport Sales Tax
)01501 347557 Community Center Revenue
D01501 341920 General Fund Copies
001501 354100 Code Enforcement Fines
601010 343800 Cemetery Lot Sales
001501 343805 Cemetery Fees
480010 341920 Bldg Dept Copies
PD Shop with a Cop
PD COPE
PD Cadets
PD SRT
l.i initials
White - Oept. of Origin
Amount Paid
Yellow. Finance Dpt. • Pink • Applicant
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Ceme tery -------- -------__
Paid by XX 2; DEED # 464
Receipt No. ... .......... Dated.....7-28- UNIT ►
� • • � • . • • 8,Z . , , . . #2 ADDN T, BLOCK 50
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st Price $, ,,350 . 00 '�� LOTS 7& 8
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_ ' Maximum No, Burial spaces . . .2, , . . . . F'�NCIS COOK
Discount $,,.
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Net Paid 350 , p p Total area in square feet ....*******��� PESTRICHELLI
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#464 Sebastian, F1c�rida 32958
(Data above this line for CIt 589'2505
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B4 • SCRIPPS TREASURE COAST NE
Obituaries
VERO BEACH
Frank T. Cook 5 K.
�Frank T. Cook, 88, died
March 13, 2007, at VNA
Hospice House in Vero Beach.
He was born in Jersey City,
N.J., and lived in Vero Beach
for 25 years, coming from Lodi,
N.J.
He served in the Army dur-
ing World War II.
He was a member of St. Hel- '
en Catholic Church.
Survivors include his wife,
Elinor A. Cook of Vero Beach; i.
son, Michael Cook of Fair '
Lawn, N.J.; daughter, Janice R,!
Pestrichilli of Sebastian.; thx�ee
grandchildren; and three F ��� �
great-�andchildren. �� � ,'
Memorial contributions may � �� �
be made to Visiting Nurse As ����"r � < �
sociatien & Hospice Founda � , � �� �,:. - � �
tion, 1110 35th Lane, Vero �" ��`�` �
Beach, FL 32960. � � ��
SERVICES: Visitation will be s,y �
frorri 3 to � 6 p.m. March 18 at ��;.�
the Strunk F�neral Home in
Vero Beach. A service will be ���`�
at 11 a.m. March 19 at the fu- �"
X XlY
neral home. Burial will follovV ���r �, ,_.:�
in Sebastian Cemetery. ;��� � �� �
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STRUNK FUNERAL HOME, P.A.
CASH ADVANCE ACCOUNT
916 17i'H ST. 772-562-2325
VERO BEACH, FL 32960
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FLORIDA DEPARTMENT OF � I"'1
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HEALT State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Francis Thomas Cook, Sr. Death 03/13/2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero beach Inst. VNA Hospice House
3. Name of Medical Address Phone Number
Cert�er Richard T. Penly, M.D. 1265 36th Street
Medical Examiner Physician Vez'o Beach , FL 3 2 9 6 0 ( 7 7 2) 5 6 7- 6 3 4 0
4. Name of Funeral Home/Dired Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 916 17th Street
Strunk Funeral Home Vero Beach FL 32960 0130 (772) 562-2325
5. Check a. � The medical certfication has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
6. Funeral DirectoN
Caii�eeF�w�eF I
b� � Ha z e l was contacted on �a�-c h 15 , 2 0 0 7
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
and that Richard T. Penly , M. D. 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 certification of cause of death within 72 hours.
F.E. No./Reg. No.
2645
Date Signed
03/15/2007
..
a. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 013 0— 0 7— 0110
� A five (5) day extension of time for filing the death certficate (exGusive of weekends) has been requested and granted since the physician has
been contaded 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.
�No extension of time for filing the death cert�cate has been requested.
Registrar or r----- -- Date Date Certficate
Subregistrar Signatu " Issued: 0 3/ 13 / 2 0 0 7 Due: 0 3/ 19 / 2 0 0 7
c. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number. Date
Medical Examiner, , gave authorization by telephone to
Funeral Diredor/Dired Disposer. Date
The Medical Examiners 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.
�. CEMETERY OR CREMATORY �_ 1'
Method of Disposition: Place of Disposition .5�,�/� �- , .�
BURIAL �STORAGE Date of Disposition �`) g�£�'•
�CREMATION
Signature of Sexton �
or Person-in-Charge
�OTHER (Specify) _
This pe►mit 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 locat County Health Department in.the county where disposition occurred.
DH 326, 8/97 Obsoletes all Distribution: White: Cemetery or Crematory
( previous ed'Rions) Yelbw: Funeral Direda or Dired Disposer
I(Stadc Number 5740-000�0326-2) Pink: Local Registrar �� `� �