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HOME OF PELICAN ISLAND
Certificate No. 2118
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Robert A. Audette 755 Wimbrow Drive, Sebastian, FL 32958
(name) (address)
in and for consideration of the sum of $700.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following lot:
Unit 4 Block 9 Lot 17
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 1st day of March, 2007.
JRIDA ATTEST:
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Sally A. Maio, MMC
ity Clerk
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March 5, 2007
Mr. Robert A. Audette
755 Wimbrow Drive
Sebastian, FI 32958
RE.• Interment Rights to Unit 4, Block 9, Lot 17, Sebastian Cemetery
Dear Mr. Audette:
Enclosed is City of Sebastian Certificate 2118 entitling you to full interment rights in Unit
4, Block 9, Lot 17. Atso enclosed is a copy of the Rules and Regulations governing the
Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Siny,
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Sally A aio, MMC
City Clerk
SAM:ar
enclosures
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City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate re tions, residence of purchaser or person for whom lot is intended for interment must be
pr ided time of purchase _
s
Address
~~ ~s~
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt i acknowledged in the sum of:
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Dollars ($ !~D ~ dd )
on this day of _ , 20b_~ for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit _~, Block _~, Lot(s) ~ 7 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:
~ ~` ~d w o H
Comer Markers (set of 4 - $20) Opening & Closing 7 ~~.~
Circle One
Vase and Ring for Niches (cost) Interment ,~ Disinterment
TOTAL $ ~~S • ~ ~
Signature of Purchaser
of Sebastian
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc
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2062
HELEN A BRULPORT
ROBERT K AUDETTE 63-643/670
BRANCH 00657
165 Delmar St
Sebastian, FL 32958 _ ~7
Date
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Unit ~~
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Date of Mark-out ~ 9~' ~" f
Date of Burial ' ~!~ ~ ~ ' ~`-"~ ~ Time ! L
Name of Funeral liome.~' ~ ' ~~ ~~~ r~ ~~±~` ~.^?~
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Authorized by ~
HELEN A.
BRULPORT
Mrs. Helen A. Brulport, 78,
of Sebastian;. FL, died
February 26, 2007 at
Sebastian River Medical
Center; Sebastian, FL.
1
She was born May 23, 1928 ~'
in Derry, New Hampshire,
and lived ~n Lake Worth, FL
since 1952, then moved to
Sebastian in 2001.
Mrs. Brulpor4t was a
bookkeeper, seamstress,
and homemaker. She was
very active with the Lake.
Worth MunicipalGolf;
Women5`Le~gue. ;
Survivors include son,
Robert (Bob) & Colleen>
Audette; grandson, Robbie
Audette; brother, Walter
(Louise) Novak living in New
Hampshire. She was
Robert avoyehAudette and
George Brulport.
!~~emorial contributions
may, be ~.,ade .to_,.,.he
Amerrcar~,, tu,, ~ssociat~an,
Southeast orida, 2701
North Australian Avenue
West Paim Beach, Florida
33407.
No sere ices to beheld.
Arrangements by Strunk
Funeral Home Sebastian,
Florida
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F[ARIDA DEPARTjjMENT OF
.IS..r
A. (TYPE)
a. ® The medical certfication has been completed and signed. A completed certificate of death accompanies this
application.
QOp~
t. Name of First Middle Last Date Month Day Year
Deceased of
Helen A. Brulport Death Feb. 26 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Sebastian Inst. Sebastian River Medical Center
3. Name of Medical Address Phone Number
Certifier Syed Zaidi, M.D. 13090 U.S. #1
Medical Examiner Physician Sebastian, FL 772-589-3755
4. Name of Funeral Home/DiPea-BispDSal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N. Central A ve.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check
Appropriate
Box
b. [~r Lynn was contacted on 2/26/07
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that I)r. Zaldl will complete and sign the medical
certification of cause of death within 72 hours.
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State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
was contacted on
Helshe verified that
,Medical Examiner, will complete and sign the
m cert' ti ca a of death within 72 hours.
S. Funeral Directorf hat /f~~ F.E. No./Reg. No. Date Signed
fiireet-IBisDr ~~'G%//J/1 ,. 1862 2/26/07
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BURIAL - TRAN$1`T PERMIT
Pe~-r:'sssiosa is. hereby granted to dispose of this body. Permit No. 1228-07-0082
A five (5) day extension of time for filing the death certificate (exGusive of weekends) has been requested and granted since the physician has
been contacted by thy; funera6 director and will not be able to complete the medical certification of cause-of-death section of the death cert~cate within
72 hours.
®No extension of time for filing the death certificate has been requested.
Registrar-r Date Date Certificate
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Subregistrar Signature ~~~~ Issued: 2 /26 /07 Due: 3 /2 / 07
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Approval Number:
AUTFIORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Date
Medical Examiner, ,gave authorization by telephone to
Funeral Director/Direct Disposer. Date
The Medics! Examiner's approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is
required for ali cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition ~ /~, ~ ~p `~.
®CREMATION ®OTHER (Specify)
Signature of Sexton
or Person-in-Charge ~.,~ clj -
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there Is no sexton! ana retui..Cu
within 10 days to 4he local County Health Department in.the county where disposition occurred.
DH 328, 8/97 Obsobtes all Distributiorr. ~~: Funeral Director Direct Disposer
( previous ed'dions)
(Stock Number. 574000-032rr2) Pink Local RegisVar w„~ ~y„