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HOME OF PELICAN ISLAND
Certificate No. 2120
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Greg Shivers
(name)
101 High Court, Sebastian, F132958
(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 15 Lot 25
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 13th day of March, 2007.
OF SEBASTIAN, FLORIDA
A`~l Minner
ity Manager
ATTEST:
H'-cu- ~ ;;~ f 4`
Sall A. Maio, MMC
City Clerk
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March 14, 2007
Mr. Greg Shivers
101 High Court
Sebastian, FI 32958
RE.' Interment Rights to Unit 4, B/ock I5, LOT 25, Sebastian Cemetery
Dear Mr. Shivers:
Enclosed is City of Sebastian Certificate 2120 entitling you to full interment rights in Unit
4, Block 15, Lot 25.
Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal
Cemetery.
If you have any questions, please contact our office.
Sinc red, ~~
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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 regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
Name(
Address
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
is acknowledged in the sum of:
// ~
// G/ .
of Sebastian
on this ~~_day of ~~ c~ , 20~ for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit ~_, Block ~, Lot(s) o~Sf Niches
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:
Comer Markers (set of 4 - $20)
Vase and Ring for Niches (cost)
Opening 8~ Closing ' ,~ . d 0 W O H
Circle One
Interment
Signature of Purchaser
Ilars ($ OQ . o~ )
Disinterment
TOTAL $,~~ a ~
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-CemeterylRECEIPT.doc
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JOHN WESLEY
SHIVERS
Mr. John Wesley Shivers,
48, o.f Sebastian, FL,
peacefully passed away
March 09,2007 surrounded
by his loving family.
He was born in Avon Park,
Florida, and lived in
Sebastian for 45 years.
Mr. Shivers worked for
Connecticut Auto Transport
for over 3 years. He also
worked fior Piper Aircraft in
Vero Beach, FL for 20 -years
and was a commerical
fisherman for a number of
years. He attended the
Church of God, Sebastian,
FL. He was an active Boy.
Scout Leader.
SurJivors include so.n,
Gregory J. Shivers of
Sebastian, FL; daughter,
Kelli Jean Shivers. of
Sebastian, FL; his mother
and step-father, Joyce &
Robert• Crerar of Sebastian,
FL; brothers, Buddy Shivers,
Bert Crerar both of
Sebastian, FL; sisters, Betty
Doty of Sebastian, FL, Janet
Bobo of Vero Beach, FL
SERVICES: a Visitation was
held 6-8 p.m. March 12, 2b07
at the Strunk Funeral Home,
Sebastan, FL. A funeral
.service will be held 2 p.m.,
March 23, 2007 in the funeral
home chapel with Rev.
Dwain Redden officiating.
Interment will follow in
Sebastian Cemetery,
Sebastian, FL.
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FLORIDA DEPARTMENT OF \~ o D
HEALT State of Florida, Department of Health, Vital Statistics v
APPLICATION FOR BURIAL -TRANSIT PERMIT
A• (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
John Wesley Shivers Death March 9 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Sebastian Inst. 1388 Coverbrook Lane
3. Name of Medical Address Phone Number
Certifier Dirk Palrvus, M.D. 13695 U.S. #1
Medical Examiner Physician Sebastian, FL 772-589-9122
~. Name of Funeral Home/D7*eeC~Bie}losal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N . Central Ave, __
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. ~ The medical cert~cation has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~i Dr. Parvus was contacted on 3/9/07
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that h'e will complete and sign the medical
certification of cause of death within 72 hours.
c. ~ was contacted on He/she verified that
Medical Examiner, wiA complete and sign the
m Ice of t7se of death within 72 hours.
6. Funeral Director/ u ~~ F.E. No.AReg. No. mate Signed
Dfreef~ineaer 1862 3 / 9 / 07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. FPrrrait i~o. 1228-07-x101
A fnre (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.
®No extension of time for filing the death certficate has been requested.
w• Date Date Certificate
SubregistrarSignature ~- ~,.~ ~,---f''~YR Issued: 3/9/07 Due: 3/14/07
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~. AUTHORIaATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approve! Number: Date
Medical Examiner, ,gave authorization by telephone to
Funera! Director/Direct Disposer. Date
Ts~e h7edical 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.
D. CEMETERY OR CREMATORY
Metho~f of Disposition: Place of Disposition Sebastian Cer~metery
BURIAL STORAGE Date of Disposition ~~~ cJ/y `
®CREMATION ®OTHER {Specify)
Signature of Sexton
or Person-in-Charge _
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.
DH 326, tU97 (Obsoletes all previous ed'Rions) Distribution: ~~~. Funeral D~rector ooartD rect Disposer
(Stock Number. 5740~000~0326-2) Pink: Local Registrar ~~ ~Q~ ~