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Home My WebLink About4-18-030 0 ~~ ~I~ ~~~~~~fi HOME OF _ PELIGN ISIAND .Certificate No. 2051 ~I Certificate of` interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the'City.of I~ '~~ Sebastian, it is hereby certified that: - ~ James F. Coker 5387Hammerstone Court, Micco, F132976-7708 (name) (address) ~~ in and for consideration of the sum of $1 125.00 is entitled to full interment ri is in ~, ~ ~ Ilj the Sebastian Municipal Cemetery for. the following plot: ~ Unit_4_ Block _18_Lot(s)/Niche(s)_ 3_ i, ~ of the Sebastian Municipal Cemetery, 'as_maintained on file in the records of the City Clerk ~, 1 d re lati ris or finances resolutions ru es an o for use m accordance with the conditions, d gu prescribed therefore by the City of Sebastian. CONVEYED .THIS 20th day of October, 2005. CITY SEB TIAN, FLORIDA 'TEST: ~ 1~,~~~,c~ C„~rt c 1 inner Sa11y Maio, MMC ~ ty anager` City Clerk r II O O ~C11Y # ~~ . __ _ __ .~~* Ha~E aF pEUC~vv rs~-ran 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 -Fax (772) 589-5570 October 27, 2005 James F. Coker 5387 Hammerstone Court Micco, F132976-7708 Dear Mr. Coker: Enclosed is City of Sebastian Certificate 2051 entitling you to full interment rights in Cemetery Lot 3, Block 18, Unit 4. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. S' cerely, J~ou-fy ~~~ ~~~~~- -~vr Sally Maio, MMC City Clerk SAM:ar enclosure ~ ~ ~° ~ ids i -~.. ~~ y HOME Ot: PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom .lot is intended for interment must be prod at time of purchase c c•J ,.~ 7E - 77G' ;~e~) Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser .Office Use Only Receipt is acknowledged in the surn of: on this ~''D ~~ day of [.0,~~ described Cemetery Lot(s) and/or Niche(s). Dollars ($~' /~ .S; ~~~ ) 20 d.5'for the purchase of the following Unit ~,_, Block / ~ , Lot(s) ~ 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 `'~%'.5~- d D O H Circle One Vase and Ring for Niches (cost) Interment Disinterment TOTAL $ ~,,~~ , d d ~~~~- Signature of Purchaser City of Sebastian Service fees are to be paid at time of need only I:\W W -DATA\Ms-Cemetery\RECEI PT.doc Name 0 Unit Block I . ~ ~~h ~~2 fir, _ic^~_. r,% Date of Mark-out ° C.~~ ;`C> ' ~ g_ ~~, 7 Date of Burial --- i ~/ i~ cJ ~~ j `. Name of Funeral Home ~l Time ~ ' Authorized by -,-'' `~" - ~ ~ , CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT ~me''_- ~.,/ - ~, ',%~.~ ^ Cash t ~'~C"~, . ~~ / L ~` ~~ Check#~ 1 ~ ate ~. Amount Paid }~ ~ i100t 208001 Sales Tax ~~°~"'~ ' °"°~''~ !1501322900 Garage Sales *~ . y X1501341920 CopieslBid Specs. t~~ ~ ~ ` ~ ~ ~ T •1501 341910 LDC/Code of Ordinances 1501 341930 Election Qualifying Fees ~~ O~. ~ ~1p ~~~ ~ 1010 343800 Cemetery Lots ~ i, LotMiche _~_, Block ~t ,Unit ~ ~. 1501 343805 Cemetery Fees ~ ~ ~ „~ 1 ~ & -'~'_ II gam, ! ~• J ~ 1 ~ ~.1 C.-C.~ T ~.d ~ ~ ~9 ~ L. "' 1 ~l a ,-. f ;~ / c~' Total Paid `` nitials White -Dept. of Origin • Yellow -Finance • Pink • Applicant - .-~ -~ ~~~~ ~~ o ~'~ ~`; 761 JAMES F. COKER o3-02 63-4/630 FL 5387 HAMMERSTONE CT. ~~~ jl y teas MICCO, FL 32976-7708 Date ."' 7 ~'~ Pte` „~`.; ~,(~?e' X e'er, Dollars ~ a,.~e,~. j.. s j BankofAmerica ~~ ~'~ ! <: i r ACH RIf 063~11j'0~].0~!/2~~r7~7/ [//~/,"_f'' -;,' Memo ,' ~ , '-G''~`2 cr ~:0630000-,7~. 00344562? II' 076E J_ FLORIDA DEPARTMENT OF HEALT A. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of Jeanne Coker Deatn Oct. 17 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Micco Inst. 5369 Bison Street 3. Name of Medical Address Phone Number Certifier Richard T . Penly M . D . 8005 Bay Street, #4 Medical Examiner Physician Sebastian, . FL 32958 772-581-9977 4. Name of Funeral Home/Bireet-Bispesel Address Fla. Lic. No.lReg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 32958 1228 772-589-1000 5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ~ Elizabeth was contacted on 10/17/05 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Penly 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 di al ce 'Ica ' of c se of death within 72 hours. 6. Funeral Director/ I ure F . No./Reg. No. Date Signed 1862 10/17/05 B, BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-05-0428 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 certification of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. {~~y~r.~~-.. Date Date Certifcate Subregistrar Signature Issued: 10 / 17 /05 pye; 10 /22 / 05 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examiner, ,gave authorization by telephone to Funeral Director/Direct 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. p. CEMETERY OR CREMATORY Method of Disposition: .Place of Disposition Sebastian Cemetery dBURIALSTORAGE Date of Disposition j C ~/ ~ Ip CREMATION Signature of Sexton 1 or Person-in-Charge J} 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. Distribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funerel Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar x.,Frr `S' P,y-