HomeMy WebLinkAbout4-18-09,~ :~~."
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HC>~RE C3F PELI~I ,95t11Nt3
Certificate No. 2058
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Michael D. O'Dea 104 Charles 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 plot:
Unit 4 Block _l8 Lot(s)Niche(s)_8 & 9_
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 4~' day of January, 2006.
CITY~F S~~STIAN, FLORIDA ATTF,S~; ~
Manager
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Clerk
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COX-GIFFORD-SEAWINQS FUNERAL HOME surirRUSr aewK 491 ~
1950 20TH STREET VERO BEACH, FL 32963
VERO BEACH, FL 32960 63-607/670
1 /612006
' ORDER OFE City of Sebastian ~ ~ ** 125.00
One Hundred Twenty-Five and 00/100***************************************************~DOL~ARS ei
City of Sebastian
..1225 Main St.
...Sebastian, FL 32958 `~
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~~'0049 LO~i' ~:067006076~: L0000 L737746 2i~'
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FLuORIDA DEPARTTMENT OF ~ ` ./ r, ~ ~ J
State of Florida, Department of Health, Vital Statistics
1 1~~11 1 /
APPLICATION FOR BURIAL -TRANSIT PERMIT ~ Q
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased
MARGARET ANN NELSON-0'DEA of JANUARY 4, 2006
Death
2. Place of Death City, Town or Location Name of (If neither, give street address)
County INDIAN RIVER VERO BEACH Hosp. or
Inst. INDIAN RIVER MEMORIAL HOSPITAL
3. Name of Medical Address Phone Number
Certifier RICHARD CUNNINGHAM, DO 787 37TH STREET
Medical Examiner g Physician VERO BEACH, FLORIDA (772) 794-5227
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment SEAWINDS FUNERAL 735 FLEMING STREET
HOME SEBASTIAN, FLORIDA 2617 (772)589-1933
5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ^
was contacted on
He/she verified that this death was from natural causes, that there was no accident nor other external cause 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 certification of cause of death within 72 hours.
o. Funeral virecior/ t!..re F.E. No./Reg. No. Date Signed
Direct Disposer '~~~~" " 2294 /- ~ n C
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 06-2617-003
^ 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.
Registrar or Date Date Certificate
SubregistrarSignature Issued: I--~j..0 ~ Dye: ~.~~.~Q~
~ 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.
D
Methcdof Disposition:
BURIAL ^STORAGE
^CREMATION ®OTHER (Specify)
Signature of Sexton
or Person-in-Char e } __~d~~~`u->~
CEMETERY OR CREMATORY
.Place of Disposition SFRASTTAN ('.F.MF.TFRY
Date of Disposition l - 7 - ~-~, ~)
I rns 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, 8/97 (Obsoletes ail previous editions) Distribution: White: Cemetery or Crematory
(Stock Number: 5740-000-0326-2) Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
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Date of Burial t + ? ~ P` p a
Time ~ ;~M ~(..; ~Jl`~/`J~.
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Name of Funeral Home S,~/`~ ~~±e -~/L
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Authorized by ,~ Jl: r' ~'~ ~ ( ~/~ `-""`~-----.-_ i