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HomeMy WebLinkAbout4-18-150 affoF SE t" HOME OF PELICAN ISLAND Certificate No. 2096 Ct OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Donald W. & Janet F. Alexander 274 Delmonte Road, Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $2,100.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit 4_ Block _18_ Lots/Niches_15,16 & 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 3rd day of August 2006. CITY/bF SFHYASTIAN. FLORIDA ATTEST: inner Jeanette Williams c Manager Deputy City Clerk 0 NameT �RX Unit Block Lot / 5 Date of Mark -out Date of Burial ZD 0 Time v Z 0 a"m Name of Funeral Home "a d Authorized by bJJL�.� The undersigned representing Brookside Crematory LLC 453 Christian Lane Berlin CT 06037 Certifies that the Remains of En LN, Ocis A. Ve (-an�-s have been cremated on g— I / -- / 0 by Brookside Crematory That cremation permits accompanied the same Subject to all legal requirements, rules and regulations. Date of Death g - 6 — I y Certificate No. (� L/ J, 4Z,� Authorized Representative CITY OF SEBASTIAN 4 711 CITY CLERK'S OFFICE RECEIPT Name t�YYe. I llheyo ,1/�QYOf'leS1 ❑Cash Date t r O ,Check # Amount Paid No. 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots LotlNiche, Block Unit 001501 343805 Cemetery Fees 0/I✓ Total Paid initials White White — Dept. of Origin • Mellow — Finance a Pink • Applicant r Name , T Unit X/ Block Lot � - }y` - Date of Mark-out r r` Date of Burial Time Name of Funeral 146 me -� !; tFij f y�j Authorized by r 54, i £ e Jf s4 fry,:rJ, ddY FLORIDA DEPARTMENT OF HEALT A. (TYPE) Z/ z", (a(tDbf o of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased EVELYN FRANCES VERONESI of JULY 27, 2006 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County INDIAN RIVER SEBASTIAN Hosp. or SEBASTIAN RIVER MEDICAL CENTER Inst. 3. Name of Medical Address Phone Number Certifier M. NASIR RIZWI, M.D. 13885 U.S. HIGHWAY 1 772 -589 -6844 Medical Examiner X Physician SEBASTIAN, FLORIDA 32958 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FLEMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958 2617 772 - 589 -1933 5. Check a. I The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. — - Box b. F-1 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. 6. Funeral Director/ 5Signature F.E. No. /Reg. No. Date Signed Direct Disposer 2294 JULY 28, 2006 444L:�� B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 06- 2617 -130 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 h Lsbeen requested. Registrar or Date Date Certificate Subregistrar Signature Issued: JULY 28, 2006 Dye: AUG. 3, 2006 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date Fill 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. A waiting period of 48 hours after death is required for all cremations. Method of Disposition: DBURIAL FICREMATION Signature of Sexton or Person -in- Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition / � A w 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 DH 326, 8/97 (Obsoletes all previous editions) Yellow. Funeral Director crematory or Direct Disposer (Stock Number. 5740- 000 -0326 -2) Pink: Local Registrar R-yd-d �. rye aiy of ,-� � to HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 August 3, 2006 Donald W. & Janet F. Alexander 274 Delmonte Road Sebastian, Fl 32958 Dear Mr. & Mrs. Alexander: Enclosed is City of Sebastian Certificate 2096 entitling you to full interment rights in Unit 4, Block 18, Lots 15, 16 & 17. 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. Sincerely, Jette(VJY/l Williams, CMC Deputy City Clerk JW:ar enclosure MY OF SEBMTKN - ;� HOME OF�FEUCAN STAND 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 ©nafd. a 4. a n c T- F' ALNE> xa11�cA- e Name(s) Address ' 'iiL) - 5-Y 9 - 1 7g 7 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Dollars ($ on this ,day of jq u-& u-s r , 2064, for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit _, Block %t , Lot(s) i S r 12 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: Corner Markers (set of 4 - $20) Opening & Closing `�-57 a 'Q W �' O H Circle One Vase and Ring for Niches (cost) nature of Purchaser Interment Disinterment ity of Sebastia'n TOTAL $ 9-/ a Service fees are to be paid at time of need only I:\W W- DATAWs- CemeterykRECEIPT.doc DONALD W. ALEXANDER OR 1662 JANET F. ALEXANDER 772 -589 -1747 - Z _ "c 274'DELAAONTE ROAD SEBASTIAN, FL j 58 Pay to the7... Order of Bankof America Bank of America age" ACH Rrr 063100277 ... r For 1:0630000471: 00 3 3886 7 79 II' 1662 now �eiax�a.,e.Ka� d to m 41 O • s m 0 i m • ar � m W C) Q/ T or m Co Q r c � N? K_ m RJ c V 14 lz�tw v o Q M. n m C N °a m I 9? ? @ H fU C/) X fD N A n m � S O � G 7 m G. C) (7 mm� C) ww -+Oy "s A Z M (n Cr) M 00 0 00 0o e 0 cn o to to cn C." o 0 0 (0 C.3 PQ 00 �bW O W N O O �n (D O O O Cl C) Q/ T or m Co Q r c � N? K_ m RJ c V 14 lz�tw v o Q M. n m C N °a m I 9? ? @ H fU C/) X fD N A n m � S O � G 7 m G. 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