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Home My WebLink About2-49-14Aul 3 I IN a 9 of ii \ �. �-J ( �� DEED # 476 Paid by "eceipt No. ?........... Dated l.0 -26 -81 ..... FOLLMER, JOHN E. (SON) List Price $200..00... , ... . Maximum No. Burial spaces ... 2, , . FOLLMER GENEVIEVE (MOTHER) 13175 North Central Avenue Discount ............. Total area in square feet - P- 0- Q-0- S.16bastian, Florida 32958 Net Paid $2QQ,.QQ ..... , ... Monument permitted Fl a.t ............... UNIT 2 addn, BLOCK 49, LOTS 13 R & R ISSUED WITH DEED (Data above this line for City Record only) Name Unit x �� Block j qq Lot /7' Date of Mark -out Date of Burial /� Time / t (, R am Name of Funeral Home Authorized by S m CD C O M �-J O > m • -a f T 'r n • v 5 s �v d 7 G K-,, °o o °o 0 00 0 0o c (D 0 r C7 T r n G7 fn m v '02. m n, CD n CD 0 y fD CD Q 7 CL Cn N D n N x 0 C Cn CD CD ur Fd ,Z: O y [O a T N CO N c� x c � � CD IG •) N C', � n a 0 r MA n < C) m o mom '9 H W 40 N n "s mz 0 o 0 (.n 0 Cn 0 Cn 0 cn 0 o 0 WA CO CD CD In W W O W (O O W (D O W to O cN0 p O O? (D 0 r C7 T r n G7 fn m v '02. m n, CD n CD 0 y fD CD Q 7 CL Cn N D n N x 0 C Cn CD CD ur Fd ,Z: O y [O a T N CO N c� x c � � CD IG •) N C', � n a 0 r MA n < C) m o mom '9 H W 40 N n "s mz Vero Beach Crematory, LLC 1830 Wilbur Avenue Vero Beach, Florida 32960 We hereby certify that these are the cremated human remains of: James Robert Follmer March 29, 2010 (Date of Death) Seawinds Funeral Home & Crematory (Funeral Home in Charge) 02014 (Cremation ID Number) April 2, 2010 (Date of Cremation) Sebastian, Florida (City and State) By: 1K . (Cre ator Signature) O'Z 9 8 February 12, 1926 - March 29, 2010 James Robert Follmer, 84 of Vero Beach, FL died on Monday, March 29, 2010 at William Childs Hospice House in Palm Bay, FL. He was born February 12, 1926 in Bayonne, NJ and was a resident of Indian River County for 10 years, coming from Chicago, ILL. Mr. Follmer was a handyman. Survivors include his brother Walter J. Follmer of Sebastian, FL and sister Genevieve Linder of Union Mills, NC i i FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY HOME OF PELICAN ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 ' City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 J Office (772) 388 -8215 or 388 -8214 Fax. (772) 589 -5570 FUNERAL HOME: _ Sit WIN 0 S ADDRESS: 73S teieA4r'"j PHONE #: ?72 -5$q- 11 33, (Check One) OPEN BURIAL LOT Lot Block Unit OPEN CREMAINS LOT Lot 114 -Block 44 Unit 2 j)oo OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: FOR DECEASED: J-A v% CAS ,Q. /moo /in Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) WA 1 �eL j-_P M %,6 -k _ 4151*0 Name Signature Date I certify that I have determined the ownership of the above described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: J "q� ��z,►/ g�slQ Name 81,9nature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Name Unit ' .{� Block Lot— Date of Mark -out ��f � r ' 7 Time �rc4�C f�. Date of Burial Name of Fu Authorized ROSELAND Genevieve Follmer Genevieve S. "Grandma" Folimer, 106, of Roseland, died (/( April 8, 2007, at her residence. She was born in Hoboken, N.J., and moved to Roseland in 1972, coming from Melbourne. She worked for AT &T in Jersey City, N.J., for two years. ' She was a member of St. Se- bastian Catholic Church, Se- bastian, and she was an hon- orary member of numerous square dancing clubs. Survivors include her sons, John Follmer and Walter Follmer, both of Sebastian, and James Follmer of Vero Beach; daughter, Jean Linder, of Union Mills, N.C.; 16 grand- children, 55 great-grandchil- dren; and 28 great- great -grand- children. Memorial contributions may be made to VNA & Hospice Foundation, 1110 35th Lane, Vero Beach, FL 32960. SERVICES: Visitation will be 2 to 4 and 6 to 8 p.m. April 12 at the Strunk Funeral Home, Sebastian. A prayer service will be conducted at 7 p.m., in the funeral home chapel. A Mass of Christian Burial will be celebrated 11 a.m. April 13 at St. Sebastian Catholic Church, Sebastian. Burial will follow in Sebastian Cemetery, Sebastian. byP , L / V d' G-u j a CYo c� F 2yT Gam, CID -1 '�RIV A 219020 A w° SHd��Oa (o �.o h 3lda oc9i9oz( -e9 d a m i m �J 0 m s X 7 m a � d m o, :Q S 02 1 0Z 9 0:1 .11b 9 09 00.li S) W - *",v Hoi OOe6 -699 (UL) queg IVUO!IVH AME UU!PUI — .•eaal � «— w —: _ 096ZE IJ'4 ..9—A = = — - == — �eld o 1-vi w 40 U896 4Z£Z-Z96 -ZLL 'Hd 096Z£ ld `HOV38 OH3A •1S H1Ll K6 NVllSVG3S-1Nn000 / 30NVAad HSVO "V*d `S3WOH ' VH3Nn:i )INnHis O O w O N O O U O O O O O -• n o m m O o m m n -a m y CD N p a CO V 0 � N A A y °a g� m 7°mT m mom C5 ca O yT T � r, a mz c_- � o _ m d � f'a V\ 30 H34HO 3 H1 01 Avd 0 o 0 0 o z 0 o o a a g g o o z 0 U O O U U U U U U U U O O O R A N N O R A A A j j w w A O n o m m O o m m n -a m y CD N p a CO V 0 � N A A y °a g� m 7°mT m mom C5 ca O yT T � r, a mz c_- � o _ m d � f'a V\ 30 H34HO 3 H1 01 Avd 0 30 H34HO 3 H1 01 Avd 0 FLORIDA DEPARTMENT OF G / • HEALT State of Florida, Department of Health, Vital Statistics [� APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Genevieve S. Follmer Death April 8 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 11375 N. Central Avenue 3. Name of Medical Address Phone Number Certifier Noor Merchant, M.D. 13060 U.S. #1 Medical Examiner Physician Sebastian, FL 772- 589 -0879 4. Name of Funeral Home/DiwctZispocal 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 certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Jamie Sue was contacted on 4/9/07 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Merchant 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 meoAcal cert' f cause of death within 72 hours. 6. Funeral Director/ F.E. No. /Reg. No. Date Signed Direct- l3ieeexr 1862 4/8/07 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-07 -0155 E] 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. RegistmF W Date Date Certificate Subregistrar Signature 5]6a.QrA— M, Issued: 4/8/07 Due: 4/13/07 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition OCREMATION Signature of Sexton or Person -in- Charge DOTHER (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. DH 326, 8/97 (Obsoletes all previous editions) Distribution: lbw: Funeral D rector or Z)a Disposer (Stock Number: 5740 - 000.0326 -2) Pink: Local Registrar A-�W G M