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HomeMy WebLinkAbout4-09-33CRY C7F ~~~~r~~ ,, , ...~ ,,, . HOME OF PELICAN ISLAND Certificate No. 2127 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Gary D. Edmunds (name) 8036 102~d Court, Vero Beach, FI 32960 (address) In and for consideration of the sum of $950.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following Lot(s)/Niche(s) Unit 4 Block 9 Lot/Niche 33 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 25th day of April, 2007. =~'lY t~F J ~F• ~' ~.r ~. April 26, 2007 Mr. Gary D. Edmunds 8036 102~d Court Vero Beach, FI 32960 RE.• Interment Rights to Unit 4, Block 9, Lot 33, Sebastian Cemetery Dear Mr. Edmunds: Enclosed is City of Sebastian Certificate 2127 entitling you to full interment rights in Unit 4, Block 9, Lot 33. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Since e ; Sally A. M ' , MMC City Clerk SAM:ar enclosures ~¢ ~a~ ~, a~ s ~. ~~ - 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 provi ed at time of purchase Names ' Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only ~ Receipt is ac/knowledged in the sum of: on this ~~_day of , 20 oZ for the purchase of the following described Cemetery Lot(s) a /or Niche(s). 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: Comer Markers (set of 4 - $20) Opening 8~ Closing ~ ~~ ~ ~ w O H Circle One Vase and Ring for Niches (cost) Signature of Purchaser Disinterment TOTAL $ ~, ©o2s~ 0 d of Sebastian Service fees are to be paid at time of need only Interment I:\W W-DATA\Ms-CemeterylRECEIPT.doc / ~ A\ i ti .-~~r tjr ~~ f c, t.: .. Name ~-(.--' ~-t~ Unit Block got .~ ~ Date of Mark-out ~ ,-- `Y~~"~ ,''T~~._.tL_ • ~ J yam. Date of Burial - fi_._ ~- _ ,j Name of Funeral Home ~~~~ Authorized by ~.~~- ~~ Time w .~ C~' a _ - - - -- - ..,. o oy A ~- C .t...r. y+ c~ '~"~" 7_~.~~' ~~ 7 Cd ~."~ ~ ^~~' ~ ~mp ~3 C~~.~ ~~ d~.U RS ~i Ol ~ "~' N ~ ~• ~ ~ GJ 'iC3~,.-r ~'~°'`oRS~c~U v.cC7~-a~~~`~m~~ °~~~~' ~ ~~a~o~ ~• ~ E N ~ D 0 r v ~ d °a U z ~ e s v ~ ~- ^ i C Z W C g LL ~ aoa -?~~5 m N . ~ m lW/f~ W ~ ~ y O J ~ C p~ • C } V "~ C ~ 0 .Z' ~ ~ A X ~ 'O ~ d Z• m Z• O F ~ ~ C m L m • 6 m (U(,,~~ a~ ZZ~ m\\\\~~ ~ ~ t6 o Q ~ ~ O m ( \ O ~ ~ C7 U ~ w U ~ U ~ m ~l ~ a 3 M ~ O O O ~ ~ O M ~ ~ N O r _ O C~7 ~ ~ C ~ N M f~7 C~'7 ~ M • k o °n .°n °n ~i O o ~O ~ A • o z o z 0 o 0 0 0 0 °o °o c°D °o FLORA, I` A~ PARTMENT OF HEALT A. 1. Name of Deceased First Middle Last Date Month Day Year of Christina C. Edmunds Death April 19 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. Sebastian River Medical Center 3. Name of Medical Address Phone Number certifier Harish Sadwani, M.D. 12920 U.S. #1 Medical Examiner Physician Sebastian, FL 772-581-2373 4. Name of Funeral Home/pirxt-Dispeeed 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 certfication has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Cynthia was contacted on 9/19/07 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Sadwani 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 medics rt' cati of se of death within 72 hours. 6. Funeral Director/ S' na a F.E. No./Reg. No. Date Signed Diree!-BispoS~T' 1862 9 / 19 / 07 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 122$-07-0169 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 cert~cation of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. Regis4rorvr^ Date Date Certificate SubregistrarSignature ~'~. ~~~.,b~Q-Q Issued: 9/19/07 Due: 9/29/07 c. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examiner, ,gave authorization by telephone to Funeral DirectorlDirect Disposer. Date The Medical Examiners 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 Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition ~~~~`~ CREMATION OTHER (Specify) Signature of Sexton or Person-in-Charge f~-c,Q Q. This permit must be endorsed by the Sexton orperson-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, 8197 Obsoletes all ) Distribution: White: Cemetery or Crematory Pow ( previous edAions Yelknv: Funeral Director or Direct Dis r (Stock Number. 5740-000-0326-2) Pink: Local Registrar ~-3~ State of Florida, Department of Health, Vital Statisti ~ D APPLICATION FOR BURIAL -TRANSIT PERMIT