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Certificate No. 2128
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Leonardo 8~ Iris Ramos 1173 Coverbrook Lane, Sebastian, FI 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
Lot(s)/Niche(s)
Unit_4_Block_9_Lot(s)/Niche_24 & 25,_
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 7th day of May, 2007.
OF BASTIAN, FLORIDA ATT[z'~' ,. -. ,
~ S
~ AI Minner Sal A. Maio, MMC
City Manager ;~ City Clerk
Name
Unit_
Lot
;+ t
'~~ _ wit {~ ;,i ' / ~ ~~
J
.c~ , .
Date of Mark-out ~'~ ~,~ ~'
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Date of Burial ~1 ~~" % Time ~ ~ ~~~ ~'' 1'~ ~ ~- ~ ~ ~~' ~-~_~
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Name of Fu
Authorized
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
~~1,~~
1. Name of First Middle Last Date Month Day r
Deceased of
1 ris Ramos Deatn May 2 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Sebastian Inst. 1173 Coverbrook Lane
3. Name of Medical Address Phone Number
Certifier Michael Venazio M.D. 8005 83rd Avenue
Medical Examiner Physician Sebastian, FL 772-388-2110
4. Name of Funeral Home/D~iweE~ieEwtal 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.
Appropriate
Box
b.
c.
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
Alethea was contacted on S / 3 / 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. Venazio will complete and sign the medical
certfication of cause of death within 72 hours.
was contacted on He/she verified that
Medical Examiner, will complete and sign the
medical rt' cat' use of death within 72 hours.
6. Funeral Director/ S' n F.E. No./Reg. No. Date Signed
eireet°Bispexr. _,,,~ 1862 _ __ 5 /2 /07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-0195
A five (5) day extension of time for filing the death certificate (exGusive 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.
~, Date Date Certificate
SubregistrarSignature ~s.rp,~,~,1.~ ~ ~ Issued: 5/2/07 Due: 5/7/07
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 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 -
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 focal County Health Department in.the county where disposition occurred.
DH 326, tv97 (Obaoletes all previous editions) Distribution: 1Nhde: Cemetery a Crematory
Yellow: Funerel Dvedor a Direct Disposer
(Stock Number 5740-000.0326-2) Pink: Local Repishar ~ i~ ~