HomeMy WebLinkAbout4-09-27U
Name
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Date of Mark -out
Date of Burial ,3 Zz 6 ® % Time
Name of Funeral Home
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Certificate No. 2133
CrrYOFSEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
George B. & Carol C. Holmes 202 Degan Place, 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
Lot(s) /Niche(s)
Unit_4_Block_09_Lot(s) /Niche_26 & 27_
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 201h day of June, 2007.
OF ASTIAN, FLORIDA ATTE f
Minner Sa A. Maio, MMC
Ci y Manager City Clerk
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
Mr
HOME OF PEUCAN KLAW
For information contact.
Kip Kelso - Cemetery Sexton
lL•^� Sebastian Municipal Cemetery
(772) 589 -2545
U City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax. (772) 589 -5570
FUNERAL HOME: STnuNK FUNERAL HOME & CRrI�:IA'a CRY
1623TIe cantralrAwe
ADDRESS: SEBASTIAN, FL 32958
PHONE #:
(Che One)
OPEN BURIAL LOT Lot 2 1 Block Unit
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIM WS 3I° S 1.
FOR DECEASED: L"m, �io oq es
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(
us provide proper documentation of ownership)
� r H� I►m�.S � ���� 3 23 � 3
_1 I
Name SIgnatur 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 aE5ii ' e.
NAIjAE AND SIGNATURE OF LICENSED -
/�\ I kJI) I o��YLI.U�� ��23 f 13
Name Date
Cemetery Sexton Certific ation:
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:
"/, (�) e"" joq,�, r), _�/, I- / 3 -
Cem tery s,ex on to
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CAROL C. HOLMES
Mrs. Carol C. Holmes, 82, died March 23, 2013 at VNA Hospice House in Vero
Beach. She was born March 2, 1931 in Medford, Massachusetts and moved to
Sebastian, FL in 1990 from Illinois. She was a member of St. Elizabeth's
Episcopal Church and was a member of their Altar Guild.
She was survived by her husband of 60 years, George B. Holmes of Sebastian;
son, Bruce Holmes of Glendale, Wisconsin; daughters, Nancy Holmes of
Sebastian and Natalie Reno of Williams Bay, Wisconsin; 4 grandchildren.
EIARlD3DFPARrbiE1igE' State of Florida, Department of Health, Bureau of Vital Statistics
HEAL�T BURIAL TRANSIT PERMIT
DATE PRINTED: March 23, 2013 TRACKING NUMBER: 2013044810
1. DECEDENT INFORMATION
Name of Deceased Date of Death
CAROL C HOLMES March 23, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE
Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No. /Reg. No. Phone Number
STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589 -1000
1623 N CENTRAL AVE
SEBASTIAN, FLORIDA, 32958
Funeral Director /Direct Disposer Fla. Lic. No. /Reg. No.
GLENN STRUNK F042972
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
�j Permit Number: 2013- FO41870 -5060
t Date Issued: March 23, 2013
`[ J t
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: BURIAL Date of Disposition:
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V- 1.011, Florida Administrative Code
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4360
RECEIPT
1 _
ame ❑ Cash
ate 93-Check #
0. Amount Paid
)1001208001
)1501 322900
)1501 341920
11501 341910
11501 341930
1010 343800
1501 343805
Sales Tax
Garage Sales
Copies/Bid Specs.
LDC /Code of Ordinances
Election Qualifying Fees
Cemetery Lots
Lot/Niche , Block , Unit
Cemetery Fees
Z7
Total Paid
Initials
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
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