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HomeMy WebLinkAbout1-30-28Certificate No. 2140 CITVOFSEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Sarah L. Thomas 12380 87th Street, Fellsmere, Fl 32948 (name) (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_i_Block_3O_Lot(s)_28_ 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 5th day of July, 2007. CI AOFSTIAN, FLORIDA ATTEST: Iwffi- /�&A lit ner *�2 ette Williams, -CMC City Manager Deputy City Clerk Name Unit Block `y Lot Date of Mark -out Ch Date of Burial` T Time Name of Funeral Home Authorized bye LotlNiche Zo . Block , Unit 001501343805 Cemetery Fees !— A All Total Paid 1 J O. 0D 'a.owua Lei Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY CLERK'S OFFICE 4602 RECEIPT ❑ Cash —0 [Check # No. Amount Paid VOW 208001 Sales Tax 001501322900 Garage Sales 001501341920 CoVwdBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying FFees 601010 343800 Cemetery Lots o vy\o.-s 1 / LotlNiche Zo . Block , Unit 001501343805 Cemetery Fees !— A All Total Paid 1 J O. 0D 'a.owua Lei Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant FLORIDA DEPARTMENT OF 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 Sarah Lee Thomas Death October 11 2009 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Inst. 12380 87th Street 3. Name of Medical Address Phone Number Certifier Ray nd S. Duong 805 37th Place, Vero Beach, Florida 32960 (772) 770 -3859 Medical Examiner lPhysician 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1655 27th Street Thomas S. Lowther Funeral Home Vero Beach Florida 32960 F041584 (772) 778 -3233 5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b• 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/ Signatlre F.E. No. /Reg. No. Date Signed Direct Disposer 17044177 nctnhpr 11, 02_09 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 2559 -09 -213 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. F�No extension of time f ' g the death certificate has been requested. Registrar or Date Date Certificate Subregistrar Signatur Issued: October 11. 2009 Dye: October 23. 2009 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 CometPnIx © BURIAL STORAGE Date of Disposition October 14. 2009 CREMATION OTHER (Specify) Signature of Sexton or Person -in- Charge IF 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: White: Cemetery or Crematory (Stock Number: 5740 -000-0326 -2) P nk: Local Registrar r rector or Direct Disposer ,�,dd 0. Cot 12 2009 1:28PM COS CEMETERY 7722289927 FUNERAL DIRECTOR'S REQUEST TO CITi OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY Moiw a �uow iw+o For Informatlon caniect: Kip Kelso - Cemetery 5extan Sebastian Municipal Cemetery . (772) 589.2545 City Clerk's office City Hall, 1225 Main Street Sebastian, ILL 32958 OMCe (772) 388.8215 or 388 -82114 Fax: (772) 58566570 FUNERAL HOME- Thomas S. Lowther Funeral Home ADDRESS: 1655 27th Street PHONE #: 772 - 778 -3233 (✓ one) ._OPEN BURIAL LOT Lot Block 30 _-,,OPEN CREMAINS LOT Lot �� Block � Unit __ OPEN COLUMBARIUM NICHE Niche Unit Block `--"' Unit __1 " BURIAL DATE AND'SERVICE TIME; Oc�. ty N o 7S _ E W � w.n FOR DECEASED: �A. - r.L —1--L-. Q Q Name NAME AND SiGNATURE'OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) P.2 ,4.,` Of m)o lir' Name Sighature 7 to — I certify that I have determined the ownership of the above described site, that all site tees and Administrative fees have been paid and authorize opening or same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: !pM - �...�,.- ...,.•_,_� Signature Date Cemetery -- ...._.. ,....._, ............. ry Sexton Certification:, ....._... 1 Certify that 1 have checked the ownership Information by viewing the Owner's deed and confirming With Cterk's office and th I all tees have been paid: i rnn�g Came xion pate This form to be provided to Clerk's Office by Sexton for permanent record upon o0 mpletlon, In Memory of Sarah Lee Thomas September 20, 1924 - October 11, 2009 Sarah Lee Thomas, 85, of Fellsmere, Florida, died Sunday, October 11 at her son's residence. She was born September 20, 1924 in Clinchco, Virginia and had been a resident of Indian River County since 1966 coming from Fairfax, Virginia. Sarah was a member of the Community Church of Fellsmere. Sarah worked as a bookkeeper in the retail industry. She volunteered at the Indian River Medical Center and at the Sheriffs Dept. under Sam Joyce. She loved sharing her plants with friends, especially the Stagg Horn Ferns she so caringly cultivated. She is survived by 2 sons, Duncan Thomas of Fellsmere, FL and Nathan Thomas of Ardmore, OK, daughter, Sue Johnson of McLean, Virginia, 2 sisters, Faye Constantino of N.J. and Betty Britt of Memphis, TN. 8 grandchildren, 5 great - grandchildren. She was predeceased by her husband Laurance T. "Tommy" Thomas in 2006 and her sister Marie Whetsel. The family will receive friends on Wednesday, October 14th from noon to 2PM with a service at 2PM at the Thomas S. Lowther Funeral Home with Pastor Ian Crawshaw, Pastor the Community Church of Fellsmere, officiating. Burial will follow at Sebastian Cemetery. aly Of t.i H HOME OF PELICAN ISLAND 1 225 Main Street, Sebastian, FL 32958 Telephone (772) 589 -:5330 — Fax (772) 589 -5570 July 5, 2007 Mrs. Sarah L. Thomas 12380 87th Street Fellsmere, A 32948 RE.' Interment Rights to Unit 1, 61ock 30, Lot 28 Sebastian Cemetery Dear Mrs. Thomas: Enclosed is City of Sebastian Certificate 2140 entitling you to full interment rights in Unit 1, Block 30, Lot 28. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, t anette Williams, CMC City Clerk JW:ar enclosures MQT HOW OF PwrIAN 15iAND r 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 Is Name(s) Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: lelp Dollars ($ &D . 4zs ) vIf t on this ,J—�` day of , 20„0 7 for the purchase of the following described Cemetery Lots ndl iche(s). Unit _, Block,-?O Lot(s) ,?,6 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 & Closing Vase and Ring for Niches (cost) Interment ; .. // 'oo' voi- ignature of Purchaser riy of -WO H Circle One Disinterment TOTAL d O Service fees are to be paid at time of need only I: \W W- DATA\Ms- Cemetery\RECEIPT.doc SARAH L. THOMAS � � � ..1908 ,. DUNCAN S. THOMAS 63 -4/630 FL 12380 87TH STREET "� 1599 FELLSMERE, FL 32948 Date /cam tot r LZ �2%t�� Dollars p ��Y an,of America�,�� ACH R/T 063100277 Memo MAP 1 :0 6300004 711: 00 5 48 6 214 2011' 1908 m • :q 0 d Ci d •1 D. M 0 0 0 o Cl o 0 ° O O O O (D 0 _ N O ro OD 00. coo (o co (D co O O O ( CD N O O r O O O O O � CJ C7 _m r 0 O N c 3 CD CD CD CL m (fT O N O C7 h ((DD N � O A Xm 0 C13 y 0 X ca M N W --40> n 0 M Z M c ❑ A � N n O ^� .°.. ryC W Vl W r� jf \K t C S f LOT AVAILABLE FOR SALE UNIT / , BLOC , LOTali>=08 City of Sebastian POST OFFICE BOX 780127 ❑ SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589 -5330 ❑ FAX (407) 589 -5570 April 12, 1993 Ilse A. Brown 8880 100th Avenue Vero Beach, Florida 32967 Dear Mrs. Brown: Enclosed you will find check number 004766, in the amount of $75.00 for payment of Cemetery Lot 28, Block 30, Unit 1. Also enclosed is a copy of the letter that you signed and returned to this office. If you have any questions please contact the City Clerk's Office. Sincerely, Kathryn . O'Halloran, CMC /AAE City Clerk KMO:lml enclosure (ws- form /cem -let) n 1 TO: FROM: C: Q \�%P qSt City of Sebastian POST OFFICE BOX 780127 ❑ SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589 -5330 ❑ FAX (407) 589 -5570 M E M O Marilyn Swichkow, Finance Director I Kay 0' Halloran, City Clerk SUBJECT: Repurchase of Cemetery Lot by City DATE: March 24, 1993 Please issue a check in the amount of $75.00, payable to the following, for the repurchase of Cemetery Lot 28, Block 30, Unit 1. Ilse A. Brown 8880 100th Avenue Vero Beach, Florida 32967 This lot was purchased on June 23, 1972 on Cemetery Deed 180 and is no longer needed. A copy of the original receipt is attached. Thank you. KOH:lml O 0 .r -%3 Ti a,j 0 CP � 0 0 a-i .r uj T Lrl C)3 LW m 0 ru 0 133 ■ 0 m cn m 03 cn C/) m Go r- 0 -n < m 0 Z 0 m 0 x Z 03 m 1-4 -4 m 0 021> M m A'. : /$� < CO r- C/) 03 0 m m x co 1:0 > U) 0 O0 M 22"n > U) M�z m M n 0 -n 03 to >r-> no (J) -n Z D k�Z r- < m (z :4c IM m US C: m C)K 0 z > r--nz ZO> }�> < > r- M, m co > Z z < 0 E5 C13 Ica -n < z \c -0 u > m > I E m 0 m :15 c z 0 =i ul -4 3: z D < m m (0 :7 a 0 C; C) < a Q. .8 Cl) 17) ■ 0 m cn m 03 cn C/) m Go r- 0 -n < m 0 Z 0 m 0 x Z 03 m 1-4 -4 m City of Sebastian POST OFFICE BOX 780127 ❑ SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589 -5330 ❑ FAX (407) 589 -5570 March 15, 1993 Ilse A. Brown 8880 100th Avenue Vero Beach, Florida 32967 Dear Mrs. Brown: This letter comes to you as a result of the meeting we had in my office on Monday, March 8, 1993. We discussed the fact that you wished to be cremated and interred in Lot 18, Block 30, Unit 1 with your husband. Your signature below will attest to the fact that you are no longer in need of Lot 28, Block 30, Unit 1. Please sign below and return to this office. Enclosed is a stamped,self addressed envelope for your convenience. Thank you for your cooperation in this matter. Sincerely, /-/CL Kathr�n M. O'Halloran, CMC /AAE City Clerk Ilse A. Brown KMO:lml Encl. ( \ws- form /lin -ltr)