HomeMy WebLinkAbout4-14-33O,
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Certificate # 1893
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Warren A. Guthenberg
(name)
(name)
an a
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HOME Of PELICAN ISWJD
1127 Breezy Way, Sebastian, F1 32958
(address)
(address)
in and for consideration of the sum of $1, 40 0 . o o ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 14 ,Lot(s) 32 & 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 11th day of April ~ 2003
CITY OF SEBASTIAN, FLORIDA A ~~
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Terrence R. oor'~ Sa y A. ~o, CMC
City Manager City Clerk
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07/05/2007 02: i0 5615892583 STRUNK FUNERAL HOME 'AGE 01
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LINDA C. GRANT
Notary Public, State of Florida
My comm. axp. Mar.1Q~ 20OS , '",.
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STRUN~~CC FUNERAL HOMES, P.A.
CASH ADVANCE ACCOUNT-SEBASTIAN
916 17tH ST.
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6213
VERO BEACH, FL 32960 63-1205/570
~ PH. 772-562-2325 - DATE ~ ~ ` ~~ ~ pi
TO THE ~~_'Y.u
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ORDER OF ~~ ` Q4
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02061252 u'
FLORIDA DEPARTMENT OF
H]EALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
~p~
1. Name of First Middle Last Date Month Day Year
Deceased of
William Thomas Thompson Death July 5 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Palm Bay Inst. Palm Bay Community Hospital
3. Name of Medic~aveen Kumar Addr4~5 Malabar NE Phone Number
certifier Palm Bay, Florida 32907 321-255-9407
Medical Examiner Physician
4. Name of Funeral Homta/DiroaWie~sal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 11623 N . Central ~+ve.
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 arxrompanies this
Appropriate application.
Box
b. ® Naveen Kumar. MD was contacted on July 9, 2007
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Naveen Kumar, MD will complete and sign the medical
certification of cause of death within 72 hours.
a. ~ was contacted on He/she verified that
Medical Examiner, will complete and sign the
' I ifi n of cause of death within 72 hours.
6. Funeral Director/ ` ig e ~~~J F.E. No./Reg. No. Date Signed
~ime4 rlicnnsnr ~( (/ L 44048
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-0285
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 cert~cation of cause-of~leath section of the death certficate within
72 hours.
~No extension of time for filing the death certificate has been requested.
,a. Date Date Certificate
SubregistrarSignature ~ ~~ ~,~„f~_ Issued: 7/5/07 Due: 7/10/07
c. AUTHORIZATION for CREM~4TION, 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
CREMATION
Signature of Sexton
or Person-in-Charge
OTHER (Specify)
Date of Disposition July 9, 2007
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.
Diatribution: white: Cemetery or Crematory
DH 326, 6/97 (Obsaletes all previous editions) Yelknv: Funeral Director or Direct Disposer
(Stock Number 5740-000-0326-2) Pink: Local Registrar ,~~ `~ r,~„