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HomeMy WebLinkAbout4-14-33O, C~Op~ 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 5~~ 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 ~~ ~ `` ~~ ~~- C Terrence R. oor'~ Sa y A. ~o, CMC City Manager City Clerk O `.:,% O 07/05/2007 02: i0 5615892583 STRUNK FUNERAL HOME 'AGE 01 1.` .f7 y r ~~ ~ ~ .. y G+/l~/2~y ~~9~Ey~~'.Q~ ~~ «t+t0 of I'b ~, County 4 ~ ~Jit~ too forploit ~ ir~a~nt vroi ~PtN~~. ~ ~~ doff of .~:. e ~ 1 MNH.Typ.r St~mpGortlmbsfawd Nameat~lolx~ D rasaaw ~ kaowa to a,e. a ~. . i~~~ lltleMiertiob: i~a ,x^ .. LINDA C. GRANT Notary Public, State of Florida My comm. axp. Mar.1Q~ 20OS , '",. Comm. No. DD 9Q58,6 r .r~ f/ ~~ ~ ~' ~` ,~ ~ ~ [~ ~~ n ~ ,~~ a ~~, , ~f ~~ ~`, ~~~~'r, '~ ~ ~ :~. * v~ ../' i Name_ Unit_ Bi~~i~_ Lot _ Date of r ~."~ Date of BLriai ~ ~~ '° S ,-~ Narrre Df Funeral H~orns.__. Authorized ~ N ~ a ~ I ~ ~,i O _ ~. ~ ~~ r ~ ~ a t A Y V m I i • _ c Z W Q ~? I n ~ i ~ I ~ ~ ~ i a0a ~ N X V WW y ~ rn (n - W O J ~ m a> ti 1 ,` V O •~ V y N n (n O ~ e3 J m 1 1 . N ~ :O ~ y ~ Q ~ L l ~ ah . io `m oa U ~ . ~ a ~ r ~~ _ y~ 0 0 0 0 0 u~ o rn ~ ~ rn o 0 c0 N ~ m O N ~ th N f~J ~ M M m M O O O O O O m O ~ t['] ~ O O ~ Z O Z O O O O O tOD O ____ ___ ._~ _:. ... _.___ _ _. c.; ,~rt~ i need documenr. See bock Jor d. STRUN~~CC FUNERAL HOMES, P.A. CASH ADVANCE ACCOUNT-SEBASTIAN 916 17tH ST. '~~ ~~ v d a r a O C t- C a • m c c 3 T 'ot O O m O 1 L `y3 (~ .`O-.. \, \ c 6213 VERO BEACH, FL 32960 63-1205/570 ~ PH. 772-562-2325 - DATE ~ ~ ` ~~ ~ pi TO THE ~~_'Y.u PAY ( ~ O 1 ~G/~~ ~L~-~ ~ ~ ~ ~ ORDER OF ~~ ` Q4 ~a Cad / O Q DOLLARS 8 ~,~e.~. , ,~~ 95820th Plata Ji` ~` = ~ ~ Vwo Baadr, FI 32%0 arww.IflNB.rnm Indian River National Bank m~ sss-92oo FOR -TS o ..) ii'0062L3u' i:0670i2057~: _ _ _ .._._. M' 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,~„