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Home My WebLink About4-09-30Certificate No. 2146 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: David R. Goff 1567 Spinnaker Lane, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following Lot: Unit 4_Block 9_Lot 30_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 5th day of September, 2007. BASTIAN, FLORIDA ATT ST � 61, �W Al Minner ty Manager Ilyy(. Maio, MMC City Clerk cnyIf SEBASTIAN l HOME OF PELICAN WM City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time ofpurc se DaVid R- C�Df- , Name(s V) Address Area Code & Phone Number PO d K1-'1'naldo Goff 1567 Spi nnc-.ket -- l Arne 5eoastali Ft 3295 Residence Address of Intended Occupant if Other Than Purchaser doh Office Use Only Receipt is acknowledged in the sum of: (Y� Q (n A (�O�D Dollars ($ /,,000. °O ) on this 4k day of SW f , 20 0 7 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 4 , Block , Lot(s) '30 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: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Signature of Purchaser Interment W O H Circle One Disinterment TOTAL F Wd_1270 I Sebastian -Wity of Service fees are to be paid at time of need only I: \W W- DATA \Ms- Cemetery\RECEI PT.doc (ve-t) Y -<g -b0 1225 Main Street, Sebastian, FL 32958 • (772) 589 -5330 — Fax 772 - 589 -5570 September 6, 2007 Laura Heaney 1567 Spinnaker Lane Sebastian, FL 32958 RE. Interment Rights to Unit 4, Block 9, Lot 30 Sebastian Cemetery Dear Ms. Heaney: Enclosed is City of Sebastian Certificate 2146 entitling David Goff to full interment rights in Unit 4, Block 9, Lot 30. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. SinViyly, Sally A. 1154-d' MMC City Clerk SAM /jw Enclosures cc: Mr. & Mrs. Capp Obituaries I lleath Notices I Newspaper Obituaries I Online Obituaries I Newspape... Page 1 of 2 View /Sign Guestbook DAVID R. GOFF and Sydney Goff through Mickey Capp. SERVICES: Visitation will be Friday, September 7, 2007 from 11am to ipm at Seawinds Funeral Home Chapel with a service at fpm. Chaplain Dick Flick of the VNA Hospice House will officiate. Burial to follow at Sebastian Cemetery will military honors. Arrangements are under the direction of Seawinds Funeral Home & Crematory, Sebastian. Condolences may be sent through www.seawindsf h.com /obit. php Paid Obit Published in the TC Palm on 9/7/2007. Notice • Guest, Book • Flowers • Gift Shop • Charities Today's_TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact Lecacy.com • Terms of us.e... http:// www .legacy.com/tcpalm/Obituaries. asp? Page= LifeStoryPrint &PersonlD =93... 9/10/2007 zlx) Total Paid �, OQQ 00 75 00 Initials Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant White - Dept. of Origin • Yellow - Finance • Pink • Applicant Name 16' Block Lot Date of Mark -out Date of Bunal Y' 5— /„ , 917 Tarne- Nlamne of Funeral Home Autivnzed by CITY OF SEBASTIAN CITY CLERK'S OFFICE 3932 CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT RECEIPT 3936 Name _ ❑ Cash Name 6 ( �jb"P Date -ib (XCheck # ,32:7 -ca. ❑ Cash Date 16 07 X Check #_ i_ t I_q_ No. Amount Paid No. Amount Paid 001001 208001 Sales Tax )01001 208001 Sales Tax 001501 322900 Garage Sales )01501322900 Garage Sales 001501341920 Copies/Bid Specs. )01501341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances )01501 341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees )01501341930 Election Qualifying Fees 601010 343800 Cemetery Lots /�� 101010 343800 Cemetery Lots / Lot/Niche,-30 Block � Unit �T Lot/Niche Block �_ Unit 001501 343805 Cemetery Fees )01501 343805 Cemetery Fees -7500 zlx) Total Paid �, OQQ 00 75 00 Initials Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant White - Dept. of Origin • Yellow - Finance • Pink • Applicant Name 16' Block Lot Date of Mark -out Date of Bunal Y' 5— /„ , 917 Tarne- Nlamne of Funeral Home Autivnzed by i\ M "S e c a r i t y p n h a n c e d d o c u m e n t.... S e e back for detail. -s, ® 1 a MEMO 1'0LLLL9no - 1 :063L02L521:10000037776211' 10 d City of Sebastian 1225 Main St. Sebastian, FL 32958 NIEM �m CITY OF SEBASTIAN CITY CLERK'S OFFICE 3946 RECEIPT Name 1� ❑ Cash Date v v —C' -7 Check # -. No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots LoWiche 30 Block Unit 001501343805 Cemetery Fees 10-00 tgr a. rnar ker Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant FLORIDA DEPARTME OF HEALT A_ (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of DAVID R. GOFF Death SEPTEMBER 5 2007 2. Place of Death City, Town or Location Name of (if neither, give street address) linsotsp.. INDIAN RIVER SEBASTIAN 1567 SPINNAKER LANE 3. Name of I I Address Phone Number Certifier RI kRD PENLY, MD 1265 36TH STREET Medical Examiner XX Physician VERO BEACH, FLORIDA 32960 772 - 567 -6340 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment SEAWINDS FUNERAL 735 FLEMING STREET HOME & CREMATORY SEBASTIAN, FLORIDA 32958 2617 772 - 589 -1933 5. Check a. The medical certification has been completed and signed. A completed certitcate of aeatn accompanies mis Appropriate application. Box b. E] 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 m I certification of ca & of death within 72 hours. 6. Funeral Director/ Signature F.E. No. /Reg. No. Date Signed Direct Disposer /��.�' �ji , A 4103 SEPTEMBER 5, _2007 B. I (,BURIAL 4TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 07- 2617 -159 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. ®No extension of time for filing the death cert' to a rn requested. Registrar or Date Date Certificate Subregistrar Signature Issued: SEPTEMBER 5, 2007Due: SEPTEMBER 15, 2007 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL- AT-SEA A 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. A waiting period of 48 hours after death is required for all cremations. Method of Disposition: ® BURIAL OCREMATION Signature of Sexton or Person -in- Charge DSTORAGE DOTHER (Specify) CEMETERY OR CREMATORY EBASTIAN CEMETERY Place of Disposition Date of Disposition SEPTEMBER 7, 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. Distribution: White: Cemetery DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director Crematory or Direct Disposer (Stock Number. 5740- 000-0326 -2) Pink: Local Registrar ,,Y-W %I AT- STATEMENT 123429 Date 19 TERM$ 7 01 S 0 v o s f 1 T 7 Y 7 es • 'O o 0 W. -1 C 7 y m 7 0 0 C, o 0 s 0 s o 0 0 0 0 0 A co O � j C> j p N N O O C N 0 - ----- ---- 7 01 S 0 v o s f 1 T 7 Y 7 es • 'O o 0 W. -1 C 7 y m 7 0 0 C, o 0 s 0 s o 0 0 0 0 0 A co O � j C> j p N N O O C N 0 z r C) m r C) O w c0D , <° Z m � � n co -� V C> C S W 7 a S 3 0 c ti 6 m o m I-�Or„ n! T S 0 m Z 0 00