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HomeMy WebLinkAbout4-10-09Certificate No. 2151 ~~ ~~ ~ ~~ Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Robin Devitis 1057 Seamist Lane, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit_4_Block_,10_Lots,_9, 10_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONV~YED THIS 8th day of October, 2007. F ASTIAN, FLORIDA A ~T: AI Minner Sal A. Maio/, MMC 'ty Manager City Clerk ~~ ~~~~~~ ~ ~ l ~ l .~ ~.,~ HOME Of PELIUN ISW~D City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase IeU,~ l Yl 1~~ U. I f I',S Name(s) t o 5 7 Se~r>1 ist l.C~h ~ Se~a..s t~'a n ~"~ 3Z~ 5~ Address ~~~ Area Code & i 3~SF-ia~ e Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: ~U ~ ~~dfl Dollars ($ ~~~-~o ) on this ~~ day of U °~ ~ , 20 D7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit ~ ,Block ~ o , Lot(s) Q °` ~ 0 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) Interment -I-~ ,p Yna-r k e r 1 0 , 0 0 W O H Circle One Disinterment TOTAL $ ~ i ~ Q ~ ~ Q Signature of Purchaser W y of Sebastian Service fees are to be paid at time of need only ~~~- ~~ I:\W W-DATA\Ms-Cemetery\RECEI PT.doc CtfY OF -~~~ HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 • (772) 589-5330 -Fax 772-589-5570 October 9, 2007 Robin Devitis 1057 Seamist Lane Sebastian, FL 32958 RE.• Interment Rights to Unit 4, B/ock 10, Lots 9 & 10 Sebastian Cemetery Dear Ms. Devitis: Enclosed is City of Sebastian Certificate #2151 entitling you to full interment rights in Unit 4, Block 10, Lots 9 & 10. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Since~y, 4.,. } , ,. ~, =-- Sally A. M o, MMC City Clerk SAM/jw Enclosures ~~ ~~ \! ~T ,I\ m ~ ~ N (~ N '1'1 t i~ O ~.. Q O m p O ~ w~~ ~ 6' D~ , ~ W ~ ~ ~ ~ ~ w m t J1 ,7 w o ~-miC g' Z ~ ~ m ~o O * ~r 0~ * 3 w ~ ~ O * m ru r LJl ru ^: r O O O O r W -J -~] RJ i ~t ~lF * < m O * C ~m * ~ n C 9E (,~ T~ * iF ~rDD w Z {l. ~' ~ ~ dF iF 9F dF iF dF -0F iF ~} ,x, * ~ ~ iE ~ U1 O ~ 00 ~~ O O N O r O J ~ 77 ~ W y m I W t~ ^' d N~ ~Vyy' O r~ ~' r ~ • ^ ~yy ~ ~..I ~ h ~ TIC ~ M o r ;~ 1"'r r w ~ C N r ~, v, < ~ -0 ~ < ~ .: O w r O rv r LJ'1 ru : ^ r O O O O r W ~] ftJ Q ~~ ~O ~~ m r i L D ~ 3 ~ 3 L ~. ~- ~t iE 9E 9E dF ib iF df * N fit- O ~ ~ ~ O O ~ r D O X '11 TI < ~ map °om mo~ D_ = Z „~v r31fR m m-mlC o Z m r 2 O m m Oc m m n C rn=~ W T W ,r.~ O 00 N O O ~- J ~ W ~ ~ F ''~ }~ 6 Name Unit Block ;, lot ,~ ,.. Date of Mark-out ' ,,: F Date of Burial ,-" ~ Time ~~. '`" .: Name of Funeral Home CITY OF SEBASTIAN CITY C RECE pOFFICE ~ (~ /, p e~~ N C ~ f f~ ~- d ame ^ Cash o~~l • ° ~~L~ ~ ~ ~ 3 73 1 Date / ; 3 ~ ~Check# 1 No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots ~CX~O.00 Lot/Niche ~,' ~ ,Block ~ ~ '1 ,Unit ~l 001501 343805 Cemetery Fees //-- tDQ~ nb ~j o ~~~ ~j ~Jr-~1S I D57 ~Arn~S~' ~.lqu~' ~~g ~ ~( 3 2 ~ S ~ 3e~ - ~ Zo? t~~~r Total Paid ~ ( W ~ ~ 0 Initials White -Dept. of Origin • fellow -Finance • Pink • Applicant . .~~ ~ ~ 1~~ fl V :~/' ~:_ Name l H ! ~ ~ ,h~ , / ~' / .~ 1! ,X / t~ ' ~%' ,~, f ' ~ -., Lot ~l ~. Date of Marls-out % ~ f ~~' ! `~ '', ~ ~ ~~.~ I Time ~~ .~> ~~if • ( ` '~/'t ~ /;..i c~' ~ ' 1<~ date ~f Eturial Name of Funeral Home --~ ~"' ~ ~" ~ '' ~ ~ ~' - --- CITY OF SEBASTUIN CITY C RECE POFFICE ~ ~ ~ n Name C ~ I ~ r~ _ . //11 C /1 o Cash ~ 13?3 ~ 0 ~L+~ ~~~~_~1. Date O lit O ~ ©V ~cneck # t 13 7 1 D S 7 ,~L~A rAI S l' ~ IV E' No. Amount Paid ~E~ ,__~( 3255' 00,00, 208001 Sales Tax ~ 8 ~ ~ Z o _. 001501322900 Garage Sales 00,50, 34,920 CopieslBid Specs. (~(~ ~ L~ /ilk ~ d 001501341910 LDCICode of Ordinances ~p 7 ~' / v 001501341930 Ektction Qualifying Fees 601010343800 Cemetery L~o}ts ~ , QQ - LotMiche _/ ~ ~ . Bkx~c _~ d . Unit. 001501343805 Cemetery Fees r ~o. od ___ __ Total Paid ~ ~D Initial: White -Dept. of Origin • Tallow -Finance • Pink • Applicant FLORIDA DEPARTMENT OF HEALT State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT i __ (~ (~~ -' j Ci . ~~ ,- A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of THOMAS J. DEVITIS Death OCTOBER 6 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER SEBASTIAN Inst. SEBASTIAN. RIVER MEDICAL CENTER 3. Name of Medical Address Phone Number Certifier MICHAEL A. VENAZIO, MD 8005 BAY STREET, SUITE 1 Medical Examiner X Physician SEBASTIAN, FLORIDA 32958 772-388-2110 4. Name of Funeral Home/Dired Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment SEAWINDS FUNERAL 735 FLEMING STREET HOME SEBASTIAN, FLORIDA 32958 2617 772-589-1933 5. Check Appropriate Box a. © The medical certrfication has been completed and signed. A completed cert~cate of death accompanies this application. 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/ afore F.E. No./Reg. No. Date Signed Direct Disposer ~ //~j 2294 OCTOBER 8, 2007 s. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. A five (5) day extension of time for filing the deatt been contacted by the funeral director and wiu not 72 hours. ~No extension of time for filing the death cent' cafe h Registrar or Subregistrar Signature Permit No. 07-2617-178 ficate (exGusive of weekends) has been requested and granted since the physician has to complete the medical certfication of cause-of-death section of the death certificate within Date Date Certificate Issued: OCTOBER 8, 2007 DUe; OCTOBER 18, 2007 ~. AUTHORIZATION for CREM14TION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date _ Medical Examiner, ,gave authorization by telephone to Funeral Diredor/Dired Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for all cremations. p. CEMETERY OR CREMATORY Method of Disposftion: Place of Disposition SFRASTT A T CEMETERY ®BURIAL CREMATION Signature of Sexton or Person-in-Charge STORAGE OTHER (Specify) Date of Disposition OCTOBER 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 sextons ana re>;urnCu within 10 days to the local County Health Department In.the county where disposition occurred. Distribution: White: Cemetery a Crematory DH-326, 8/97 (Obsobtes all previous ed'dions) Yelbw: Funeral Director or Direct Disposer (Stock Number: 5740-000.032rr2) Pink: Local Registrar ~ `~ rye