HomeMy WebLinkAbout4-10-34HQME OF PELICAN ISLAND
Certificate No. 2152
~~ ~~'' ~~
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Oscar Villalobos, Jr. 3747 Chisholm Road, Iron City, TN 38463
(name) (address)
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit_4_Block_10_Lot 34_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 22~dday of October, 2007.
CITY~F SSTIAN, FLORIDA A'
i. / ~
P'
~I Minner
City Manager
Sally Maio, MMC
itv Clerk
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HOME Of PE4ICAN ISWVD
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
'~; SCc~;~ Ilr. ~ ~~a ~c~ ~c~ S ~~
Name(s) ~
~~7~~ ~ ~2~'S~~I~-~ ~~
Address
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Area Code & Phon Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
~1~~("'~~~l~a,~.!~C~-ti<L~ Dollars ($ ~~.~~C10,~(~ )
on this ~' ~ day of I - ~'~~~- , 20~ for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit ~, Block ~ L , Lot(s)~_ 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 ~ ~ cJ ~ ~ W O H
Circle One
Vase and Ring for Niches (cost) Interment
Signature of Purchaser
Disinterment
TOTAL $ ~~~ I ~ ~ L C~
Cl'fy_of Sebastian ( '
~ J~
Service fees are to be paid at time of need only
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Obituaries (Death Notices (Newspaper Obituaries (Online Obituaries ~ Newspape... Page 1 of 1
OSCAR "EL YAKI DE SONORA"
VILLALOBOS SR.
Oscar "EI Yaki de Sonora" Villalobos Sr., died Oct. 17, 2007, at Sebastian River Medical
Center in Sebastian. He was born in Bavispe, Sonora, Mexico, and lived in Vero Beach
since 1972, coming from Utah. He worked in the agriculture industry as a crew leader.
Survivors include his wife of 36 years, Lydia Villalobos of Vero Beach; sons, Oscar
Villalobos and Eberardo, both of Phoenix, Oscar Villalobos ]r. of Iron City, Tenn., Victor
Villalobos of Fellsmere and Mickey Villalobos of Vero Beach; daughter, Daisy Maqdaleno of
Vero Beach; brothers, Ruben Villalobos of Oregon and Armando Villalobos of Phoenix;
sister, Guadalupe Cruz of Phoenix; and 17 grandchildren. SERVICES: Visitation will be
from 5 to 7 p.m. Oct. 22 at the Strunk Funeral Home in Sebastian. A Mass of Christian
burial will be celebrated at 11 a.m. Oct. 23 at St. Sebastian Catholic Church in Sebastian.
Burial will follow in Sebastian Cemetery.
Published in the TC Palm on 10/20/2007.
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http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=9... 10/22/2007
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
llfY Y
HOME OF PELICAN ISLAND
For information contact:
Kip Kelso -Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME: Strunk Funeral Iliom+e
ADDRESS: 1623 Id. C~entrai ~1v~nu~, Sebastian, FL
PHONE #: 772-583-i®®ti
(Check One)
~/ OPEN BURIAL LOT Lot ~~ Block ~3 Unit '~
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: f3ctober 23, 20sQ7 - 13 a.ra~.
FOR DECEASED: Oscar Villalobcas
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
~~~ia ldgllal+~b~s~
Name Signature Date
I certify that I have determined the ownership of the above described site, that all site fees and
administrative fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNE DIRECTOR:
la ~~ .
Cem ery exton Date
®avici L. Hincee~on ~ -
4U 13 Q7
Name Signature Date
----------------------------------------------------------------------------
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid:
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
FLORIDA DEPARTMENT OF
HEALT] Sta
HTaRANSIT PERMIT cs
APPLICA TION FOR BURIAL
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased
C?scar
Yiilalobos. Sr. of
Death
Oct. l7 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian ~2iVer SebaStiarl Inst. S@baStiarll River ~ecilcal Center
3 Name of Medical Address Phone Number
. Certifier '~~~ ~rittl~C'-ttat't, a • ~ • ~ • 200 S.35th Street
Fort I'iierCe, FL 772-455-7378
Medical Examiner Physician
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1523 ~I. Central 1~ve-
Strunk '1=~IZt~ra1 Flo a Sebastian, 1=L 122 772-589-1®~~
5. Check a. The medial 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
medi cert' se of death within 72 hours.
6. Funeral Director/ Si r F.E. No./ . No. Date Signed
/f aoa8 10/17/07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-018
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 certfication of cause-of-death section of the death certificate within
72 hours.
~No extension of time for filing the death certificate has been requested.
Registrar~br Date Date Certificate
Subregistrar Signature Issued: 10 / 17 / 07 Due: 1®/ 22 / 07
~. 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. Awaiting period of 48 hours after death is
required for all cremations.
D. CEMETERY OR CREMATORY
Met odof Disposition: Place of Disposition Sf;baStian Cefirtetery
BURIAL STORAGE Date of Disposition `b,~~3/0
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge ~.~,' Q .
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 a Crematory
DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral DMedor or Direct Disposer
(Stock Number 574Q-000-0326-2) Pink: Loca! Registrar ~~ i~ M