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Home My WebLink About1-29-06�?iY of HOME Of PUTCAN ISLAND �Op}� Certificate No. 2073 Mi' OF SUE IS TIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Russell W. & Patricia Farabaugh Watson 3304 E. Derry Dr., Sebastian, FI 32958 (name) (address) in and for consideration of the sum of $1,400.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit 1_ Block 29 Lot(s)Niche(s)_6 & 7 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 22nd day of March 2006. OF S BASTIAN, FLORIDA i1 Cif 1V1.11111G1 ity Manager A' Sally aio, MMC Clerk SEBASTIAN Pieper - Watcon, Patricia Rita `Pat' Patricia Rita ,Pat' Pieper - Watson, died Dec. 2, 2007. Survivors include her hus- band, Russell W. Watson of Se- bastian; daughter, Patricia Wendt of Lincoln, Neb.; and two grandchildren. SERVICES: Private grave- side services were conducted on Dec. 5 at Sebastian Ceme- tery, Sebastian. Arrangements are by Strunk Funeral Home, Sebas. tian. Name Unit Block Lot Date of Mark-out % r Date of Burial Time z2 1h Name of Funeral Home— Ok v P "kJ vyt''j, Authorized by RECEIPT 4046 M wL4f�15 I Name S�dlan 0 Cash Date Q-5-0-7 Check No. Amount Paid R Vj wrwN 001001208001 001501322900 001501341920 001501341910 001501341930 601010 343800 001501343805 Sales Tax Garage Sales Copiesffilid Specs. k3 ;L 9, L4, 'r <0 LDCICode of Ordinances Election Qualifying Fees C (_j Cemetery Lots Lot/Niche Block: , Unit Cemetery Fees 150.00 41: PUMM-RAL HordE CentrW Ave. Total Paid ��T�FL (772) Initials White - Dlpvof Origin • Yellow - Finance • Pink • Applicant - FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY cm Y SE 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 Home ADDRESS: 1623 N. Central Avenue, Sebastian, FL 32958 PHONE #: 772- 589 -1000 (C - One) OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE ANI FOR DECEASED: Lot to Block oZ Q Lot Block Niche Block N S Unit Unit Unit E U NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership i ev �, � "; �� I e 1�� Name Sign ture 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 SIGNAT RE OF LICENSED FUNERA DIR CT Name Signature Date ii ----------------- - - - - -- 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: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CM OF HOME OF PELICAN OSIAN 3' 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 March 22, 2006 Russell W. & Patricia Farabaugh Watson 3304 E. Derry Drive Sebastian, Fl 32958 Dear Mr. & Mrs. Watson: Enclosed is City of Sebastian Certificate 2073 entitling you to full interment rights in Cemetery Lots 6 & 7, Block 29, Unit 1. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Jc h( CC f «, Sally Maio, MM City Clerk SAM:ar enclosure 00F SEISASTL HOME OF PELICAN ISLAND 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 Name(s) Address :33 6 �Y � . IDc2�2 Y %�d'C' �"E'�i9sTi Area Code & Phone Number 7723 31/ ZP Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Ilars ($ . 00 ) on this day of ,. , 20_L(,_ for the purchase of the following described Cemetery Lot(s) and /or Niche(s). I 1 Unit 1 , Block , 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 Vase and Ring for Niches (cost) i nature of l5urchaser Interment Disinterment W O H Circle One C� TOTAL $ LALO Ofty-df Sebastian Service fees are to be paid at time of need only 1: \W W- DATA \Ms - Cemetery\RECEI PT.doc 54 (l ri r� ,y S' ti Ste`• t 'l ' fir-.. � ,••S � T .f i O fn t fnL • u � Q r " OREDA 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 Patricia Rita Pieper - Watson Death Dec. 2 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 3304 E. Derry Dr. 3. Name of Medical Address Phone Number Certifier David DePutro , D.O. 13838 U.S. # 1 Medical Examiner MPhysician Sebastian, FL 772- 581 -6900 4. Name of Funeral Home/Diwcisiepeyal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) 1623 N. Central Ave. Establishment Sebastian, FL 1228 772 - 589 -1000 Strunk Funeral Home 5. Check a. Ll The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Dr. DePutron was contacted on 12/3/07 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that he will complete and sign the medical certification of cause of death wi n 72 hours. C. � was contacted on He/she verified that Medical Examiner, will complete and sign the medical cat10 of gose of death within 72 hours. 6. Funeral Director/ �/ S' nat F.E. No. /Reg. No. Date Signed D oct9isaeeer 44048 12/3/07 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-07 — 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 certificate has been requested. , Date Date Certificate Subregistrar Signature 1''` Issued: 12/3/07 Due: 12/8/07 C. 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 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. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL FISTORAGE Date of Disposition / f{ X5-16 r CREMATION Signature of Sexton or Person -in- Charge OTHER (Specify) 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 retumed within 10 days to the local County Health Department in -the county where disposition occurred. Distribution: White: cemetery or crematory DH 326, W (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 5740. 000-0326 -2) Pink: Local Registrar ,.P" `I Ar-