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Home My WebLink About2-37-15 Name .f> ,~~ '~(~ ~~ i s ~ rtr~,f' ~'~ ~~ O ! "~ Unit Lot ~,, ~ Date of Mark-out f, i, c, ~ ~ ~i Date of Burial ~-~~ ~~ t ~~ ~ Time ~ ~ ' r~'' ~ i ~ ~~'~~ ' ''~~ ,~ Name of Funeral Homg ~ ~ ,; "~~ /`~ ~+ \~ Authorized by k- ~l 12/23/2007 05:52 5615892583 STRUNK FUNERAL HOME PAGE 01 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY . ~fi v ' NOME Oi PE LI~AN ISUN~ Fo- information contact; Kip Kelso -Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office City Hall, 1225 Ma;n Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: Strunk Funeral Home ADDRESS 1623 N Centre Ave Sebastian, F_ L 32958 PHONE #: 772-589-1000 (C ck One) OPEN BURIAL LOT Lot 15 Block 37 Unit 2 OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block ~ Unit N S E W 6URIAL DATE AND SERVICE TIME; FOR DECEASED: Alexa N. Schauman Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) 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 SIGNATJtJRE OF LICENSED FUNEI~ ~~fOR: ~~ Name igrlature ~L'G~ 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 th all fees have been paid: - i S off. Cemet y Se on pate This form to be provided to Clerk's Office by Sexton For permanent record upon completion. ~; 11 ~ _.. ~T ! ~: . .~ (~ - ~ n I; ~' jl ~: f~ W ~} ~ ~ ~' r', y • • AFFADAVIT THIS IS TO CERTIFY THAT I , ~~ ~ ~ C~t,t_hnQM/ REQUEST TO BE INTERRED IN LOT /.S BLOCK, UNIT ~ AND THAT I UNDERSTAND THAT IT IS THE GENERAL POLICY OF THE CEMETERY THAT THE WOMAN BE INTERRED TO THE LEFT OF HER HUSBAND. ~a~ ~~ ~ DATE ll /~ ~~~~' - Notary Notary Public, State of Florid My Commission Expires Oct. 22, 1981 ~p0u0 in~~ iroy fa~p. IIliupn4o. bfr °~.,... ~ti1, f!, , _. r ;+~~ SCHAUMAN, FJm, H, & P_Iexa 14445 80th Ave. Sebastian, Florida 32958 Lots 15 & 16, Block 37, Unit 2 Mrs, Schauman requests to be buried in Lot 15. Deed #1010 Receipt #375 Paid by CEMETERY Receipt No. , , ,375 List Price S .. , 3 0 0:00 ... ........Dated ... 6 /5 /84 _ ..... . Net Paid S .. , 300:00...... , Maximum No. Purial Spaces , .. , ..2 ......... . Monument perrrutted . -f1 a t- Lots ZS & 16, Block 37, Unit 2 ........... .......... (Data above tf~la li ne i'or City Record only) NO. Wm. H. & Alexa Schaunfa~ - 14445 80th Ave, Sebastian F'Ia, 32858 A i , Cite of Sebastian James Gallagher POST OFFICE BOX 127 ^ SEBASTIAN, FLORIDA 32958 Mayor TELEPHONE (305) 589-5330 June 8, 1984 Mrs. Alexa Schauman 14445 80th Ave. Sebastian, Florida 32958 Dear Mrs. Schauman: Attached, please find an Affidavit that needs to be signed by you and notarized. Please attach it to your deed. Also, at your convenience, we would like a copy of it returned to City Ha11. This is a new policy we have started so that there will be no questions as to why you will be interred where, by general policy of the Cemetery, your husband will be interred. Thank you for your help and prompt attention in this matter. If you have any questions, please feel free to call. Very truly yours, -~ : :~-~ f~~- K. Nappi City Clerk's Office k THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida ~..~' 7 S RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: / ~c ~~' '~~~_s~ll~2~-~` -~......- i o d Dollars !$ ~~. n n ) FROM: ~J~j~,r... ~~ ~ ~1~ti.a S ~ ~~~~ ~ ~ S~.~os~~ ~.~ ~ ~ ~~.~ S, Y on this S +H day of ~i.,~vt , 19 Spy for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot (s) i~J S ~' (~_ B1ock~f 3~ vnit(i q~. Purchase Frice:.~.Rp . n~ Dollars ($ ~ a D• cS h ) Terms and'conditions of sale: Ca~~~ ~` S17 - ~ 300-a0 This contract sha11 be binding upon both parties, the seller and the purchaser, when approved by the owner pf the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: ~~ ~ ~ x c. ~ )C~l y~~u.w. ¢~ The City of Sebastian agrees to se11 the above mentioned property to the above ru~med purchaser(s) on the terms and conditions stated in the above instrument. City o S ian Witness Ubituar~es ~ lleath Notices ~ Newspaper Ubituar~es ~ Unlme Ubituanes ~ Newspaper ll... Yage 1 of 1 ~~ ViewjSg.n Guestbook ALEXA SCHAUMAN " ALEXA N. SCHAUMAN MELBOURNE BEACH Mrs. Alexa N. Schauman, 79, of Melbourne Beach, FL, died Wednesday, December 26, 2007 at her res idence. She was born Sep tember 20, 1928, in Passaic, NJ, and lived in Melbourne Beach for 24 years, coming from Indian Mills, NJ. Mrs. Schauman was a broker at Prudential Bache. She was a member of Immaculate Concep tion Catholic Church, Melbourne Beach. She is survived by her hus band of 58 years, Mr. Bill Schauman of Melbourne Beach; daughter, Sandee Schauman of Melbourne Beach; sons, William J. Schauman of Melbourne Beach; Nick Schauman of Indi an Harbor Beach; nine grand children, and four great- grandchildren. The family will receive friends from 2-3 p.m. on Saturday, December 29th, followed by a funeral service at 3 p.m. at the Strunk Funeral Home, Sebas tian, FL. Burial will follow at Sebastian Cemetery, Sebastian. Family suggest that memorials may be made to William Childs Hospice House, 381 Medplex Pkwy, Palm Bay, FL 32905. Published in FLORIDA TODAY on 12J28/2007. Notc....e.... • Guest Bao_k. • Flowers • _G_ ift S_h_o..p. • Charst.es Today'_s_FL.ORIDA TODAY ob_tu_ arie Questions about obituaries or Guest Books? Contact_Legacycom • Terms_of use obituaries ~sateanwide Back http://www.legacy.com/floridatoday/Obituaries. asp?Page=LifeStoryPrint&PersonID=... 12/28/2007 ITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name Date ~- No. 001001208001 Sales Tax 001501322900 ~ Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualihring Fees 601010343800 001501 343805 Cemetery Lots LotlNiche 15 . Block ~_, Unit • Cemetery Fees aw Initials White -Dept of Origin • Yellow -Finance • Pink • Applicant ~405~ _ ~~ ~-~ _ - - Amount Paid (~ , " a ~ / ~ S ~~~.~. MaM • far ^_ S"~e.~u -- ~ ~ a9 01 ~~oL (3116 3? ~o ; t ~' E`9.~.~. t~ 1 a t ~ ~~~ - ~ No. ~: _~L~- ~; caen Check Total P FLORIDA DEPARTME OF HEALT State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT A. ('TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Alexa N . Schauman Deatn Dec. 26 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Melbourne Beach Inst. 8585 Hi hwa A1A 3. Name of Medical Address Phone Number Certifier David Packey, M.~p. 1333 Pine Street ntu~tst ~„sm;~. ot,,..t.as., Melbourne, FL 32901 321-984-9400 4. Name of Funeral H Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL .1228 772-589-1000 5. Check a. ~ The medical certificattion has been completed and signed. A ~mpleted certifi(~te of death accompanies this Appropriate application. Box b. ~ Melissa was contacted on 12/29/07 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. P ackey 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 rtifi n use of death within 72 hours. 6. Funeral Director/ ig F.E. No./Reg. No. Date Signed DireotDlsp~''' 44048 12 /27 /07 B. BURIAL -TRANSIT PERMIT ermission is Hereby granted to dispose of this body. Permit No. 1228-07-0526 A five (5) day extension of time for filing the death certificate (exGusive of weekends) has been requested and granted since the physician has n contacted by the funeral director and will not be able to complete the medical oertifieation of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death osrtficate has been requested. Date Date Certficate SubregistrarSignature ~ ~.. Issued: 12/27./07 Due: 12/31/07 r~ 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 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. Method of Disposition: BURIAL CREMATION Signature of Sexton or Person-in-Charge This permit must be endot within 10 days to the local CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery STORAGE Date of Disposition jo~ /'' ~/D OTHER (Specify) DH' 326, 8/97 (Obsolstes aB previous ed'Aions) (Stock Numt»r. 5740.000•~i28-2) the Sexton or person-in-charge (or by the Funeral Dirnctor/Direct Disposer when there is no Sexton) and r Health Department in •the county where disposition occurred. Distribution: While: Cemetery or Crematory Yslk>w: Funeral Director or Direct Disposer Pink: Loeal Registrar ~~ ~ „~