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CITY OF SEBASTWN
CITY CLERK'S OFFICE 3 3 9 8
___ _ ___ _ ._ RECEIPT
-- -
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^ Cash
i Name
-_ - _ I
Date
K. ~,-- -
--_ - ~ Amount Paid
No.
- _- - ~ _ _ _ _ _ _ -_ _ _ _ ~; 001001208001 Sales Tax
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' ~kl`r'~-.tit. o~. , ~_~ ~C. 3 ~7 . __T ~. I
-- I 001501322900 Garage Sales
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~ - - -- -- 001501341920 Copies/Bid Specs.
1• S22t1~ er-¢- - ~ ~a0 I d S ~ ~ 001501341910 LDCICode of Ordinances
~ I
t - ~`'- ~ ~'1 _ _ _ -- 001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots
- - _ LotMiche ~ Block .Unit
__ _ Q.''y..yC> _ - - _.
001501343805 Cemetery Fees ~~~~~ ~
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Initials
_ _ -
White -Dept. of Origin • Yellow -Finance • Pink -App cant
~'
Melvin Hugh Barnes,
Micco
Melvin Hugh Barnes, 69,
died Aug. 16, 2005, at. Sebas-
tiara River Medical Center hi
Roseland.
He was born in Virginia '
Beach, Va., and lived in Mic-
co for 49 years, coming from.,
Portsmouth, Va. ".
He was a,carpenfer and
worked in'
;~ ` 'the`construc-
tiom Indus-
try, <He also'
worked in
the Mainte-
riahce De`
partrrienf'af
The'New
Piper Air-
craft in Veru Beach for 15
years. He was a member of
River'Of,Life Fellowship in
Barefoot'Bay.
Survivors include his wife ,
of 15 years, Shirley Zirkle
Barnes; daughter, Melissa C.
Young of Micco; stepdaugh-
ters, Linda Futch, Betty
Drawdyand Cindy Hender=
son, all of Vero Beach, and
Pat Yates of;Okeechobee; '
stepsons, Robert Hardwood
and Donnie Hardwood, both
of Vero Beach; brother,
Frank Barnes of Vero Beach; ,
sisters, Melissa Woolard and' '
Betty Tatum, both of Virgin-
ia:Beach; 11 grandchildren; r
and numerous great-grand-
children.
He was preceded iri death
by his first wife, Helen
Barnes.
SERVICES: Visitation will
be from 11 a.m. to 2 p.m. Aug:
20'at the Strunk Funeral
Home, Sebastian: A service
will follow at 2 p:m., in the
funeral home chapel with the .
Rev: Roger Yates and the
Rev. John Morine officiating: -
Burial will follow in Sebas-`
tian`Cemetery; Sebastian.
Name ~ ,~ ~•< Y / X41 rt ~ ~ ~,~t~''~" ~,~' ~~~ ~~~
Unit
Block %_~
Lot
Date of Mark-out
Date of Burial ~d ~~ ~~ ~~ Time ~'~oC~ ~'C~/ ,,,,%
.~.-""~_ ~`~
Name of Funeral Home~_~QG//+./ /'t:_.-
Authorized by _, .
Paid by CEMETERY Receipt No...: d4• , , 10 /S /84
• ......Dated .... •
List Price$„• 450.00 .•..•••....•........ NO.
.......... Maximum No. Putial Spaces . -2-
NetPaid$ ,•• 450.00 ••~•••••"""'•
' ' ' ' ' ' • • • • • Monument permitted . • • , FI a t ~ O
••••••••......... Melvin Barnes ~
Lots 1 & 2, Block 37, Unit 2 3715 Church St.
(Data above ffiL line for Ci Micco, Florida
___- - ty Record only)
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
1. Name of First
Deceased
Melvin
Middle Last Date Month Day
Df Aug. 16
Hugh Barnes Death
Year
2005
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 Medir~;Chard
tC Cunningham, D.O Address901 37th Street Phone Number
Certifier Vero Beach, Florida 32960 772-978-5600
Medical Examiner Physician
4. Name of Funeral Home/[~ir~t-Bisryesal Address1623 N. Central Ave. Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment
Strunk Funeral
Home Sebastian, FL 1228 772-589-1000
5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~ Austine was contacted on 8../16/05
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Cunningham 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
me ical ificati o use of eath within 72 hours.
6. Funeral Director/ gn r F.E. No./Reg. No. Date Signed
[~est+^,ispc~r /I,,. _ 1862 8/16/05
B. .BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-05-0360
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.
~t~~ Date Date Certificate
Subregistrar Signature (~ Issued: 8/16/05 pye: 8/21 /05
-t-1 -
c.
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
STORAGE
OTHER (Specify)
`~ r
CEMETERY OR CREMATORY
Place of Disposition S/ebastian Cemetery
Date of Disposition ~ / ? r1 ~~ ~
This permit must be endorsed by the Sexton or person-in-charge (or by the FL~neral 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 or Crematory
DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar p"s`1rd `I~ P°1°
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
~~ .-. _
t~~ ~ '-%~ , ~'ca;
State of Florida, Department of Health, Vital Statistic
APPLICATION FOR BURIAL -TRANSIT PERMIT