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Home My WebLink About4-18-39GiY OF HOME OF PELICAN ISLAND Certificate No. 2161 ~~ ~~ ~~ Certificate of Interment Rights IN ACCORDANCE with provisions, of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Andrew &/or Rose D'Hondt 177 Empress Avenue, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4 Block 18 Lots 39 & 40 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 8t" day of January, 2008. SEBASTIAN, FLORIDA r V AI Minner City Manager ATT ST: Sally .Maio, MMC City Clerk a1Y ~ S~BAS~r1A~j ~~ -~~ ~ ~ ~- FIOME OF PEUGN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase ~~~~ew ~ .~'vse D' l-~v~o~~f Name(s) (~~ ,~ m~ress ~v~ vo ~ 3Z Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: %ao '~J ars ($ ~ (SOU °U ) on this `~ day of ~Yt, , 20~ for the purchase of the following described Cemetery Lot(s) and/or Niches . Unit _~, Block ~_, Lot(s) 3~} ~- ~ U 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 - $20) Opening & Closing ~ ~l^U, V V l W~ O H ' Circle One Vase and Ring for Niches (cost) Interment Signature of Purchaser Disinterment TOTAL$~IJ~(,,OD W, i y of Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEI PT.doc FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ma ~~ 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 North Central Ave., Sebastian, FL 32958 PHONE #: 772-589-100'0 (C ck One) OPEN BURIAL LOT Lot 39 Block 18 Unit ~ OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 1 /9/08 @ 11 A.M. FOR DECEASED: Rose M. D'Hondt Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper docu entation of ownership) Name ~, (~ ~ _ c~ (~ 5' ~ Signatur 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 sa e NAPv1E AND SIGNAT RE OF LICENSED FUNER I ~~ ~~ ~ 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: ~ °~- Cem ery exton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. ? 1225 Main Street, Sebastian, FL 32958 (772) 589-5330 – Fax 772-589-5570 January 9, 2008 Mr. Andrew D’Hondt 177 Empress Avenue Sebastian, FL 32958 RE: Interment Rights to Unit 4, Block 18, Lots 39 & 40 Sebastian Cemetery Dear Mr. D’Hondt: Enclosed is City of Sebastian Certificate 2161 entitling you to full interment rights in Unit 4, Block 18, Lots 39 & 40. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Sally A. Maio, MMC City Clerk SAM/jw Enclosures AnrfrewG. D'~[oncft o9-83 ® 7450 ~ose ~ D'J10lLlCt r.r 63-751/631 4 4 Barefoot B(z/d BtuNCH ooeo~ Barefoot''BBay, fL 32976 Q' G ~ O Q 8 cDate n1 Qy f0 tde -S/" ! . - . ..Ogden o¢ ~ ~ `' ~ ~ ~-5^4- a'o ~, v i - ---_ WA~CHOVIA Wachovia Bank, NA. wechovla.com ~oM~.' ~ s ,L~_~ G~_. ~ iur ~:063~07 L3~:ii6° 9 5 I~ ;~ .949693 7450 ®HARUNO /LIBERT' RAIN60W ANDREW L DHONDT ROSE M DHONDT 434 Barefoot Blvd Barefoot Bay, FL 32976 1031 63-751/631 p' BR~AJNCH 00607 r/ O v O Uate PdY t0 the ~ _..,.. .. ... o1r~derof ~ G ~ ~ , ~~ ~~ `~'~/~ U Gyr'~I/' ~~ Dollars , . 8 o I~: o~ - 9~ k WACHOVIA. HIGH PERFORMANCE MONEY MARKET Wachovia Bank, N.A. wachovia.com For ~~-~° ~'~GT~ 1/ Ch's ~ M+ 1' -~~ .063~075~3~.LOLOLL3634420ii' 103L 7 .-i_.' d N S 0 I 9 0 m a s f I 5 ~ ~ a ~ a !J d d d H !~ .,°c 0 0 0 0 0 0 0 0 ° 0 o 0 0 0 0 0 ~ A W W j N N O W OpD tD tD (O i 0 O (T O O O O O ~ Z 3 Iv 1 ~ ~ 3 gmg n v°. ~ m ~ ~ ~ ~ ~ ~ can ~ -n rcn fD n o~ ~+ ~2' O c~ ~ n , ~ o=i Q~_ 3E _~ ~' ^ ~ m ~ q ~ ~ 0 `~ M o- C a c 0 A ~~ mm~ y W ~ O H T ~..~ '-' s ~Z m 1 '~'^ v, w t&t News You Can Use -Page 5 Local Services provided by AT&T Florida ANDREW D'HONDT Account Number 772 589-2485 063 0455 Amount Monthly Statement Account Summary Previous Balance .. ................................ $119.92 as of December 19, 2007 ' ' -119.92 Payments (Posted as of December 19) .................... . $.00 Balance .................................... ...... Current Charges Summary: AT&T Companies $29 52 Local & Local Toll (Page 3) ......................... . 3.50 Long Distance (Page 4) ....................... Total Current Charges ... $33.02 AT&T Questions? Customer Service: 1 888 757-6500 PIN; 0435 Outside Calling Area: 1 800' 753-0710 Repair: 611 Online: www.att.com at&t ,v._;,, Account Number 772 589-2485 063 0455 Page 1 of 7 Convenient Payment Options: Online: www.bellsouth comlpay Pay By Phone: 1 888 757-6500 To be paid by your bank on or after January 4. P.O. Box 105503 Atlanta, GA 30348-5503 ~n~~nr~r~~r~nr~~~r~n~u~i~n~~nr~n~u~r~~nr~~ur~n~r X003963 1 AV 0.312 81121900.014 ANDRER D'HONDT RM 5 177 EMPRESS AVE SEBASTIAN FL 32958-5642 77295892485063045021270128D],80100DDDD000000000000000003302 I~6 ~ ^`°`a`"~`~ (b) Your refund will be paid within 45 days from the date we receive your written notice of termination; however, in no case will your refund be paid before your room is vacated. (c) If we change the ownership of the facility, you may either remain in the facility, in which case all credits will be transferred to the new owner, or you may be discharged from the facility in which case your refund will be made to you as provided in the proceeding paragraph. (d) [n case of the closing of the facility, you will receive the prorated refund based on the daily rate within 10 days of the closure of the facility. 20. SERVICES FOR WHICH THERE IS AN ADDITIONAL CHARGE: A. Late payment fee for delinquent accounts. B. Guest meals C. Cost of telephone services in your room and long distance calls made from our general telephone. D. Laundry services for personal belongings wl~icl~ is not performed by us on our premises, such as dry cleaning. E. Maintenance and repairs of your personal property, Hairdresser and related personal services. G, Transportation for personal appointments. ~. Damages to the facilities. Storage costs for abandoned property. FLORIDA LAWS ON ADULT CONGREGATE LIVING FACILITIES This facility and all other Adult Congregate Living Facilities in the State of Florida are regulated by Chapt r 400, Part 11, of the Florida Statutes. A copy of the law is on file in the facility. The law gives you or your I gal representative the right to inspect our most recent financial statement and inspection report before lignin this Agreement. A copy of this contract (including the house rules), the residents' bill of rights, and the procedures for ng Long Term Ombudsman Council have been received by me or my agent. This Agreement is executed this _ ~~~~~ ~z ____day of (V~/~~y-~~ ~ % ~. ,20.0/_ Witne ed,f~y: Facrli Representapve tartness A/ f~ / 1 ~L7 ~ 2.... _ 1//r{!/~ /lam `~. Yi ~..~1.~ ~tesident of Re~ponsibte Party (((///~~~ 8 ~~ ~b ~a GUARANTY In consideration of the admission of the Resident mentioned above the undersigned hereby guarantees paym nt to Pelican Garden, LLC of all indebtness arising by virtue of the residency of the Resident and agrees to the ollowing: 1, The undersigned shall pay all costs and legal expenses, including reasonable attorney's fees, which may occur in enforcing the obligations contained in the guaranty. 2, We may demand payment directly under this guaranty without first seeking payment from the resident or other guarantors. 3. This guarantee shall retrain in effect until all payments Dave been made to us. 4. Obligations under this guaranty shall survive tl~e death of the undersigned and shall be binding on his/her estate or on any surviving guarantor as though death had not occurred. 5. Notice of acceptance of this guaranty is waived. Date ~ n igne Name Address City, State, Zip_ Phone E-mail 9 Obituaries ~ Death Notices ~ Newspaper Obituaries ~ Online Obituaries ~ Newspaper D... Page 1 of 1 ROSE M. D'HONDT Rose M. D'Hondt, 90, died Jan. 5, 2008, at the VNA Hospice House, Vero Beach. She was born in Rochester, N.Y., and lived in Barefoot Bay for 24 years, coming from Hollywood. She was a member of St. Luke's Catholic Church. She was a member of the Ladies Guild, Barefoot Bay, and of the Upstate New York Club and the Italian-American Club. Survivors include her husband of 24 years, Andrew D'Hondt of Barefoot Bay; daughter, Elizabeth VanZile of Barefoot Bay; stepdaughter, Barbara Maginn of Barefoot Bay; brothers, Chuck DiLella, Anthony DiLella, both of Rochester, N.Y.; sister, Mary Dewey of Rochester, N.Y.; three grandchildren; and eight great-grandchildren. Memorial donations may be made to the VNA & Hospice Foundation, 1110 35th Lane, Vero Beach, FL 32960. SERVICES: A visitation will be from 10 to 11 a.m. Jan. 9 at the Strunk Funeral Home, Sebasitan. A funeral service will follow at 11 a.m. in the funeral home chapel. Interment will follow in Sebastian Cemetery, Sebastian. A,A~ Published in the TC Palm on 1/8/2008. Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact Legacy.com • Terms of use Fvwerer! by L~`~;t1c"t~.GOt11 obituaries nationwide Back http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=100873... 1 /8/2008 Name ~ 1~'~ l_: ' ~ ~~ ~ ~ I`) ~ /~ ,~ ~'.~ ~J /~%:,~ 1/ Unit !! Block ` ~, ~"' '~ Lot f Date of Mark-out l /~~~' ~' '~ Date of Burial i! `T ~~' cam' Time ~-~'~~~ Name of Funeral Home >~ / '~ " ~f ~/ r Authorized by t^ ` s ` FLORIDA DEPARTMENT OF HEALT 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 Rose M. D'Hondt Death Jan. 5 2008 2. Place of Death City, Towri or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. V NA Hospice House 3. Name of Medical Address Phone Number Certifier Melissa Dean, M. 1265 36th Street Medical Examiner Physician Vero Beach, FL 32960 772-567-6340 4. Name of Funeral Home/~iwaE9ispos7ll Address Fla. Lic. No.lReg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 1228 772-589-1000 5. Check Appropriate Box a. ~ The medical certification has been completed and signed. A completed certificate of deatn acxompan~es mss application. b. [~ Lisanne was con4aded on 1 /7/08 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Dean 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 cat' use.of death within 72 hours. 6. Funeral Director/ S' n F.E. No./Reg. No. Date Signed p 44048 1/7/08 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No.1228-08-0006 A five (5) day extension of time for filing the death certificate (exGusive 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 Crtficate Subregistrar Signature ~ Issued: 1 /7 /08 Due: 1 / 12 /08 c. AUTHORIZATION for CREME4TION, DISSECTION, or BURIAL-AT-SEA Approval Number. Date D. Medical Examiner, ,gave authorization by telephone to Funeral Director/Dired Disposer. Date The Medical Examiners approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for ail cremations. Method of Disposition: ~- BURIAL CREMATION Signature of Sexton 1 or Person-in-Charge J) STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition / /9~6 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 or Crematory DH-326, 6/97 (Obeoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 5740-0064326-2) Pink Local Registrar ,~,~ `~ ~