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Home My WebLink About4-24-28Name �NL�� ,%i o ��c° ✓�%� �-%�� D Unit Block Lot 5 - Date of Mark -out 7!ZZ,^' Date of Burial J/bo/ Time !•d1�' D Name of Funeral Home Authorized by lb -S General Information Full Name Date of Birth Date of Death Service Information When Location Address Page 1 of 1 IN MEMORY OF THEODOOR VAN GELDER Theodoor Van Gelder Saturday, June 11th, 1927 Tuesday, February 28th, 2017 Monday, March 6th, 2017, 1:00pm Seawinds Funeral Home 735 South Fleming Street Sebastian, FL 32958 Map & Directions Share on Facebook This obituary is protected by copyright by Sea%inds Funeral Home & Crematory. Proudly Serving the Communities of Brookside, Cummings, Fellsmere, Florida Ridge, Gifford, Indian River Shores, Nevins. North Beach. Orchid, Oslo, Riomar, Roseland. Royal Poinciana Park Sebastian, South Beach, Vero Beach, Veto Lake Estates, Wabasso, Wabasso Beach, Winter Beach Micco, and Gran. Seawinds Funeral Home & Crematory is located in the state of Florida, United States. All rights reserved. This obituary is also archived at ObitsforLife.com Seawinds Funeral Home & Crematory Print http://Www.seawindsfh.com/book-of-memoriesl2862962Nan-Gelder-Theodoor/service-det... 3/6/2017 Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta(a citVofsebastian.orq Funeral Home: 1-5E'`fWOWDJ rvNe.VAI i. H/GiIpE . Address:?i�.50�/1/✓ Llc'�� ST SEw I L, Phone: ^lam - SRsi-/933 (Chet Open Burial Lot Lot216 Bloc_ kZ7W4/ Unit Open Cremains Lot Lot_ Block_ Unit_ Open Columbarium Niche Niche_ Block_ Unit_ (Circle) N S E W Burial Date and Service Time: �' Q0%" '3—` — � 7 Deceased Name: TiYE70d4111PO Y4IVC- 6 0-f e. Name and Signature of Lot Owner or Representative: (Must provide proper documentation of ownership) Print 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 authorized opening of same. Name and Signature of Licensed F w ra Direct r. :p0gyid All.u/v//.y Ce _ / - 1 Print Name Date I certify that I have checked the ownership information by viewing the owners deed and confirming with Clerk's Office and that all fees have been paid: Cemetery Sexton Certification: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Black Matte Exterior-Rosetan Crepe Interior 20 gauge carbon steel - non Apollo Black Matte New Pointe gasketed $1,795.00 WARRANTIES Our funeral home makes no representations or warranties about the protective value of certain caskets or outer burial containers other than those made by the manufacturer. The only warranties expressed or implied, grant in connection with goods sold with this funeral service are the written warranties, it any, extended by the manufacturers thereof. No other warranties and, specifically, no warranties of merchantability and fitness for a particular purpose are extended by the seller. Clifton Taylor Stratus PECAN LINFORD CHERRY PINE CREMATION CASKETS Hardwood Veneer Charpente Rosetan Crepe Interior— Batesville LifeView Cap Panel Hardboard- Woodgrain Finish Batesville Rosetan Crepe Interior Fiberboard — Woodgrain Finish Batesville Optional Ivory Crepe Interior CREMATION RENTAL. CASKETS $2,095.00 $1,295.00 $545.00 Pecan Wood Finish, Velvet Interior, Swing Bar, Hardwood Dark Hardwood, Rosetan Crepe Interior, Cremation Container Included Chevy Wood Finish, Velvet Interior, Stationary Handles, Hardwood Pine Wood Finish, Crepe Interior, Stationary Handles, Hardwood WARRANTIES $ 895 $ 895 $ 695 $ 495 Our funeral home makes no representations or warranties about the protective value of certain caskets or outer burial containers other than those made by the manufacturer. The only warranties, expressed or implied grant in connection with goods sold with this by service are the written warranties, if any, extended by the manufacturers thereof. No other warranties and, specifically, no warranties of merchantability and fitness for a particular purpose are extended by the seller. CITY OF SEBASTIAN 10419 ADMINISTRATIVE SERVICES RECEIPT Name �C_AWtNZS/4tkn;UCash I, Date �6Ii7 Check# a3` 6 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 001:t01 343905 oil:- \ # L 2 1 .00 LINert+ gikq - Lar A8 ' fi Total Pal �W. In' ials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant Certificate No. 2160 PIN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Theodoor VanGelder 6045 River Run Drive, 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 lot: Unit 4—Block-24—Lot-28 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 7th day of January, 2008. CT%/fY Of EBASTIAN, FLORIDA Al Minner ity Manager ATT S . Sally . Maio, AMC City Clerk art OF SERASTIM HOME OF PWC M MUM 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 -Oie_bc�oo r Hari 6 e lder Name(s) &C,q5 Ki�,tr pan Dr SSfjoa.5tl'ay. F-L- 32g5Y Address ( -7-7,2 ) 5Fs9- Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: w�4 u a'P-d �X16-6 Dollars on this V'k day of -ah. - , 20 08 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit Block Lot(s) c� Niches) 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) Interment Disinterment W O H Circle One TOTAL $ L, ()061 ay / Signature o urchaser v of Sebastian Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEI PT.doc Total Paid 1:2. 0000 ' Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 3952 a%1 � d/ e r Name V l 11 Cash Date -Ta ti �(Z / 7 , � C� �v` 1VCheck # 427q 7 No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots 200 1111 Lot(Niche �, Block 2 Unit 001501 343805 Cemetery Fees Total Paid 1:2. 0000 ' Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant State of Florida, Department of Health, Bureau of Vital Statistics '^�La" BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: March 2, 2017 TRACKING NUMBER: 2017035505 1. DECEDENT INFORMATION Name of Deceased Date of Death THEODOOR VAN GELDER February 28, 2017 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE Name and Address of Funeral Honr irect Disposal Establishment Fla. Lic. No./Reg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No. DAVID W. WALLACE F046853 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: March 1, 2017-5053 �— Date Issued: March 1, 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY Method of Disposition: BURIAL Date of Disposition: EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10/12 64V-1 011, Florida Administrative Code