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Certificate No. 2161
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby cer.tified 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
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V AI Minner
City Manager
ATT ST:
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Sally . Maio, MMC
City Clerk
Name
Unit_
Block
Lot -
Date of Mark-out i ���/J�
i '
Date of Burial � /16 l �� ' _Time �� � o
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Name of Funeral Home s r!p u h��
Authorized by
CITY OF SEBASTIAN
CITY CLERK'S OFFICE � 4 7 7 9
RECEIPT
Name S�j'�'u,nk�l�'r1�r1d�'
Date � - � � ' 1 _ �
No.
001001 208001
001501322900
OOt501341920
001501341910
001501 341930
601010 343800
001501 343805
❑ Cash
[)(Check #_ 5 9 � �� I
Sales Tax
Garage Sales
CopieslBid Specs.
LDCICode of Ordinances
Election Dualifying Fees
Cemetery Lots
LoUNiche�, Biock_J_Q__, Unit!
Cemetery Fees
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Amount Paid
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W' Totai Paid �j d. UO
Initials
White — Dept. of Origin • Yellow — finance • Pink - Applicant
ANDREW L. D'HONDT
Andrew L. D'Hondt, 96, died January 13, 2013 at William Childs
Hospice House in Palm Bay. He was born November 10, 1916 in
Rochester, New York and lived in Barefoot Bay coming from Rochester,
New York in 1983. He served in the US Army during WWII in both the
European and Pacific Theaters. He retired from Eastman Kodak
Company, Rochester, NY after 27 years.
Mr. D'Hondt was a member of the Knights of Columbus, Rochester, NY,
the American Legion, the Italian American Club of Barefoot Bay and
was Past President of the New York State Club of Barefoot Bay. He also
volunteered at Dodgertown in Vero Beach.
He is survived by his daughter, Barbara Maginn (Patrick) of Geneseo,
NY and Barefoot Bay, FL, step-daughter Elizabeth VanZile of Barefoot
Bay, FL, Granddaughter Colleen Wiggs (Wayne) and her children
Autumn Wiggs and Harley Wiggs, Granddaughter Kerry Geedy
(Michael) and her children, Meaghyn and Heather Graupman , all of
Spencerport, NY.
He was preceded in death by his wife )ohanna in 1982 and his second
wife Rose in 2008. Also preceding him was a brother, George.
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EL4RID�DFI'dELCGiE�iOP�, ,�' State of Florida, Department of Health, Bureau of Vital Statistics
HE�LT BURIAL TRANSIT PERMIT
DATE PRINTED: January 14, 2013 TRACKING NUMBER: 2013006759
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ANDREW L D'HONDT January 13, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
BREVARD PALM BAY WILLIAM CHILDS HOSPICE HOUSE
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589-1000
1623 N CENTRAL AVE
SEBASTIAN, FLORIDA, 32958
Funeral DirectorlDirect Disposer Fla. Lic. No./Reg. No.
TIMOTHY W. MARVIN F022789
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: 2o�3-FOa�s7o-5o�0
. QG / �� • Date Issued: January 14, 2013
({, ��� J
Meade Grigg, 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
PIaCe Of DISpOSitlOn: SEBASTIAN CEMETERY �� �'
Method of Disposition: BURIA� Date of Disposition: I � c� ��
Signature of sexton or person-in-charge (or by the funeral director/direct disposer when there is no sexton)
DH 326E, 1/11
64V-1.011, Florida Administrative Code
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNIClPAL CEMETERY
��
HOME OF�PELICAN ISIAW
For information contact:
Kip Kelsa - Cemetery Sexton
Sebastian Municipa/ Cemetery
(772) 589-2545
Cify Gsrk's O�ce
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772} 388-8295 or 388-8214
Fax: (772) 589-5570
4��...�.»�i Y 4s�±�
FUNERAL HOME: ���� HOh1E & CR����; ��y
� �'�" � � • -en ra Ave.
ADDRESS: SEBQSTIA
PHONE #: , 58g`��
( eck One) �J
OPEN BURIAL LOT Lot � Biock �� Unit " T-
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Bloek Unit
BURIAL DATE AND SERVICE TIME: I� `1 �� ` - r � S� E __'W � L�O ��
(�-,)—
FOR DECEASED: �iU�%LEcJ �-. I� ��pN[��
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of owne ip)
�� ���C'���'t � � C� i n � �`,��,� a � �';�, t�� C� � n-„� � S � � �-) i �
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 SIGNATURE OF LICENSED FUN L DIREC70R:
J`�'�c.i Gti • l/1/( rA-2-v r iJ " t��i /3
I/MD ��
Name ignature D te
Cemetery Sexton Certification:
I certify that I have checked the ownership inforrnation by viewing the owner's deed and confirming
with Cferk's office and th t all fees have been paid:
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Ce tery ex on � Date
This form to be provided to Clerk's Office by Sexton for permanent record upon cornpletion.
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