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HOME OF PELICAN ISLAND
Certificate No. 2343
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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 certified that:
.7eanie Colberg
885 Gladiola Avenue
Sebastian, FL 32958
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 28, Lot 19
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 6th day of August, 2012.
CITY OF SEBASTIAN, FLORIDA
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� AI Minner
City Manager
ATTEST:
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Sally . Maio, MMC
City Clerk
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GLORIA E. RAZZINI
Miss Gloria E. Razzini, 75, died July 31, 2012 at her residence in
Sebastian.
Miss Razzini was born June 12, 1937, in Bethpage, NY and moved to
Sebastian, FL in 1999.
Survivors: nieces, ]eanie Colberg and Barbara Robinson both of
Sebastian.
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ElARID�DFI'hRCD.iEVi �F �. ,.' State of Florida, Department of Health, Bureau of Vital Statistics
HE�I,, 1 BURIAL TRANSIT PERMI i
DATE PRINTED: August 2, 2012 TRACKING NUMBER: 2012105201
1. DECEDENT INFORMATION
Name of Deceased Date of Death
GLORIA E RAZZINI July 31, 2012
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER SEBASTIAN 879 GLADIOLA AVENUE
�lame and Acidress 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 Director/Direct 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: 2o12-FO41870-503s
. QG / �� • Date Issued: August 2, 2012
c� r�
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
Place of Disposition: SEBASTIAN CEMETERY
Method of Disposition: Bu IAL Date of Disposition: J2 �
S gnat re of s ton or person-in-c rge (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 MUNICIPAL CEMETERY
CllY6
HOMEOFPEUCAN K4AND
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
FuNERA� HoME: STRUNK �UNERAL HOME & CR'�M�la ��iY
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ADDRESS: SEBASiIAN, �L 32958
PHONE #:
�( eck One) ,r
4PEN BURIAL LOT Lot �� Block 2-� Unit `T
OPEN CREMAINS LOT Lot Bfock Unit /� ,_��
OPEN COLUMBARIUM NICHE Niche Block Unit �-�
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BURIAL DATE AND S RVICE TIME: � IIIQ� �$ -- `�(7 I�►"�
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FOR DECEASED: �'D rl �i�.- �Q 221 Yl 1
Name
NAME AMD SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
QCc.r1 n� �'ol b S 2 � t�
Name Si ature 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.
�AME AND SIGNATURE OF LICENSED FU ERAL DIRECTOR: ,
1 Util I� C(a,�Vl.u►�. � �z.� I 2
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 an that all fees have been paid:
• � �Z ,
Ce te Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon cornpletion.