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Home My WebLink About4-10-24CITY OF HOME OF PELICAN ISLAND Certificate No. 2166 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: David Mitek 983 Genesee Avenue, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $.1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: U n it_4_Block_10_Lot_24_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk . for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 21St day of February, 2008. CITY OF SEBA TIAN, FLORIDA ATTE~ I inner Sall . A. Maio, MMC City anaQer City Clerk Name ~ ~Y ~ (~ fI /~1 i~~--_~~ "7 I~ ~ ~~ !I Unit Block r D Lot ~` ~ Date of Mark-out ~ ~ y~ D ~' ~~~ / ~~ ~ Time ~ p O Date of Burial Name of Funeral Home 5 ~ ~ ~ ~ ~ n Authorized by ,-___ . ~/ ~~.. VV~•`~-G~.~Y~'1.~• Qllf Of S~BASTL~,t~j ~,~ ~~ HOME OF PELIUN IS[AIVD City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Name(s) ~ ~3 ~ ~ ~s 5 e_~ ~q-v ~. 5 e,~as ~ an F ~ ~3 z~ 5 ~ Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged Ci~n,~ the sum of: (~/l.Q. NL~~ ``~ ~~0 Dollars ($ OO. ~ ~ ) on this ~" fi day of `~'P~ID . ~ , 20 (~ ~ for the purchase of the following described Cemetery Lot(s) andlor Niche(s). Unit ~, Block (~ ,Lot(s) ~, ~ 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 Vase and Ring for Niches (cost) Interment W O H Circle One Disinterment TOTAL $ ~ , I ~C~, 0® CQ-S~~ Signature of Purchaser W , t of Sebastian Service fees are to be paid at time of need only I50,o~ I:\W W-DATA\Ms-Cemetery\RECEI PT.doc FUNERAL DIRECTOR'S REQUEST TO CITY• OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY :mr ~;_' ~ HOME OF PELICAN ISLAND For information contact: Kip Kelso -Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 ADDRESS: 73S ~~G ~nr~~J q .,~ 1~ -.~E~' AS T7i9~ 1~'~ City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 rr, ~ FUNERAL HOME: /EA' w~ N oS ~~ ~ ~R9! ~~6" PHONE #: ~? )L- 589- r933 (Chec One) OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: ~ ~A Lot Block Unit Lot Block Unit Niche Block Unit N S E W Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) ` 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 FUNER (RECTOR: Name S gnature ~ 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/a/nd that all fees have been paid: Cemet y S ton ~~ Date This form to be provided to Clerk's Office by Sexton far permanent record upon completion. In Memory of David A. Mitek, Jr. ~. May 31, 1986 -February 16, 2008 Service Information: St. Sebastian Catholic Church Sebastian, Florida View Map Service Date and Time: Thursday, February 21, 2008 at 11:00 am Visitation Information: Seawinds Funeral Home Sebastian, Florida View Map Visitation Date and Time: Wednesday, February 20, 2008 at 10:00 am David A. Mitek, Jr, 21, of Vero Beach died unexpectedly February 16, 2008 at Sebastian River Medical Center. David was born May 31, 1986 in Long Branch, NJ and moved to Sebastian in 1988 from his birthplace. He was a 2004 graduate of Sebastian River High School where he played defensive end of the football team and compete with the weightlifting team. He recently completed Fire and EMT school at Indian River Community College. Surviving are his mother and stepfather, Cynthia Volek and Daniel Chico of Vero Beach; father and stepmother, David and Celisa Mitek of Sebastian; a stepbrother, Brian Broderick of Long Island, NY; a stepsister, Teanna Harringan of Sebastian; maternal grandmother, Carol Volek of Vero Beach; paternal grandparents, Doris and Bill Stevens of Metuchen, NJ; paternal great-grandfather, Richard Nicolas of Barefoot Bay; step-grandparents and aunts, uncles, cousins and many friends. Friends may call form 10:00am- 8:OOpm on, Wednesday, February 20, 2006 at Seawinds Funeral Home, Sebastian, Fl. Mass of Christian Burial will be at 11:00 AM, Thursday, February 21, 2008 at St. Sebastian Catholic Church. Burial will follow in Sebastian Cemetery. N ~ ~' 1~1 ~ ~ ~ 0 , ~ Q (i. Z I1J h LL 0 m ~n ~~ O ~ V U `. 3 ~~ ~ ~ ~ `. u ~ a z ~~ ~ 4 ~.. 0 ~; ,,;;~ a (~ '~ ,~ ~ >', v~ ,. ~' ,~ ~, .V; ~_ ~ ~ \ ~ ~~ `I`•~• ~ J `lY''~ 1 „~~ A a 0 E a t a m A r ~. ,~ v ~ ~ \ ~`~-° ~J O m R c o O ~ ~ ~y d c x d ~ O 7 J L(~ IL ~ pl V d N 0 0 0 0 0 .n ° rn rn rn rn o _ _ c`On r°pi N c'N') ~ c~7 ~ { t'7 M s c'7 O O O O O O O ' O ~fJ ~ ~ 1l) O ~f J O Z O O O O O O ~~ A a a :S a F' Y m V C A W 3 e I a- I • 0 1° m i N N N O Y OX-GIFFORD-SEAWINDS FUNERAL HOME suN-rRUSr BANK 1 ZG47 1950 20TH STREET VERO BEACH, FL 32960 VERO BEACFf, FL 32960 63-215/631 2~21~2008 *"15.00 ORDER OFE C1tV Of SebaStlaT1 ********************#***************~*********~******~ I******~k* f'iftPen and OO/1OO DOLLARS 8 City of Sebastian 1225 Main St. ~ Sebastian, FL 32958 j u. y u^OL264711' ~:063~02L52~:10000L7377762u^ Ctl'Y OF SEBASTIAN CITY CLERK'S OFFICE ~ 3 9 6 5 RECEIPT ~ ' ~ ~ ,~ rd ~ Name /~ ^ Cash l-t ! Date ~ '~ c ryry ~ ~~ j_1 ~-~ ~ ~ ~ ~~ Check #_~ 2~ ZL No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopiesBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010343800 Cemetery Lots LotlNiche ~~ .Block 1 D .Unit 001501343805 Cemetery Fees ~fe~~ mcrr key' Id. D~ Total Paid ~ ~ • ~o Initials ~~1 White - pt. of Origin • Tellow -Finance • Pink • Applicant 5 , ~ t/ ~~ X- Ca ~ 'fro rd FLORIDA DEPARTME T OF HEALT State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT A. (n'PE) 1. Name of First Middle Last Date Month Day Year Deceased of DAVID A. MITEK, JR Death 2/16/08 2. Piave 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 Medical Address Phone Number Certifier ROGER E. MITTLEMAN, MD 2500 S. 35TH ST , Medical Examiner Physician FT. PIERCE, FL 34981 772-464-7378 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 PEENING ST SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772-589-1933 5. Check a. ® The medical certfication has been completed and signed. A completed certificate of death acx:ompanies this Appropriate application. Box b. c. was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medial certification of cause of death within 72 hours. was contacted on He/she verified that Medical Examiner, willcompiete and sign the of cause of death wkhin 72 8. Funeral Director/ na F.E. No./Reg. No. Date Signed Direct Disposer F044126 2/ 19 /08 B. Permission is hereby granted to dispose of this body A five (5) day extension of time for filing the d ti been contacted by the funeral director and will t 72 hours. ®No extension of time for filing the deat certifi t ha Registrar or Subregistrar Signature ~. AUTHORIZATION for CREMI4TION, DISSECTION, or BURIAL-AT-SEA 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 CEMETERY OR CREMATORY ~ ,.---- ~~ , Method of Disposition: Place of Disposition ~p ®BURIAL STORAGE Date of Disposition p~%l~ Y~ CREMATION Signature of Sexton or Person-in-Charge OTHER (~S•pecify) BURIAL -TRANSIT PERMIT Permit No. 08-2617-032 certificate (exctusive of weekends) has been requested and granted since the physician has able to complete the medical certification of cause-of~eath section of the death certificate within requested. This permit must be endorsed by the Sexton or person-in-charge (or by the ,Funeral Director/Direct Disposer when there Is no sexton/ within 10 days to the local County Health Department in.the county where disposition occurred. Date Date Crtficate Issued: 02/19/08 Due: 02/26/08 returned Distribution: White: Cemetery a Crematory DH' 326, 8197 (Obaoletes all previous edNions) Yellow: Funeral Director a Direct Disposer +.~ `~ ~ (Stock Number: 5740.000-0328-2) Pink: Local Registrar