HomeMy WebLinkAbout4-10-32CfTY OF
~~ ~~
HOME OF PELICAN ISLAND
Certificate No. 2171
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Melinda Martin 250 Breakwater Street SE, Palm Bay, FL 32909
(name) (address)
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
U n it_4_B lock_10_Lot_3 2_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 18th day of March, 2008.
CITY] OF SEBASTIAN, FLORIDA
~AI Minner
City Manager
ATTEST:
~ --,
~.~' b..
Sally .Maio, MMC
City Clerk
~~
S~B~T~I ~~
-~ ~~
HOME OF YPEUCAN ISLAND
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
~'l/1 ~-j ~, ~a~C~ . lVl..r~.. ~ ~i ~
Name(sl
Ad
Area Code & Phone
is
~C. 3 zgv q
Residence Address of'l~tended Occupant if O~Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
~ , ~ c not
Dollars ($~~~. UCH )
on this ~~ day of i~~rch , 20 (~ for the purchase of the following
described Cemetery Lot(s) and/or 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:
`(~~.Y(~D~U
Corner Markers (set of 4 - $20) Opening & Closing ~~~~ . ~U W O Hr
Circle One
Vase and Ring for Niches (cost)
Signature of Purchaser
Disinterment
TOTAL $ ~ ~ DU ~~
~ ~i~Z~CiCJK-
C' of Sebastian
Service fees are to be paid at time of need only
- ~DS~
~ ~f .5 ~
Interment
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc
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
KARMA E. DAVIS Death MARCH 18 2008
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
BREVARD PALM BAY Inst. 250 BREAKWATER STREET SE
3. Name of Medical Address Phone Number
Certifier VINCENT GIUSTI, MD 50 W. STURTEVANT STREET
Medical Examiner g Physician ORLANDO, FLORIDA 32806 321-841-8588
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment DAVIS-SEAWINDS 560 MONTREAL AVENUE
FUNERAL HOME MELBOURNE, FLORIDA 32935 2076 321-254-1532
s. cnecx a. ~
Appropriate
Box
b.
c.
was contacted on He/she verified that
Medical Examiner, will complete and sign the
medical rtification of cause of death within 72 hours.
6. Funeral Director/ f{ store F.E. No./Reg. No. Date Signed
Direct Disposer i>(Oie?c. /K1 , _ n~i} ~ F042963 MARCH 18. 2008
B. BURIAI/-TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 08-2076-054
®A five (5) day extension of time for filing the death certificate (exclusive 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.
Registrar or Date Date Certificate
SubregistrarSignature ~t7~. •p-(,~,~ Issued: MARCH 18, 2008 Due: MARCH 28, 2008
c. AUTHORIZATION for CREMATION, 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 SEBASTIAN CEMF.TRRY
BURIAL
CREMATION
Signature of Sexton
or Person-in-Charge
STORAGE
OTHER (Specify)
Date of Disposition MARCH 22 , 2008
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.
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
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 medical
certification of cause of death within 72 hours.
Distribution: while: Cemetery o< Crematory
DH-326, 8/97 (Obwleles all previous eddions) Yellow: Funeral Dvector or Direct Disposer
(Stock Number. 5740.000-0326-2) Pink: Local Registrar ~~ i~ ~
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Date of Mark-out ~ /~ ! ~-° ~~~> ~'
Date of Burial r~ ,~"~'~ ~ ~~.4.s t`"'l Time 1 ~ ~ ~' ~~~' 4~ /+r"? i ` ` , =?`,' ~
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Obituaries ~ Death Notices ~ Newspaper Obituaries ~ Online Obituaries ~ Newspaper D... Page 1 of 1
View/Sign Guestbook
.~
KARMA DAVIS PALM BAY Karma Elaine Davis, 7, -ost her battle
with cancer on Mon day, March 17, 2008. She is survived by her
parents, Melinda and Brian Martin; many grandpar ents, aunts,
uncles and cousins. She will always be loved. She is greatly
missed but will always be our angel. We love you baby, Mommy
and Daddy A viewing will be held from 6:30 to 7:30 p.m., Friday,
March 21st, at Davis Seawinds Funeral Home. Services will be
held at 12 Noon, Saturday, March 22nd at The Mission Church,
100 Emerson Drive NW, Palm Bay.
Published in FLORIDA TODAY on 3/20/2008.
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http://www.legacy. com/floridatoday/Obituaries.asp?Page=LifeStoryPrint&PersonID=1... 3/28/2008
KARMA DAVIS