HomeMy WebLinkAbout4-14-39
Certificate # 1868
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
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Certificate of Interment Rights
Helen Turner
(name)
(name)
(name)
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Hones of p~.iuN ~suNu
1306 Dewitt Lane, Sebastian, FL 32958
(address)
(address)
(address)
in and for consideration of the sum of X1,400.00 ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 14 ,Lot(s) 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 22nd day of November
C3TY SEBAST. ,FLORIDA
Terrence R~-1V'Ioore
City Manager
2002
ATTEST:
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Sally A. M~ o, CMC
City Clerk
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
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Date """"
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001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501 362100 Community Center Rent
001501 362100 Yacht Club Rent
001501 362150 Non Taxable Rent
001501 343800 Cemetery Lots
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601010 343800 Cemetery Lots
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001501 369400 a
Interment Fee
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800 220683 Riverview Park Security Deposit
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CITY OF SEBASTIAN
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)01501 322900 Garage Sales
)01501341920 CopieslBid Specs.
)01501 341910 LDClCode of Ordinances
)01501341930 Election Qualifying Fees
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)01501 343805
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
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HOME OF PELICAN ISUND
For information contact:
Kip Kelso -Cemetery Sexton
Sebastian Municipal Cemefery
(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
FUNERAL HOME: Strunk Funeral Home
ADDRESS: 1623 N. Central,,Avenue, Sebastian, FL
PHONE #: 772-589-1000 '
(C~eck One)
OPEN BURIAL LOT Lot 39 Block 14 Unit 4
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: March 25, 2008 - 11 A.M.
FOR DECEASED: Helen M. Turner
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 SIGNATU OF LICENSED FUNERAL ECTO
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 and that all fees have been paid:
Ce tery ex on Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
FLORIDA DEPARTMENT OF
HEALT
A.
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
Helen VIA. Turner Death March 20 2008
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Palm Garden of Vero Beach
3. Name of Medical Address Phone Number
Certifier I heonu U . Oriaku, M. D . 631 17th Street ~-
Medical Examiner Physician Vero Beach, FL 772-778-1603
4. Name of Funeral Homelt~irp~~;^~~ Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N . Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. L:neCK a. LJ I ne medlCal certiflCation has been completed antl signed. A completed certificate of death accompanies this
Appropriate application.
Box L
b. L]i Dr. Oriaku was contacted on 3/21 /08
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that he will complete and sign the medical
certification of cause of death within 72 hours.
a ~ was contacted on He/she verified that
Medical Examiner, will complete and sign the
m Ice t of cause of death within 72 hours.
6. Funeral Director/ ig a F.E. No./Reg. No. Date Signed
Diwc~.Dicpocar+ ~ 44048 3/20/08
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-08-0131
A five (5) day extension of time for filing the death certificate (exGusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not bt: 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.
AegiatraFeF- Date Date Certificate
SubregistrarSignature ~.. `--~f.i.~,,,`s, Issued: 3/20/08 Due: 3/25/08
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 Cert~etery
~/ BURIAL STORAGE Date of Disposition , 3 ~ s; ~ ~. _
CREMATION OTHER (Specify)
Signature of Sexton // ~
or Person-in-Charge ,~~~ Q, / Q./'. ~.C~ ,
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.
Distribution: White: Cemetery or Crematory
DH 326, 8/97 (Obaoletes ell previous eddions) Yellow: Funeral Director or D'vect Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar ~~ i~ ~