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HomeMy WebLinkAbout4-10-14CITY OF SE HOME OF PELICAN ISLAND Certificate No. 2180 C ITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Mr. Kaare Haugland 1712 Shakespeare St., 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 lot: Unit 4 Block 10 Lot 14 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 30th day of May, 2008. F ggBASTIAN, FLORIDA ATT CAI Minner City Manager SallyMaio, MMC ity Clerk Name XIVA14 Unit 7 Block Lot Date of Mark -out Date of Burial A �� U Time. Name of Funeral Home 4,j 1, r' Authorized by_� =—�"`� 1h Obituaries I Death Notices I Newspaper Obituaries I Online Obituaries I Newspaper D... Page 1 of 1 ANNAMARIE HAUGLAND Annamarie Haugland, 75, died May 29, 2008, at her home. She was born in Milford, Mass., and moved to Sebastian three years ago, coming from Patchogue, N.Y. Before retirement, she worked in the family business of Haugland Construction Corp. in Patchogue for 30 years. She was a member of the Welcome Wagon of Sebastian and the Sebastian Property Owners Association. urviv rs include her_hg5.bAr,df 41 years, Kaare Haugland of Sebastian; sons, Greg Houston of Fort Worth, Texas, David Haugland of Manahawkin, N.J., Seth Haugland of River Head, N.Y., and Kaleb Haugland of Shirley, N.Y.; stepson, Corey Haugland of Monroe, N.J.; daughter, Deborah Newton of Bellport, N.Y.; stepdaughter, Kimberly Metry of Atlanta; brother, Albert Scrivo of Salisbury, Md.; stepsisters, Marie Hallock of Albany, N.Y., and Linda Alesico of Scharrie, N.Y.; and 15 grandchildren. SERVICES: Visitation will be from 4 to 7 p.m. June 1 at the Seawinds Funeral Home in Sebastian. A funeral service will be at 10 a.m. June 2 at the funeral home, with Pastor Jerry Lawrence officiating. Interment will follow at Sebastian Cemetery. Arrangements are by Seawinds Funeral Home and Crematory, Sebastian. Condolences may be sent through www.seawindsfh.com /obit.php. A,A❑ Published in the TC Palm on 5/31/2008. Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact Legacy.com • Terms of use Powered by Legac rxom obituaries nationwide Back http:// www .legacy.com/tcpalm/Obituaries. asp? Page= LifeStoryPrint &PersonID= 110747... 6/2/2008 CITY OF SEBASTIAN CITY CLERK'S OFFICE /, O RECEIPT 4 Name 4U ❑ Cash //�� Q r�] Date ��- � � --;zoo Check# (_ No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies /Bid Specs. 001501341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche, Block Unit �; 001501 343805 Cemetery Fees 1000 C) %� Total Paid UL70(1 -Ink als White - Dept. of Origin • Yellow - Finance • Pink . Applicant ilk C_) FLififl 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 ANNAMARIE HAUGHLAND Death 5/29/08 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER SEBASTIAN Inst. 1717 SHAKESPEAR STREET 3. Name of Medical Address Phone Number Certifier DIRK PARVUS, MD 13695 US 1 Medical Examiner MPh ysician SEBASTIAN, FL 32958 772 -567 -0033 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No]Reg. No. Phone No. (Area Code) Establishment 735 FLEMING ST SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772 - 589 -1933 5. Check a. Lj The medical certrtcation has been completea ana slgnea. A completea certmcate or aeam accompanies mis Appropriate application. Box b. 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. c. El was contacted on He /she verified that , Medical Examiner, will complete and sign the medical goAcation of cause of death within 72 hours. 6. Funeral Director/ i at F.E. No. /Reg. No. Date Signed Direct Disposer F044126 5/30/08 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 08- 2617 -101 E3A 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 eath has been r quested. Registrar or Date Date Certificate Subregistrar Signature Issued: 5/30/08 Due: 6/6/08 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY , Method of Disposition: Place of Disposition ® l ' BURIAL STORAGE Date of Disposition iol. 1A� /p g CREMATION Signature of Sexton 1 or Person -in- Charge J} DOTHER (Specify) 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, 6197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number, 5740- 000 -0326.2) Pink: Local Registrar ,Rf,,, `1 1 , s r a 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, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Address :1 -7 0 Area Code & Phone Number r jK )_ Name & Residence Addrpss of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: ©O Dollars ($ on this 2J day of , 20jX for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 4, Block , Lot(s) Niches) 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: n c� Corner Markers (set of 4 - $20) Opening & Closing / W O H ircle One Vase and Ring for Niches (cost) Interment 00 Temporary Marker Preparation & Installation Signature of Purchaser I: \W W- DATA \Ms - Cemetery\RECEIPT -doc Disinterment Q TOTAL $ I Sebastian The following documents were provided as Proof of Residency: 7rn _. aTrti