HomeMy WebLinkAbout4-10-05Name _,�1 4
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Date of Mark-out
Date of Burial (" Z/ - j//
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CITY OF
S
HOME OF PELICAN ISLAND
Certificate No. 2184
CITY 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:
Barbara P. LoProto 974 Greenbriar Avenue, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit —4— Block 10 Lot —5—
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 20th day of June, 2008.
CITY,OF SEBASTIAN, FLORIDA
Minner
Manager
ATTEST:
Sally -A. Maio, MMC
City Clerk
C" or
SfOISAST
AN
HOME OF PEGC10.N ISI.AN€i
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
S ar ba ra p Lo pro �-a
Name(s)
R 7q G r 2ehbr� � � AVM sebaz5 t < °a v� FL
Address
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
PAL � a-rLA Z/ 6-0 Dollars ($ /, 660. 00 )
on this day of , 20 for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit . 5� _, Block / D , Lot(s) -5 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)
Temporary Marker Preparation & Installation
ignature of Purchaser
I: \W W- DATAWls- Cemetery\RECEIPT.doc
Interment
/W O H
Circle One
Disinterment
TOTAL $ 10DO, ®0
Pty of Sebastian
The following documents were provided as Proof of
Residency:
and
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3998
Name 13& aa�Ka LO Pr& t -0 o Cash
Date & — ,;, 0 6y 01(6heck # 09q
No.
001001208001
001501 322900
001501 341920
001501 341910
001501 341930
601010 343800
001501 343805
Amount Paid
Sales Tax
Garage Sales
Copies/Bid Specs.
LDCICode of Ordinances
Election Qualifying Fees
Cemetery Lots 1000.0
LotfNiche , Block 10 Unit `'i
Cemetery Fees
Total Paid /0()0.00
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE _ 4391
RECEIPT
NamePrlt? El Cash
Date D- I q' 1 )'Check # 4 V 135
No.
001001 208001 Sales Tax
001501322900 Garage Sales
001501341920 Copies/Bid Specs.
Amount Paid
001501 341910 LDC /Code of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots
!;ot/Niche _, Block, Unit4
001501 343805 Cemetery Fees
Lo
Total Paid,D�
Initials �-�-°
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
mm
HOA4E OF PEIiCAN KINVP
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
FUNERAL HOME: STRUNK FUNERAL HOME & CREWATCRY
1623 No Cant:ral Ave
ADDRESS: SEBASTIAN, FL 32958
(712) 589-1000
PHONE #:
(Check One)
OPEN BURIAL LOT Lot 95
OPEN CREMAINS LOT Lot
OPEN COLUMBARIUM NICHE Niche
BURIAL DATE AND SERVICE TIME:
FOR DECEASED: �>ay bafa,
Name
_ Block
Unit
_ Block
Unit
_ Block
Unit
111 FIT,?.S
- —r
"&J6
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of owners
aLm t!Z, V. 011 a�IA� VA V Jam,
Name Sign u e 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.
�IAi11E AND SIGNATURE OF LICENSED F L DIRECTOR:
rqu ti MOLAq I U(\ C OO/RJ LIV-- 13.13
Name Signature 1j Date
Cemetery Sexton Certification:
I certify that 1 have checked the ownership information by viewing the owner's deed and confirming
with Clerk's offir and that all fees have been paid:
Z q. L 3/5,
Cepfietddry texton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
7
mopm.kDErARrm=4ror'. ,' State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: June 13, 2013 TRACKING NUMBER: 2013086548
1. DECEDENT INFORMATION
Name of Deceased Date of Death
BARBARA PATRICIA LOPROTO June 12, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER
Name and Address 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: 2013- FO41870 -5094
Q G /� Date Issued: June 13, 2013
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: BURIAL Date of Disposition: Lo
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V- 1.011, Florida Administrative Code