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HomeMy WebLinkAbout4-11-10• Certificate No. 2227 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: Charlie Shihadeh 1307 Clearbrook Street,, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Bilk 11, Lot 10 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 6th day of July, 2009. CITY OF SEBASTIAN, FLORIDA �f Minner City Manager ATTEST: Sally Maio, MMC City Clerk Name Unit Block Lot Date of Mark-out- Date of Burial �7 5 Time Name of Funeral Home— Authorized by In Memory of Shihadeh A. Shihadeh February 27, 1950 - June 30, 2009 Shihadeh A. "George" Shihadeh, 59 of Sebastian, FL died Tuesday, June 30, 2009 at his residence. He was born February 27, 1950 in Jordan and was a resident of Sebastian for 5 years coming from Ft. Lauderdale, FL. Survivors include his sons Aziz G. Shihadeh of Fontana, CA, Charlie Shihadeh of Sebastian, FL, Abie Shihadeh of Sebastian, FL, Freddy Shihadeh of Weston, FL, David Shihadeh of Coatesville, PA; brother Musa Shihadeh of West Chester, PA; sisters Sylvia Kasses of Kingman, AR, Doris Springman of Pottstown, PA, Nabila Babcock of Sebastian, FL, May Diab of Exiter, NH, Diana Urbonowicz of West Palm Beach, FL and five grandchildren. ON Of w AW S HOME OF s City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. C'-ha -r- I i e. 5hi hcde- h (Son Name(s) 13o-7 CALe6- r1gr061C Street, SebasHarx FL 32-958 (-7 7Z)7&(o y Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: i � ,�i' Dollars ($ /, 000,.°"°) on this. _ & day of -, . 1( , 20 a q for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit , Block I_, Lot(s) 1 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, Signature of Purchaser Interment C2-50, 00 W O H Circle One Disinterment TOTAL $ I Z5 0, 0'0 (Al ity of Sebastian The following documents were provided as Proof of Residency: I: \W W- DATA\Ms- Cemetery\RECEI PT.doc and 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 SHIHADEH A. SHIHADEH of 06 30 2009 Death 2. Place 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 C.M.E. 2500 I S 35TH ST FAMedical Examiner Physician FORT 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 S FLEMING ST SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772- 589 -1933 b. cnecR a. i he medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. F� 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. F-1 was contacted on He /she verified that Medical Examiner, will complete and sign the medical ce ation of cause of death within 72 hours. 6. Funeral Director/ nature F.E. No. /Reg. No. Date Signed Direct Disposer FO 44126 07/02/09 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 09 -2617 -157 ® 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. �r FjNo extension of time for filing the Beat certifi a h s be requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 07/02/09 Due: 07/14/09 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 SEBASTIAN CEMETERY BURIAL STORAGE Date of Disposition �r Ar CREMATION OTHER (Specify) Signature of Sexton 1 �• or Person -in- Charge J) _ 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 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740- 000 - 0326 -2) Pink Local Registrar Re ,d d % Pap IE LL i 0 0 9 • i T 7 7 • 0 r` v l O C S S S S S S S o 0 o m m o m m lip CD N 1 z 3 R x � s $ 'Y• N 0 TT V� -A il T c R x , N 0 TT V� -A il T 1 !1 T n m_ pp p y T � T s rn m Z Cn a) (�� (V� O V © Z el ti i CD �aIs r fZ I, Marvin Klein, bought a Sebastian Municipal Cemetery lot located in Unit 4, Block 11, Lot 10 on July 3rd, 2008 for the amount of $2,000.00. no longer desire to keep this lot and request a refund of $2,000.00 from the City of Sebastian and hereby relinquish all rights to the lot. F Ma in Klein r, / ��� Date 11806B695i'' i :06 70064 3 2,:20000 273 l6 296,1' I LACP4GL Wap,011 LWA CITY OF SEBASTIAN CHECK REQUEST Accounting Use Only Input Date Fiscal Period Document # Entered By Document Amount # of Lines Total HC Hash To Be Completed By Department Due Date 7/11/2008 Single Check Y / N Y Vendor Number LN TC Document Reference Organization Code Object Code Project Code Amount 601011 534959 $2,000.00 Amount $2,000.00 Description Refund for Unit 4, Block 11, Lot 10 Husband changed mind ISSUE CHECK TO NAME Marvin Klein ADDRESS 6613 Nuevo Lagos Ft. Pierce, FL 34951 Check Drawn By APPROVED BY JDATE BUDGET APPROVAL (534,g6n AND 535450 ONLY) Please make copy of check for Clerk's files Mr. Klein to pick up Friday afternoon, July 11th M ! 5y'y Si'i ! City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. s Y,et 3 95_� Name(s) Address Area Code & Phone Num 52-960 772- X-2-9-05 0 -1131 Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: A U 4) tars ($ 20o o . 60 ) on this. day of Jtt& 2069 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit q , Block , Lot(s) /0 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: Corner Markers (set of 4 = $20) Opening & Closing Vase and Ring for Niches (cost) Interment Temporary Marker Preparation & Installation kZ!Z�Zd Signature of Purchaser /W O H Circle One Disinterment TOTAL $ 2 d oU City of Sebastian The following documents were provided as Proof of Residency: I: \WW- DATA\Ms- Cemetery\RECEIPT.doc I and CITY OF SEBASTIAN . FINANCE DEPARTMENT RECEIPT Name t ��% Cash `` 1 Date - ❑ Check # Amount Paid 001001 208001 Sales Tax 001001.220000 Security Deposit -Com. Center 001001 220000 Security Deposit -Yacht Club 001501 322900 Garage Sale Permit 001501 329500 Alarm Citation 001501341920 Copies 001501 35fi140 Parking Citation 001501 354100 Code Enforcement Fines 001501 342100 Police Security Services 001501 359000 Other Fines/Forfeitures 001501.362100 . Rent - Royalties/ Com..Center 001501 362100 Rent/Royalties/Yacht Club 001501 362150 Park Rent/Pavillon/Elect W1501 369900 Other Miscellaneous Revenue Total Paif. IN ' s ' White - Dept. of Origin • Yellow - Finance Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY MIN SEA, HOME OF PELICAN ISLAND 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: ADDRESS: 735- Hj5i 1hfG J�— 3�? fS Y PHONE #: (Check One) ,iOPEN BURIAL LOT Lot 1 O Block / Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: 'Z ' S -D N S E W q NO FOR DECEASED: .�p446' SA 1 A Ad X-L 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. NAMES AND SIGNATURE OF LICENSED FUNERA (RECTOR: 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: J/ 114 r / Ce et Sexton / Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Oct 25 11 03.26p Everlasting Stoneworks 17725899312 p.3 City:_ of Sebastian Sebastian cemetery Pb. M 1(772) S89 - 2545 l:ax# 1(772) 228 - 9927 Note .: TlRis ls.tor Iurorl"Otional purpmes reVardiog Monuments Setnstfge,Cemetsry Note Please return to Attention Sebastian. Cetnetery 192I North Central Ave. 32958 Cemetery Sesto■ Size: - "1 K %- X CZ/ . standard grey granite flat grass marker Names &Dates : r Shy dad e.. His ; �� t-�iC L 'Her: D.O.B. ���1 I .. �J,o D.O.D. lc� :7✓� QCG ) 8981 Description: Unit: Blk.:. Lot. p Approved BY: K. G . K. Chocked By: K. G . K. Date.: By : everlasting stone works Nample : D.O.S. Zugg aw Foundation soured by : everlasting /jamie date: 1A110/j/ atone installed by : everlasting / jamie date na C) 0 LO r� U) r� I •d 7P1 / p b'd Z l£6699ZLL 6 f� 4=J O mg MA . r. c`�c S tG im 1 r� lit G aN • 1 slioMeuolg 6wIseIaen3 r 0 M�n WIN 1 no, .r • tt i d9Z :£o 6l SZ Po • na C) 0 LO r� U) r� I •d 7P1 / p b'd Z l£6699ZLL 6 f� 4=J O mg MA . r. c`�c S tG im 1 r� lit G aN • 1 slioMeuolg 6wIseIaen3 r 0 M�n WIN 1 no, .r • tt i d9Z :£o 6l SZ Po