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Home My WebLink About1-29-05aTyof SIESASTIAN HOME OF PELICAN ISLAND Certificate No. 1995 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Lola Brown 124 Capri Avenue, Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $700.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1 Block 29 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 9th day of December, 2004. OF Moore City Manager FLORIDA ATT>;FsT,: Sall A. Maio, CMC City Clerk o: 0 O� O 4�0 Name Unit Block Lot Date of Mark-out /0 Date of Burial Time ;Z Name of Funeral Home Authorized by U 0 Cr. Z. LU U- U. 0 w CO w Ui LL W 0 -j LU I.— M mi 1 EO C2 gym" m O 0 ZI W C Z Cy :2 CD U- CO ?—.- S? L cc cc E 0 E 0 CD L 2 Cv .0 -0 C�. CIj Cn I I I M to CO C> L 2 Linda Brown, Sebastian Linda May Brown, 92, died Nov. 19, 2004, at The Palms in Patin Bay. She was born in Kingston, Jamaica and moved to Sebas- tian.l0 years ago from her birthplace. She was a homemaker. Survivors include chil- dren, Ethel Morris of Oak- land, Calif:, Elma Hall of Fort Lauderdale, Barrington Brown of Birmingham, Eng- land, Lola Brown of Sebas- tian, Yvonne Brown of - Bridgeport, Conn., Isaac Brown Jr. of Albany, N.Y., Peggy Brown of Vero Beach; A grandchildren and eight. great-"grandchildren. She was preceded in death by daughters Lynette Moore and Veta Brown: SERVICES: Visitation will be 1 -2 p.m. on Dec. 6 at Cal- vary Baptist Church, Sebas -' tian with a service at 2 p.m. Burial will be in Sebastian Cemetery. Arrangements are by Seawinds Funeral Home and Crematory, Sebastian. FLORIDA DEPARTMENT OF HEALTH State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of LINDA MAY BROWN Death NOV. 19, 2004 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or BREVARD MELBOURNE Inst. THE PALMS REHAB & HEALTHCARE CENTER 3. Name of Medical Address Phone Number Certifier JOHN POTOMSKI, MD 720 EAST NEW HAVEN AVE 321- 724 -4545 Medical Examiner Physician MELBOURNE, FLORIDA 32901 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FLEMIGN STREET 2617 772- 589 -1933 SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958 5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this 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 ❑ was contacted on He /she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ Sign ur F.E. No. /Reg. No. Date Signed Direct Disposer Mot& /V 2294 11/19/04 g. b BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 04- 2617 -209 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 filin the d th ertificate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 11/19/04 Due: 11/29/04 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. Method of Disposition: nX BURIAL ❑CREMATION Signature of Sexton or Person -in- Charge STORAGE ROTHER (Specify) CEMETERY OR CREMATORY r Place of Disposition Date of Disposition -his 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 vithin 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory H 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral'Director or Direct Disposer hock Number: 5740- 000 - 0326 -2) Pink: Local Registrar CRY or / SJOASTIM 5 HOME OF vPWCAN 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 Name(s) 12.4 16NUt �f. �AS7 -JAW �'% 329519 Address ?T 2- 34B$- O $Z? Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: 4.. LA 6. j M K ars ($ 8�5• o ) on this 115 day of OIts c , 20!Q+ for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit ! , Blockjaj , 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: 00 Corner Markers (set of 4 - $20) Opening & Closing W O H Circle One Vase and Ring for Niches (cost) Interment Disinterment T, $ vd Signature of Purchaser tty of Sebastian Service fees are to be paid at time of need only I :1W W- DATAUNs- CemeterylRECE I PT.doc Ulf OF S. E K� t/�erW.i.rr. HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 December 9, 2004 Ms. Lola Brown 124 Capri Avenue Sebastian, Fl 32958 Dear Ms. Brown: Enclosed is City of Sebastian Certificate 1995 for the purchase of Cemetery Lot 5, Block 29, Unit 1. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Sally A. Maio, MMC /CMC City Clerk SAM:ar enclosure lam - AO Brown 11000 2074u' 1:0670060761:10000 1 7 3 7 7 76 211' °o 0 0 0 °O Oc _°O c �v �z 0 0 0 0 0 o S m m w w w w w w a _a N o w co W O O w O N O O c M O O O O O 9 cs O I v or A m r 0 CD 3 o 0 :� ^? c�no• E3 H i o m D a as cn m m n m x m m o m o N O N • 3 G n mT 0) N e m f m H T x 'm C • a ° C v D d CL n n < 1 L -C r mom M H m 4 O NT M Z M C.l� s' x 0 N N 0 m U O U U U U O CD O W A A P A N O co 0W0 f0 (O tD (ND O y (O1 O O O O O S m 1 ' N N Frl D o d m CD Lm 42 CD CD m Fit o �° n • .—f a r O 4 c��m : 00 CO) m i -SON T T � M m • m a e 3 c _y c O � � a N m Co r-� N w W I, Oo i.: m U O U U U U O CD O W A A P A N O co 0W0 f0 (O tD (ND O y (O1 O O O O O S m 1 ' N N Frl D o d m CD Lm 42 CD CD m Fit o �° n • .—f a r O 4 c��m : 00 CO) m i -SON T T � M m • m a e 3 c _y c O � � a N m Co r-� N w W I, Oo