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Home My WebLink About4-23-26ai O. MIl V! S~~sT~' irr+r:.+ HOME OF PEUGN ISWYD Certificate No. 2002 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Maria Hernandez (name) 738 S. Elm Street, Fellsmere, Fl 32948 (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 4 Block 23 Lot 26a 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 25th day of January, 2005. Y OF SEBASTIAN, FLORIDA ATT~j ..rren oore Sall A. Maio, MMC City anager City Clerk O O ,~' 1' Name~i~~'~' /..,1 Jam' ,~' ~_' Unit ~- ~ Block .~ i_ot ,r ~~ Date of Mark-out ~'~~"~~-'• `l ~~'" •' ~. ,/'~ c~- ~ ~ ~ ~• ~ Date of Burial ~ ! ~~'' ~~ Time °'`-' ~~' - ~ ~ ~' ..,: Name of Funeral Home ; ~ ~"'~~^~'~ ~ -~`-~ CF r1 ' ! ~ ~` ~ r Authorized b ~ _ r ~" r ~ ~~` ~,~-:,-..~~°~ ~ ~....- Y,__ 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 -Fax (772) 589-5570 January 25, 2005 Ms. Maria Hernandez 738 S. Elm Street Fellsmere, Fl 32948 Dear Ms. Hernandez: Enclosed is City of Sebastian Certificate 2002 for the purchase of Cemetery Lot 26a, Block 23, Unit 4. 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. Since ~~' ~~ _ b, Sally A. M ' , MMC City Clerk SAM:ar enclosure ana ~~Zoo ~ S~~s~u~N tam of rrttc~ ~ 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 ' ACfCiresS Jd"~ ll Area Code & Phone Residence,pddress of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: `~'ty~ ~.,~.a~,~_~ Dollars ($5s-(~ °-~' ) on this~,~~_day , 20au for the purchase of the following described Cemetery Lot a dlor Ni e(s). Unit .~._, Block ~_, Lot(s)~,~ Niche(s) r .• for use in acxordance with the conditions, ordinances, resolutions, rules and regulations prescgt~ed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Comer Markers (set of 4 - $20) Opening & Closing 1 5 ~ c 4~ H Cirde One Vase and Ring for Niches (cost) Si ature of P rchas Interment Service fees are to be paid at time of need only Disinterment $_~Sa. o v is\W W-DATAV~As-Csrr~beryWZECEIPT.doc No. 001001208001 001501322900 001501341920 001501341910 001501341930 601010343800 001501 343805 CITY OF SEBASTUIN CITY CLERK'S OFFICE RECEIPT 3.223 Cash k*~~ Amount Paid Sales Tax Garage Sales CopieslBid Specs. LDC/Code of Ordinances Election Qualifying Fees Cemetery Lots ~~+~~ ~ LoUN~he ~ Btu ~~ UMt~ Cemetery Fees ,~5~0 4 ®~ e Z/ _ Total Pat ~~ -Finance .Pink • Applicant A. FLORIDA DEPARTMENT OF HEALT (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 of KIMBERLY HERNANDEZ Death JAN 21, 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL 3. Name of Medical Address Phone Number Certifier HUA'1BERT0 POSADA 787 37TH STREET 772-770-6116 Medical Examiner X Physician VERO BEACH, FL 32960 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING STREET 2617 72-589-1933 SEAWINDS FUNERA HOME SEBASTIAN, FL 32958 5. C:hecK a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ~ was contacted on Helshe 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 ertification of cause of death wit ' hours. i. Funeral Director/ S' n ure F.E. No./Reg. No. Date Signed Direct Disposer 2294 1/21/05 3. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. OS-2617-020 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 filing the death ifi to has en requested. Registrar or Date Date Certificate SubregistrarSignature Issued: 1/21/05 Due: 1/29/05 ,. 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. ~. CEMETERY OR CREMATORY _ Method of Disposition: Place of Disposition ~ BURIAL STORAGE Date of Disposition f r ,~ g"-~a 5~ CREMATION Signature of Sexton 1 or Person-in-Charge J OTHER (Specify) -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 Within 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory H 326, 8/97 (Dbsoletes all previous editions) Yellow: Funeral Director or Direct Disposer hock Number 5740-000-0326-2) Pink: Local Registrar