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Home My WebLink About4-22-09o o alyOf SEXASTPAN .................... . ROME OF PELICAN ISLAND Certificate # 1935 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Kathryn & George Westerfield 291 Faith Terrace, 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 _ 4_, Block _22 , Lot(s)_09_ 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 8th day of January, 2004. C OF SEBASTIAN, FLORIDA ence . Moore City Manager O TTEST: 50y A. Maio, CMC City Clerk Name Unit Block Lot Date of Mark -out t el Date of Burial ' Time Name of Funeral hlome t Authorized by t,- 2-z, 7' CITY OF SEBASTIAN CITY CLERK'S OFFICE 3 317 RECEIPT �� ❑ Cash _ r heck N �� Je Amount Paid Sales Tax Garage Sales Copl Bid Specs. LDC/Code of Ordinances Election Qualifying Fees Cemetery Lots Lot/Niche . Bkx* Unit C�emette/ry y Fees Total Paid • Aa 'hits - Dept. of Origin • Yell - In • Pink • Applicant _' 01:1. d�a.r•. �L 3 � 5 5 . g - -- - - i71 - S % I 04a.( L4LHOUE___ - - - — - � - te�3Na o«r��w•. January 8, 2004 Kathryn & George Westerfield 291 Faith Terrace Sebastian, Fl 32958 Dear Mr. & Mrs. Westerfield Enclosed is City of Sebastian Certificate Number 1935 for the purchase of Lot Number 9, Block 22, 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 , Sally A. aio, CMC City Clerk SAM:ar enclosure QOpr CITY OF SEBASTIAN CITY CLEWS OFFICE RECEIPT 2433 Ne,l Date ❑ Cash 0,6eckl No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche Block Unit 001501343805 Cemetery Fees InIflils Total Paid White - Dept. of Origin • Yellow - Finance • Pink • Applicant NT 00 10 �5. . C; z cc cc Jell Ac C: LO LO rM C: :1 0 Co Ln nj 0 W U LD rq a ❑ CRY 01 SEBASTKN 1. HOME OF PELICAN 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 X� .107 ame( Addr s Area Code & Phone Number C� Residence Address of Intended Occupant if Other Than Purchaser Office Use Only is acknowledged in the sQum o ory _111z'_,�� " - , L Dollars ($ on this day , 20.for the purchase of the following described Cemetery Lot( and�or Ni he(s). Unit , Block ,A Z , Lot(s) 2 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 W O H Circle One Vase and Ring for Niches (cost) Interment f J Disinterment $ 5 d - 40 Signature of Purchaser ity of Sebastian Service fees are to be paid at time of need only I: \W W- DATA \Ms- Cemetery\RECEIPT.doc FLORIDA DEPARTMENT OF HEALT /TV DC\ State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT y -'-74 -off'. 1. Name of First Middle Last Date Month Day Year Deceased Frederick Karl Hoehl of Death July 9 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Palm Garden of Vero Beach 3. Name of Medical Address Phone Number Gary R. Silver n, M.D. 1265 36th Street Certifier Vero Beach, FL 772- 567 -6340 MMedical Examiner FTPhysician 4. Name of Funeral Home /9W611 Qicpowl, Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) 1623 N. Central Ave. Establishment Strunk Funeral Home Sebastian, FL 1228 772- 589 -1000 5. Check a. U The medical certification has been completea ana slgnea. H Completes certtncate of ueaa1 ncwniNainaa una Appropriate application. Box b � Dr. Silverman was contacted on 7/11105 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that he 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 9017ficatio4f qpO15 of death within 72 hours. 6. Funeral Director/ / F.E No.lReg. No. Date Signed gimst -.; pe"r 862 7/9/05 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -05 -0299 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 certificate has been requested. RogisUar or. Date Date Certificate Subregistrar Signature Issued: 7/9105 Dye: 7114105 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 y�rSebastian Cemetery BURIAL FISTORAGE Date of Disposition OCREMATION 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) ana returneu 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 N-yd d %I P.P.