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Home My WebLink About4-21-08O, cm or SIE]BASTI_M ;r HOME OF PELICAN ISLAND Certificate No. 2009 CJ. T OF SEB,AST'IAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Edward T. Lyles 9385 Fleming Grant Road, Micco, Fl 32976 (name) (address) in and for consideration of the sum of $1,125.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 4_ Block _21_ Lot 8_ 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 12th day of April, 2005. CITY OF SEBASTIAN, FLORIDA ATTEST: James A. Davis Interim City Manager ---------- A. Maio, MMC City Clerk O, Name f, k-2 <7 Unit Block Lot Date of Mark-out Date of Burial Time Name of Funeral Home ri s t,. Authorized by H !TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Name of First Middle Last Date Month Day Year Deceased of EDWARD TAYLOR LYLES Death 4/10/05 Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or BREVARD MICCO Inst. 9385 FLEMING GRANT ROAD Name of Medical Address Phone Number Certifier JAMES W. NEEL, MD 200 E. SHERIDAN ROAD Medical Examiner Physician MELBOURNE, FL 32901 321- 725 -4500 Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 F EMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772- 589 -1933 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 mPriical certification of cause of death within 72 hours. 3. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 05- 2617 -074 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. UNo extension of time for filing the death ktific a has be requested. Registrar or 1 ' Date Date Certificate Subregistrar Signature Issued: 5/11/05 Dye: 5/19/05 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. 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 — ❑CREMATION ❑OTHER (Specify) Signature of Sexton or Person -in- Charge 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 Nithin 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 ;Stock Number: 5740 -000- 0326 -2) Pink: Local Registrar R � p� CITY OF SEBASTIAN CITY CLERKS R CE,IPT FFICE 3280 ell- 0 Cash Amount Paid 11208001 Sales Tax 1322900 Garage Sales 1341920 Copies/Bld Specs. 1341910 LDC1Code of Ordinances 1341930 Election Qualifying Fees 1 343800 Cemetery Lots Lot'Niche . Block Unit 343805 Cemetery Fees i Initials Total Paid ZY. Od White — Dept, of 0ripin . Yellow—Finance . Pink • Applicant Imof SEXY 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 Name(s ilmori Address 0/e 2 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: ,,�� Dollars ($ f /w7-5 od ) on this day of 200—c-- for the purchase of the following described emetery Lot(s) a d /or Niche(s). Unit _, Block_, Lot(s) K 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) Interment Xt4iganaa-litere of Purcha r 5fy of Sebastian Disinterment Service fees are to be paid at time of need only I: \W W- DATA \Ms- CemeterylRECEI PT.doc W O H Circle One Cie 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 April 12, 2005 Mrs. Edward T. Lyles 9385 Fleming Grant Road Micco, Fl 32976 Dear Mrs. Lyles: Enclosed is City of Sebastian Certificate 2009 for the puroase of Cemetery Lot 8, Block 21, Unit 4. Also enclosed is a copy of your receipt and the Rles and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Sally A. Maio, MMC City Clerk SAM:ar enclosure