HomeMy WebLinkAbout4-21-14CAT Or
40ME OF PELICAN ISLAND
Certificate No. 2089
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
William H. Dunwell 9086100`h Court, Vero Beach, Fl 32967
(name) (address)
in and for consideration of the sum of $950.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following plot/niche:
Unit —4— Block 21 Lots/Niches 14
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 21st day of June 2006.
)RIDA
ATTEST:
Sall aio, MMC
ity Clerk
.�J
gyp.,
Unit
Block CI
Lot
Date of Mark -out u^ 4` F
Date of Burial Time Name of Funeral Home J e }-
Authorized by a !�
VER6113 ft'CH
Tot A1111
cos . v
__. Dun
Set
_enter.
- - :)Or-in
in -Verc
-oming
Calif.; brothers, Andrew Hoop -
.'- m 0,
of Homosassa Springs and
a marine w k
at - Culture Try - r
er
Perry Hooper of Bolinas, Calif;'
w�
gi e s iii -
and sister, Linda Hooper of .
Pierce r^ r f
Shelton, Conn.
years.
Memorial contributions may
She N --z a g K. -
be made to the Humane Socie-
uate of 1--) t, da
ty of Vero Beach, P.O. Box 644,
Atlantic =`
Vero Beach, FL 32961
r _
SERVICES: Visitation will be
sity cc.t a
noon to 2 p.m. June 21 at the
gree m :=-ne
biology-
Strunk Funeral Home in Se-
v.-as a membe. - the
-an
bastian. A service will be at 2
in the funeral home cha-
A merican Cluj. and the
-` Ladies' Auzziarz Post
p.m.
pel, with reired Navy Capt.
in Sebastian; she
Richard "Dick" Flick, Chap
Honors conducted
--=.' ` er Own band called
�_ tern
lain Corps, .
by the VFW Women's Auxilia
Breeze" and was
-e2: = ._er; and she was a
ry Post 10210 will follow. Buri -.
_ - :riast who showed
al will follow in Sebastian
shows.
Cemetery.
+:= are her husband
TNilliam Dunwell of
er o B _ ach; daughter.
Mari arm 7:-_:. per of Oceanside.
FLORIDA DEPARTMENT OF
Hiki7
A. (TYPE)
�i �� /�/
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
Joy
Ann
Dunwell
Death
June 16 2006
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 Michael Venazio M.D.
8005 83rd
Avenue
Medical Examiner Physician
Sebastian,
FL
772- 388-2110
4. Name of Funeral Home /DireeKftposV
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
1623
N. Central
Ave.
1
Strunk Funeral Home
Sebastian, FL
1228
772 - 589 -1000
5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. Liz was contacted on 8/19/06
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Venazio 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
m ical ificat, use of death within 72 hours.
6. Funeral Director/ Igna re F.E. No. /Reg. No. Date Signed
Difeet- 2isposet 1862 6117/06
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-06 -0239
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.
E] No extension of time for filing the death certificate has been requested.
-Registril"SP' Date Date Certificate
Subregistrar Signature .A.�5� r �� ,a,+„�Q Issued: 6/16/06 Dye: 6/21/06
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 FiSTORAGE 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) ana returnea
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 ,�,r `�• ►�
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HOME OF PELICAN ISLAND
1225 Main Street, Sebastian, F132958
Telephone (772) 589 -5330 — Fax (772) 589 -5570
June 21, 2006
Mr. William H. Dunwell
9086 100' Court
Vero Beach, Fl 32967
Dear Mr. Dunwell:
Enclosed is City of Sebastian Certificate 2089 entitling you to full interment rights in Unit 4,
Block 21, Lot 14. Also enclosed is a copy of the receipt and the Rules and Regulations
governing the Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Since ,
Sally Maio C
City Clerk
SAM:ar
enclosure
yy c1'l4� � 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, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
Address
Code & Phone
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars
on this dy of , 20� for the purchase of the following
described Cemetery Lots d/or Niche(s).
Unit �, Block, Lot(s) ILI 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 & Closin <0 O H
Circle One
Vase and Ring for Niches (cost) Interment
Signature of Purchaser
of Sebastian
Disinterment
)0r,
TOTAL /�4•
Service fees are to be paid at time of need only
1: \W W- DATA\Ms- Cemetery\RECEI PT.doc