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HomeMy WebLinkAbout4-20-35J CIN OF SIE]BASTIAN HOME OF vPELICAN ISLAND Certificate # 1951 C11 /1" BASS771AN 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 _20 , Lot(s)_35_ 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 22nd day of March, 2004. ATTE Sally A aio, CI\ City Clerk 161 0 0 Name Unit Block. Lot — Date of Mark-out vi Date of Burial Time—// ,!J© Name of Funeral Home— Authorized by FLORIDA DEPARTMENT OF HEALT�- A /TVor_\ State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT COPY 1. Name of First Middle Last Date Month Day Year Deceased STEPHEN HOWARD LYLES of Death MARCH 19, 2004 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER ROSELAND Inst. SEBASTIAN RIVER MEDICAL CENTER 3. Name of Medical Address Phone Number Certifier TALIB HUSSAIN, MD 7770 BAY ST Medical Examiner X Physician SEBASTIAN, FL 32958 772- 589 -7177 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Re7-589-1933 No. (Area Code) Establishment 735 FLEMING ST SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 5. Check a. [ The medical certlticatlon nas Deen completeo ano slgneo. H completes GtlrrOlGdW U1 ucdui dULU111Nd1noa 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 medica ertification of cause of death within 72 hours. 3. Funeral Director/ S n F.E. No. /Reg. No. Date Signed Direct Disposer 2294 3/20/04 3. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 04- 2617 -063 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. to extension of time for filing the deaf certific a has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 3/20/04 Due: 3/25/04 AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date . J 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: Mt-URIAL CREMATION Signature of Sexton or Person -in- Charge DSTORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition �fS j?w Date of Disposition 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, 6/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer Stock Number 5740- 000 - 0326 -2) Pink: Local Registrar i��X611i SE' HOME OF PELICAN ISLAND March 24, 2004 Edward T. Lyles 9385 Fleming Grant Road Micco, Fl 32976 Dear Mr. Lyles: Enclosed is City of Sebastian Certificate Number 1951 for the purchase of Cemetery Lot 35, Block 20, 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. Sincer -ely, Sally A. o, CMC City Clerk SAM:ar enclosure X N SEAWINDS FUNERAL HOME 735 FLEMING STREET SEBASTIAN, FL 32958 TO THE C I ORDER OF j 4079 1 63- 643/670 DATE � - 2� O 1 BRANCH 87979 �i h C S m I 0 O m 0 • m f T n v 0 a � v .o n d 1\ Id 0 0000° °Z o °o o C> C? w w w m w cc cc co to o 0 o cn o w ° o o °° ° 0 r n m r n O w CD Z m c v m' a, T m C O X G E Q O d _O N w N O m ti m 0 m Co N y O c n � m ik D O ` G a � n n < n mmo m P5 m � N W —r O y T 1 "s MZ M aff of S 9 NOME 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 Cd,vjAIZ a -T. L— 4 IEs Name(s) Address .7 ?L- (,Io3 -d10� Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Dollars ($ 11. 2S. n-) ) on this 22 day of MAQ-e-t, , 20 "_ for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit -4 , Block ZO , Lot(s) 3 S- 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 Signature of Purchaser of Sebastian Disinterment Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEIPT.doc W O H Circle One O o a 3 w C w r O r 0 o `C a O O •� X- C:) w � X Cv r riv J w III, O O ti 91;Cm 0Go Zo O�D� N am� �4ZNr M P f w CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 2 6 Name —+ ❑ Cash Date a eck # Z a,? No. Amount Paid 001001 208001 w 001501 322900 001501341920 001501 341910 001501 341930 601010 343800 001501 343805 Sales Tax Garage Sales Copies/Bid Specs. LDC /Code of Ordinances Election Qualifying Fees Cemetery Lots Lot/Niche , Block '` � Unit Cemetery Fees r Total Paid ,�, 464 Initials White - Dept. of Origin • Yellow - Finance a Pink - Applicant