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Home My WebLink About4-10-22CITY OF ~ L'~~ ,: : -: ,- HOME OF PELICAN ISLAND Certificate No. 2189 ~~~~ 0 ~'~ ~~~~~~~~ Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Ms. Alice Lawley 1250 Emerson Drive NE, Palm Bay, FL 32907 (name) (address) In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4 Block 10 Lots 22 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 18th day of August, 2008. O EBASTIAN, FLORIDA ATT~~ST: ,~ -~ AI Minner Sally .Maio, MMC T City Manager pity Clerk s~~~~ ~~~ . ::.:..__ ~ ~-I HOME OF PELIUN IS[J1ND 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 , . ~1~ ~~~~ ~~l~l~ T~ Name(s) r~:~ , ~---L 3aYO7 Address r ' ~ ' 3al -~~7-~9~0 Area Code & Phone Number ~ ~ ~~ Residence Addres to d d Occ ant if her Than Purchaser Office Use Only Receipt is ac,~cnowledged in tie sum of: on this ~ ~~ day of~ ~ , 20~ for the purchase of the following describled~ Cemetery Lot(s) and/ r Niche(s). Unit " Z ,Block ~ ~ ,Lot(s) ~c~ 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: ~0 Corner Markers (set of 4 - $20) Opening & Closing W O H Circle One Vase and Ring for Niches (cost) Interment TOTAL $ ~ o ~ C~ Signature of Purchaser City of Sebastian Service fees are to be paid at time of need only Disinterment I:\W W-DATA\Ms-Cemetery\RECE I PT.doc FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ~mR SEB~sTtA1V HOME OF PELICAN ISLAND For information contact: Kip Kelso -Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office Cify Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: Strunk Funeral Home ~ Crematory ADDRESS: 1623 N. Central Avenue Sebastian, FL 32958 PHONE #: 772-589-1000 ( eck One) OPEN BURIAL LOT Lot Block Unif OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: _ Aqust 21, 2008 • 2:00 P M FOR DECEASED: Jeffery Wayne Joiner Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signature Date I certify that I have determined the ownership of the above described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGN URE OF LICENSED FUNER DI E R: Name Si ature Date ~~~ --------------------------------------------------------------------- ------------------------------- Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming C r 's office and th II fees have been paid: ~~ r ~ ~ ~ z~g, Cemetery Sexton Da This form to be provided to Clerk's Office by Sexton for permanent record upon completion. TCPaIm: Obituaries and Death Notices Login ~ Member Center ~ Archives ~ Alerts I Subscribe to the paper ~ Already a subscriber? Login here HOME NEWS SPORTS BUSINESS ENTERTAINMENT LIFESTYLE OBITS OPINION VIDEO ~x.r .:Po .~ Click here to get involved Howl bituaries and Death Notices ~~ Slte =, ,, ' ' Web Search -~ ~- pewerett-~y-Y-IkFit~t~!~-SEA~6#___.... _-, ---. _.___ __._.. Page 1 of 3 JOBS HOMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NEW! Clink the li Jeffery Wayne "Jeff" Joiner ,,ewslette, Jeffery Wayne "Jeff" Joiner, 45, died Aug. 17, 2008, at his residence. He was born in Jacksonville and was TCPaIr a former resident of Fellsmere and moved to Palm Bay in 1982. He was an electrician and worked for Daily ~ Service Electric in Palm Bay for 18 years. He attended Living Waters Church of God in Palm Bay. Survivors include his daughter, Amanda Lynn Joiner of Palm Bay; mother, Alice M. Lawley of Palm Bay; Fishinc and brother, Richard Allen Joiner of Norfolk, Va. Memorial contributions may be made to Wuesthoff Treasu Brevard Hospice & Palliative Care, 8060 Spyglass Hill Road, Viera, FL 32940. SERVICES: Visitation will be from noon to 2 p.m. Aug. 21 at the Strunk Funeral Home, Sebastian. A funeral service will follow at 2 ~~ p.m. in the funeral home chapel, with the Rev. Kenneth Ellis officiating. Interment will follow at Sebastian Cemetery, Sebastian. Get the la Breakir Today's TC Palm obituaries and death notices ~` Questions about obituaries and death notices or Guest Books? Contact Legacy.com Terms of use Click the li treasur P~rer~d ~y ~~~T.cOV'1'1.H obituaries nationwide Dodge Reade Newsp Treasu Treasu Ask the ~~ Sign up to http://www.legacy.com/tcpalm/Obituaries.asp?Page=Lifestory&PersonId=115939801 8/19/2008 ~ --~. , Name ,~~' `-; ~; Unit ~~ Block f....- ~_~~~~'' _ ~'' ~ r~~ ~' ~~~ Date of Mark-out , ~. Date of Burial ~, Name of Funeral Home[_ Authorized by ~ ~ ~' !~ ~,% Time ~~,' ,~ -%~ YCt'~'~'% tC t t ~~_'~ d S O 0 m r r ~ a °~ ~ ~ '+~ g o $ o o S °o c ~+ 0 o 0 cn c cn O c c o c w ~ N o ~ ~ O O j O O N O O W ~ ~ ~ or ~ ~ m r n ~ ~ d m ~ D ~ ~; ~ -~ O ~ ~ c$ oNi ~` ,~ a F~ii3 ao T ~ Qd to O ~/-~ ~,./ c ~ ~ ~ I ~ d ~ m ~ ~ D 3 ~„ o ~` `~~ n n ~~ n r T _m "' a Oy Ts ~ Z m ~ , 1 1 J FIAR[DA DEPARTMENT OF HEALT 0 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 Jeffery Wayne Joiner Death August 17 2008 15 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay Inst. 1250 Emerson Drive, N.E. 3. Name of Medical Address 1344 Apollo Blvd., # 303 Phone Number Certifier Craig Badolato, M.D. Melbourne, FL 32901 321-727-3495 Medical Examiner Physician 4. Name of Funeral Homel9ireet~ispvsel Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. trunk Funeral Home ~ Cremato y Sebastian, FL 1228 772-589-1000 5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ~ Jessica was contacted on 8/18/08 He/she verged that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. BadOlato will complete and sign the medical certification of cause of death within 72 hours. a ~ was contacted on He/she verified that Medical Examiner, will complete and sign the medics fits ' n use of death within 72 hours. 6. Funeral Director/ gn u F.E. No./Reg. No. Date Signed Ri~icpeser 44048 8 / 18 / 08 B, BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-08-0387 ~A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has een contacted by the funeral director and will not be able to complete the medical cert~cation of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. ,~. Date Date Certificate Subregistrar Signature ~~ `•-~'f~aC Issued: 8 / 17 /08 Due: 8 22 /08 ~. 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 Examiners approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for a-I cremations. ®_ CEMETERY OR CREMATORY M hod of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition S~Q/~D $ , CREMATION OTHER (Specify) Signature of Sexton ~ ~ /J or Person-in-Charge y('/,w~ OJT This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Dlsposer when there !s no Sexton} and returned within 10 days to the local County Health Department in .the county where disposition occurred. Distrib~rtion: white: Cemetery or Crematory DH 326, 8/97 (Dbsoletes al! previous editions) Yelkrv+: Funeral Director or Direct Disposer (Stock Number 5740-600-0326-2) Pink: Lo•..a! Registrar ,~,~ ~~ r„M