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HOME OF PELICAN ISLAND
Certificate No. 1982
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Esther Marie Craig -Rea 472 Rolling Hills Drive, 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 _17_ Lot _3_
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 13th day of August, 2004.
OF SEJ ASTIAN, FLORIDA A'
6rrena%�. Moore
City Manager
r^
•
Sally A. Maio, CMC
City Clerk
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Name -f 5Th _----- ._"T' X 10 _ _ gk o.
Unit `7'
Block 17
3
Lot
Date of Mark -out 0
Date of Burial v 7 +i Time 0 " (c ` 7 a
Name of Funeral
Authorized by
FLORIDA DEPARTMENT OF
HEALT
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
(I Yl -t)
1. Name of First Middle Last Date Month Day Year
Deceased ESTHER CRAIG of JULY 31, 2004
Death
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 AIJAZ SYED, MD 1621 US HIGHWAY 1
Medical Examiner Physician SEBASTIAN, FLORIDA 32958 772-388
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 735 FLEMING STREET 2617 772-589-1933
SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958
5. Check
Appropriate
Box
a.
q.
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
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
medical certification of cause of death within 72 hours.
6. Funeral Director/ Signature F.E. No./Reg. No. Date Si ned
Direct Disposer 2294 82/04
B_ BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 04-2617-146
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 certific ha been requested.
Registrar or Date Date Certificate
Subregistrar Signature Issued: 8/2/04 Due: 8/10/04
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 LL
Method of Disposition: Place of Disposition
BURIAL STORAGE Date of Disposition
11 CREMATION OTHER (Specify)
Signature of Sexton
Person -in -Charge s C? "
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
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
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QIY OF
SEBAST_"
HOME OF/VPELICAN 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
F--S?Afi2 t-ANR1r. C1z1�tq -
Name(s)
412 i 61).% N. J t � E (. AS) A �l . ( T Z 4 S -3
Address
-772- 5'b l-
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars ($ 70A )
on this day of 9` , 20 C9t for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit 14 , Block ) 7 , Lot(s) 3 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)
gaZ" -cam !f� . &.x -
Signature of Purchaser
Interment
ax -o W4 W O H
Circle One
Disinterment
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc