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HomeMy WebLinkAbout4-17-08Name -T—O /4 vC 4 t, l tJl �2 Yl rJ Unit Block Lot Date of Mark -out /I 1<6' Date of Burial �A3 / `6 Time /v : v�Q • s' " 7 ' Name of Funeral Home S4,4 A2 / N n 6 lit.•' Authorized by Cff# SE TLOW HOME OF PELICAN ISLAND Certificate No. 2049 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Arthur J. and Joan F. Burns 549 Carnival Terrace, Sebastian, FI 32958 (name) (address) in and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 4_ Block _17 Lot(s)/Niche(s)_ 8_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 11th day of October, 2005. CITY Manager , FLORIDA F:1 v � Sally,,Maio, MMC ty Clerk O �, a f of SJ11ASTIM HOME Of PEUCAN IAAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate re lations, residence of purchaser or person for whom lot is intended for interment must be prQ,Vide,d at time of purchase Names) Address 71.,7 _Zgr �5/9 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only pt is acknowledged in the sum of: Dollars ($ji2� , a,,�Y ) on this / day of 20©_5-' for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit , Block / 7 Lot(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: Comer Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Interment Signature of Purchaser of Sebastian W O H Circle One Disinterment TOTALS %e Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEI PT.doc No. 001001208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 1 001501 343805 0 CITY OF SEBASTIAN CITY CLERK'S OFFICE 3 414 RECEIPT ❑ Cash V<-heckff %d Amount Paid Sales Tax Garage Sales CopleafBid Specs. LDC/Code of Ordinances Election Qualifying Fees Cemetery Lots �— LotlNiche Block Unit Cemetery Fees F Total Palet �4� White — 04/tof Origin 9 Yellow — Finance • Pink - Applicant 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 — Fax (772) 589-5570 October 11, 2005 Arthur J. & Joan F. Burns 549 Carnival Terrace Sebastian, Fl 32958 Dear Mr. & Mrs. Burns: Enclosed is City of Sebastian Certificate 2049 entitling you to full interment rights in Cemetery Lot 8, Block 17, Unit 4. 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 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 — Fax (772) 589-5570 October 11, 2005 Arthur J. & Joan F. Burns 549 Carnival Terrace Sebastian, Fl 32958 Dear Mr. & Mrs. Burns: Enclosed is City of Sebastian Certificate 2049 entitling you to full interment rights in Cemetery Lot 8, Block 17, Unit 4. 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. Sincerely, Sally Maio, MMC City Clerk SAM:ar enclosure Sea 2009 2:13PM COS CEMETERY 7722289927 P.2 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL, CEMETERY . S hen w ►�ucu+ niwo For informelion contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 588.2545 FUNERAL HOME: city clrx s viae City Heir, 1225 Main Street Sebastian, FL 32958 O•ff/ce (772) 388-8215 or 288.8214 Fox: (772) 589-5570 V MVV G ST•CE"eg'1" PHONE #: %%Z -Se9" /9,:M (C=I -n 9) Mock /7 Unit PEN BURIAL LOT Lot _�,DPEN CREMAI NS LOT Lot Block ��� unit ^_OPEN COLUMBARIUM NICHE Niche Block 'Unit BURIAL DATE AND SERVICE TIME: FOR DECEASED: ivame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name 9nature Date I certify that I have determined the ownership of the above described 41te that ail site fees and administrative fees have been paid and authorize opening of same NAME AND SIGNATURE.OF LICENSED FUNER Tt7R -Signature....... at e rvame---------------------------- ---------------------------- --• ----- •---_..__._..�. -----• -__.._..._...... Cemetery Sexton Certification: I cerlify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid Cemetery axion pale This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT0, r 7 8 Name Seawinds/Ilurns L] Cash Date 2/8/16 W Check # 1996 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501 362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001218010 CobraSenre 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 343805 0/c 15n_nn U4, B17, T.8 �/�� �- `� "� Total Paid 150.00 Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT J p Name Seawindsf Burns ❑Cash Date 2/12/16 i]Check# 2005 ❑Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit- 001501 362100 Taxable Rent- 001501 362150 Non-Taxable Rent- 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501 341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 343805 SatyrdaY 100. 00 U4, B1 , L8 rf yrr 10_0_._ Total Paid 0 0 itialsC/ White-Dept.of Origin • Yellow-Finance • Pink-Applicant State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT 1-1E117-',E- DATE PRINTED:February 9,2016 TRACKING NUMBER: 2016018461 1. DECEDENT INFORMATION Name of Deceased Date of Death JOAN FRANCES BURNS February 2,2016 Place of Death-County City,Town or Location Name of facility,or street address it not a fac,lity INDIAN RIVER VERO BEACH GRACE REHABILITATION CENTER OF VERO BEACH Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No./Reg.No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772)589-1933 735 SOUTH FLEMING STREET SEBASTIAN,FLORIDA.32958 Funeral Director/Direct Disposer Fla.Lic.No./Reg.No. DAVID W.WALLACE F046853 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2016-F073380-5024 � -- Date Issued: February 3.2016 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CITY CEMETERY Method of Disposition: BURIAL Date of Disposition: 0V/ii A6 EDRS maintains all statutorily required information regarding the death record and related burial transit permit,therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E,10/12 64V-1 011,Florida Administrative Code