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Home My WebLink About4-17-11my of SEBASTMN HOME OF PELICAN ISLAND Certificate No. 2001 CITY OF SEB',. ST-7I N Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Sarah Porter 502 Taylor Avenue, Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of 7$ 00.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit —4— Block 17 Lot 11 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 F City day of January, 2005. , FLORIDA ATTE Sally,A. Maio, MMC City Clerk HEALTHY StaAte of Florida, Department of PPLICATION FOR BURIAL HTaRAN , Vital IT PERMIT'cs A. (TYPE) X- i,-,- -/i 1. Name of First Middle Last Da y Year Q Deceased 1 ADV N THOMAS PORTER Death 005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or BREVARD MELBOURNE Inst. HOLMES REGIONAL MEDICAL CENTER 3. Name of Medical Address Phone Number Certifier WESLEY FOSTER, MD 1314 PINE STREET 321- 952 -9500 Medical Examiner ITIPhysician MELBOURNE, FL 32901 3. 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, FL 32958 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this 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 medical certification of cause of death within 72 hours. i. Funeral Director/ ignature F.E. No. /Reg. No. Date Signed Direct Disposer 4 1/14/05 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 05- 2617 -017 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 rtifi to has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 1/14/05 Due: 1/24/05 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. > CEMETERY OR CREMATORY Method of Disposition: Place of Disposition _ 5 J y� y� 4 URIAL STORAGE Date of Disposition J z_ CREMATION OTHER (Specify) Signature of Sexton 1 or Person -in- Charge J �%- 1 his 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 iithin 10 days to the local County Health Department in the county where disposition occurred. Distribution White: Cemetery or Crematory H 326, 8/97 (Obsoletes all previous editions) Yellow, Funeral Director or Direct Disposer ;lock Number 5740 - 000 - 0326 -2) Pink: Local Registrar nr I j Unit Block Lot I / Date Of Mark-out Date Of Burial Name Of Funeral Home --7 Authorized by —Time- CITY OF SEBASTIAN CITY CLERK'S OFFICE 3224 RECEIPT Namto� ❑ Cash Date heck ,« No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots ��=v Lot/Niche ZZ Block/7 Unit z__� 001501 343805 Cemetery Fees gv Total Paid v 10� In tial$ White Dept. o in • Y ow - Finance • Pink - Applicant ana A► SP TIM NOME OF 1'ELIM MM City of Sebastian Municipal Cemetery Purchase Receipt �dd / To enable the City of Sebastian to deteamine the correct rate, and in accordance with cemetery rate regulations, resida= of purchaser or person for whom lot is intended for interment must be provided at time of purchase Name(s) Address i Jar - Jb 1 • -1 go Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: 20 0-5" for the purchase of the following Unit _�, Block �, 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 ) Z S J H CiraMne Vase and Ring for Niches (cost) Interment Disinterment TO $ �� • ° d ature of Purchaser CiW of Sebastian Service fees are to be paid at time of need only I:WWV -DATA FrAoc Jddyn Porter, Sebastian` + �� Jadyn Thomas Porter, in- fant son of Sarah Porter of Sebastian and Lawrence James Jr. of Vero Beach, died Jan. 13, 2005, at Holmes Regional Medical Center, Melbourne. Survivors include mater - al grandparents, John and Milbrie Porter of Sebastian; paternal grandparents., Lon- nie and Reba James of Vero Beach; and maternal great- grandparents, Joyce Quaise of Sebastian and Wil- liam.and Barbara Porter of Arizona. SERVICES: A funeral serv- ice will be 1 p.m. Jan. 22, at Seawinds Funeral Home, Se- bastian, with burial to follow at Sebastian Cemetery. M ff#,A ISE HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 January 25, 2005 Ms. Sarah Porter 502 Taylor Avenue Sebastian, Fl 32958 Dear Ms. Porter: Enclosed is City of Sebastian Certificate 2001 for the purchase of Cemetery Lot 11, Block 17, 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. Sin re4l Sally A. Maio, MMC City Clerk SAM: ar enclosure