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Home My WebLink About4-17-14N ariOF SERASIM HOME OF PEUCAN ISLAND Certificate No. 2022 JT_[Y 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: W. Osborne Evans 8241 NW 170`' Terrace, Hialeah, FI 33015 (name) (address) in and for consideration of the sum of $950.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit —4— Block 17 Lots 14 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 3rd day of June, 2005. SEBASTIAN, FLORIDA Al Minner ity Manager ATTEST: Sally A , aio, MMC City Clerk N • O I Name Vv / I- A tok Unit Block Lot r Date of Mark -out =� Date of Burial Name of Funeral Ho e Authorized by I . 4, 3 1 _ FLORIDA DEPARTMENT OF aix (TYPE) Name of First Deceased William 2. Place of Death County State //— /7- /Y of Florida, Department of Health, Vital Statistic APPLICATION FOR BURIAL - TRANSIT PERMIT ( D Middle Last Date Month Osborne Evans of July City, Town or Location Death Name of (If neither, give street address) Plantation Hosp. or Westside Regional Medical Center Inst. 3. Name of I%ca Certifier ne Rutherford, M.D. Medical Examiner , 4. Name of Funeral Home /Direct Disposal �VMN 8- 'Lowther Funeral Home 5. Check a Appropriate Box b. M M-1 6. Funeral Director/ Direct Disposer ay Year 18 2006 West Sunrise Blvd., Suite 102, Fort Lauderdale, Flo Phone Number lician Address 1655 27th Street Fla. Lic. No. /Reg. No. Phone No. (Area Code) Vero Beach, Florida 32960 2559 (772) 778 -3233 The medical certification has been completed and signed. A completed certificate of death accompanies this application. 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. was contacted on He /she verified that , Medical Examiner, will complete and sign the nealcal certification of cause of death within 72 hours. F.E. No./Reg. No. 2588 Date Signed � — July 18, 2006 B. BURIAL - TRANSIT PERMIT Permit No. Permission is hereby granted to dispose of this body. IVfive (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. FIND extension of time for f ' g the death certificate has bgen requested. Registrar or Date Subregistrar Signatur@� y �i �,L' - tr -F.> July 19 2006 Date Certificate .3! -t �"LY� - Issued: y Dye. July 28, 2006 r - C. Approval Number: TION for CREMATION, DISSECTION, or BURIAL- AT-SEA 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. A waiting period of 48 hours after death is required for all cremations. I D CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery 15BAURIAL STORAGE OCREIVIATION Signature of Sexton or Person -in- Charge This pen-nit 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. DOTHER (Specify) I Date of Disposition July 21, 2006 )H 326, 8/97 (Obsoletes all previous editions) Distribution: White: Cemetery or Crematory ,Stock Number: 5740. 000 -0326 -2) Yellow: Funeral Director or Direct Disposer Pink: Local Registrar �� CITY OF SEBASTIAN CITY CLERK'S OFFICE 3305 RECEIPT Name 7-51- 0. �G-�LL Date No. 001001208001 Sales Tax 001501322900 Garage Sales ❑ Cash eCktI&k Amount Paid 001501341920 CopIWB1d Specs. 001501341910 LDCICode of Ordinances 001501 341930 Election Oualiying Fees Q 601010 343800 Cemetery Lots LotlNiche Block 1? ..Unit. 001501343805 Cemetery Fees Total Paid initials White - Dept. of Origin • Yellow - Finance a Pink • Applicant Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE 3657 RECEIPT Na ✓� 0 Cash S� eckG► Date Amount Paid No. 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery,Lots Lot/Niche Block Unit. 001501343805 Cemetery Fees Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant M OF .12- IZ SEXY 4r f HOME 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 jgl� .0 1417J Name(s) get'S�/ �uJ ♦7o7'X T.�.¢./crr ��' /�.y� �L .r'.�o�.S" Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: i Dollars ($ on this day of 20 0-5� for the purchase of the following described Cemetery Lot(s) offd /or Niche(s). Unit _, Block 17 , Lot(s) /y Niches) 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:1W W- DATA\Ms- CemeterylRECEIPT.doc W O H Circle One Cwt � � � �a�lC�•� -+ S � ` S� Z Z S /�' /4.1 L�. �• r 6L 3Z ?5 i i. S a B iLZ Q TLw4' -1/y Z4/ l AZ l.J 176 -� JEWSPAPERS • THURSDAY, JULY 20, 2 HIALEAH W. Osborne Evans W. Osborne Evans, 91, died July 18, 2006, at Westside .Re- gional Medical Center in Plantation. He was born in Messick, Va., and was a resident of Se- bastian for. 25 Years, and moved to Hialeah four years ago. Before retirement, he worked as a sheet metal engi- neer, and worked with Shelly Manufacturing for 10 years. He was a member of the Fellsmere Community Bible Church of Fellsmere and the Bible Baptist Church of Pem broke Pines. Survivors include sons, Wil- liam O. "Ozzie" Evans Jr. of Hialeah, Floyd F. Evans of Ve- ro Beach, and David N. Evans of North Carolina; daughter, Theresa Dale Bentavegna of Chicago, Ill.; seven grandchil- dren; and five great grandchil dren. Memorial contributions may be made to Fellsmere Commu- nity Bible Church Mission Fund, 14 North Hickory St., Felismere, FL. 32948. SERVICES- Visitation will be noon to 2 p.m. July 21 at the Fellsmere Community Bible Church with a service at 2 p.m. with Dr. Leon Essex WE- ciating. Burial will be at Sebas- tian Cemetery. Arrangements are by Thomas S. Lowther Home and Crematory, Vero Beach. Ct1Y OF SEB�'�Alti1 HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 June 3, 2005 Mr. W. Osborne Evans 8241 NW 170th Terrace Hialeah, Fl 33015 Dear Mr. Evans: Enclosed is City of Sebastian Certificate 2022 for the purchase of Cemetery Lot 14, 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. S cerly, Sally A. aio, MMC City Clerk SAM:ar enclosure