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S EA'MN
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Certificate No. 2031
Ct 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:
Clarence & Loretta Epsilantis 481 Kendall Avenue, Sebastian, Fl 32958
(name) (address)
in and for consideration of the sum of $1,400.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit-4— Block _17 Lots _29 & 30_
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 8th day of August, 2005.
OF SE )3 rfSTIAN, FLORIDA
ATYFST:
'U�
Sally . Maio, C
ity Clerk
0
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ai
Name !(.n Lf /4, 6 d,5
Unit
Block
Lot j v
j
Date of Mark -out
Date of Burial / 7 /a Time < ot, ,Q
Name of Funeral Horke.
Authorized by
y 17,-
EPARTMENT OF
FLORIDA HWi f State of Florida, Department of Health, Vital Statistic /"\ D
APPLICATION FOR BURIAL - TRANSIT PERMIT [�.J)
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Loretta M. E silantis Death February 3, 2006
2. Place of Death City, Town or Location Na a of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Insti VNA Hospice House
3. Name of Medical Address Phone Number
Certifier Richard R. Cunningham, .O.
MMedical Examiner rNPhysician 901 37th Street, Vero 'Beach, Florida 772- 978 -5600
4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code)
Establishment 1623 North Central Avenue
Strunk Funeral Homes Sebastian, Florida 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. Richard R. Cunningham, ' O.O. was contacted on February 3, 2006
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Or. Cunningham will complete and sign the medical
certification of cause of death within 72 hours.
C. M
was contacted on
He /she verified that
Medical Examiner, will complete and sign the
medical i ti of se�of death within 7 hours.
6. Funeral Director/ t e . No. /Reg. No. Date Signed
Direct Disposer Z'(04 February 3, 2006
B.
C.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -06 -0056
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.
FIND extension of time for filing the death certificate has been requested.
-Registrar er Date Date Certificate
SubregistrarSignature rY,_ � /l Issued: 2/3/06 Dye: 2/8/06
Approval Number:
AUTHORIZATION 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.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
ITSURIAL FISTORAGE Date of Disposition February 7 2006
OCREMATION OTHER (Specify)
Signature of Sexton
or Person -in- Charge
This permit must be endorsed by the Sexton or person -in- charge (or by the F
within 10 days to the local County Health Department in the county where dis
DH 326, 8197 (Obsoletes all previous editions)
(Stock Number: 5740- 006 -0326 -2)
Director /Direct Disposer when there is no Sexton) and returned
n occurred.
Distribution: white: Cemetery or Crematory
Yelkyr: Funeral Director or Direct Disposer
Pink: Local Registrar A-WW %I Aw-
00 - - -- -
E4 78 E
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3529
RECEIPT
Name -«�� ap�Cash .
Date
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
LoUNiche , Block
Unit
001501343805 Cemetery Fees
e--'
(((•••�«�� /C
Total Paid/ y d
Initials
White - Dept. of Origin • Yellow - Finance
• Pink • Applicant