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HomeMy WebLinkAbout4-17-33U a, n OF HOME OF PELICAN ISLAND Certificate No. 2057 CITY OF SEBASTIAN Certificate of Interment Rights fN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Jewell F. & Stanley W. Steiner 754 Rolling Hill Dr., Sebastian, F7 32958 (name) (address) in and for consideration of the sum of $1,400.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit-4— Block _17 Lot(s)Niche(s)_32 & 33_ 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 of January, 2006. MCITYF TIAN, FLO RIDA A 5) er Sall aio, MMC ger itv Clerk i ?J Name A) � In.� . S r 4`x i � ' Unit Block ),7 Lot 33 - Date of Mark -out Id, j ©C� Time QQ.p4i C J1 ,AiP,L _ Date of Burial Name of Funeral Ho Authorized by ��: FLORIDA DEPARTMENT OF HEALT (TYPE) Deceased r'Irst Stanley 1-17- -3-5 State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT Uk UUduk city, Town or Location County Indian River Vero Beach 3. Name of Medical Certifier Edward Murphy, nMedical Examiner 4 N .D. /i Middle Last Date Month Day Year William Steiner of Death Det-_ 7R 711I01C Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial Hospital Ph, n NNumhcr 1285 36th Street Vero Beach, FL 772- 770 -0323 ame of Funeral Home /®heel -Bispm Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 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. k Kay was contacted on 12/29/05 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Murphy p y 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 cation of e Of th within 72 hours. 6. Funeral Director/ Si Hato F.E. No. /Reg. No. Date Si ned DiFeet- aisix>ser 1862 1229/05 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -05 -0535 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 certificate has been requested. Date Date Certificate Subregistrar Signature Issued: 12/28/05 Dye: 1/1/06 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 Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL OCREMATION Signature of Sexton o Person -in -Char e FISTORAGE DOTHER (Specify) Date of Disposition (- 3 = ® 6 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. DH 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 s<ydr & Ar- OA42 ., CO _ ; N ca Q cts _ y�� '�, y Cn s� V N cvop cts v ° 'moo ay oC40. E51 45. H V1 c�xPa'vi� Aw °PCIA:�GT, o�v) p