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Home My WebLink About4-17-40alyor SFOIDAST HOME OF PELICAN ISLAND Certificate No. 2008 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: Vicky Geary (name) 602 Layport Drive, Sebastian, Fl 32958 (address) in and for consideration of the sum of $700.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 4_ Block _17_ Lot-40— 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 April, 2005. CITY OF SEBASTIAN, FLORIDA 1--James A. Davis Interim City Manager AT Sal A. Maio, MC City Clerk L 10- R w 2. Name- Unit Block Lot Date of Mark-out Date of Burial Time 2' Name of Funeral Home Authorized by FLORIDA DEPARTMENT OF HEAL1T A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 7 - �o 1. Name of First Middle Last Date Month Day Year Deceased of JAMIE WILLIAM STERLING Death APRIL 2, 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER ROSELAND Inst. SEBASTIAN RIVER MEDICAL CENTER 3. Name of Medical Address Phone Number Certifier TIMOTHY SIGMAN, MD 7965 BAY STREET 772- 388 -1161 Medical Examiner ElPhysician SEBASTIAN, FL 32958 f. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FLEMING ST 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. F-� 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. 5. f=uneral Director/ Signature F.E. No. /Reg. No. Date Signed Direct Disposer '� 2294 4/5/05 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 05- 2617 -070 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 dire x and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. t ®No extension of time for filing the d t' c icate ha een requested. Registrar or ` Date Date Certificate Subregistrar Signature t Issued: 4/5/05 Dye: 4/10/05 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 !% J Method of Disposition: Place of Disposition / f / ✓ r ®BURIAL STORAGE Date of Disposition 71,n 5 ❑CREMATION Signature of Sexton or Person -in- Charge ®OTHER (Specify) '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 vithin 10 days to the local County Health Department in the county where disposition occurred. Distribution: white: Cemetery or Crematory ,H 326, 6197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer hock Number: 5740 -000- 0326 -2) Pink: Local Registrar aK.I a WP.F- CITY OF SEBASTIAN 3278 CITY CLERK'S OFFICE RECEIPT Name Cash Date ate- k S4l.� No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBkl Specs. 001501341910 LDC/Code of Ordinances 001501341930 Electlon Oualiying Fees 601010 343800 Cemetery Lots %De•00 Lot/Niche Block_ Unit 001501343805 Cemetery fees .04 Total Pal/ w' ad itials White - Dept. of Origin • Yellow - Finance • Pink • Applicant > W<° xx� Lo o� NQ ��x•a c,a� a m `) O aAi a� o a � .n c0 CL _ N 'a co � ^n d°,a +°'• C!� � 3 a� 0 0 no � o 0 N CO i 3 4 .o �cz CU N �80 o 0 .=5b �,• r cn U) CZ ~ .9 M c3 � `8 a) .a>�a> R d. tai oxbo}�.x aia�iyc�'cz cd c a o � 4.j a O a� S-+a oo�� aa• Rio a �".•� � C � � 3w > 10 � W Cd � � O � W d 0 P4 v toy v] >� CZ CO 1-4 0 n4� 9 � E CJD 4-1 rn 21 o� cn .c CRY CF aoo8 SES"TN HOME OF PFLXAN 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 Vicky Name(s) ` U 0 2. t-A PCJLT' Cd S711A j F1 3L5S� Address - -nt 6(A Z. Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: 1.4 on this day of , 20 oJ'rfor the purchase of the following described Cemetery Lot(s) a d /or Niche(s). Unit L1 , Block �_, Lot(s) C40 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: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) OP 8ignat4fe of Pu aser Interment -75 Disinterment 0 O H Circle One $ 115.0 � Service fees are to be paid at time of need only I: \W W- DATA\Ms- Cemetery\RECEIPT.doc QTY or SEBALST .}. i 4' HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 April 8, 2005 Mrs. Vicky Geary 602 Layport Drive Sebastian, Fl 32958 Dear Mrs. Geary: Enclosed is City of Sebastian Certificate 2008 for the purchase of Cemetery Lot 40, 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. Siny, Sally A. io, MMC City Clerk SAM:ar enclosure