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Home My WebLink About4-16-01�: �� S�B�T�°,N � .�.. . �..�.�. � HOME OF PELICAN ISU►ND Certi�cate # 1943 �,I. � -�' 0)�' ��,��:�-��tl Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Colleen & Laurence Kennedy 506 Seagull Drive, Barefoot Bay, Fl 32976 (name) (address) in and for consideration of the sum of 2$ ,250.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit _ 4_, Block 16 , Lot(s)_1 & 2_ 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 6t" day of February, 2004. ATTEST: � ..-�----- ly A. Maio, CMC City Clerk o; �I�I O � • �. Name � � ,1�.� �,f� J � �t ,�^ h�/�J� /J V � � 1 � � /1�� , Unit � — Block �� - — Lot � — Date of Mark-out � � � a� — Date of Burial � / 1' /� � Time ` � �'� ' — r �� Name of Funeral Home_�_ ' � �:� �; . /j j%�� ..� Authorized by _ � i' 1 � A. 1. Name of Deceased 2. Place of Deat County gg��D 3. 4. 5. ' State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT First Middle LAIIRENCE ��Y Date of City, Town or Location Death Name of (If neither, give street address) �REFOOT BAY Nosp. or 506 SEAGUl,i, D Name of Medical Inst. �� Certifier ��g�y ��N� � Address Medical Examiner 7744 �Y ST�ET Name of Funeral Home/Direct Disposal g Physqdd�ess S��TIAN� FLORIDA 32958 Establishment Fla. Lic. No./Reg. No. Sg,A��s �I. HOME 735 FLEMING STRFFT 2617 Check The medical ce Sfic�atioSn hT a� en��A 3295g a. � Ap ro ' Month Da- y yea� FEBRIIARY 6, 2003 Phone Number �72-388-3186 Phone No. (Ar— ea � tl 772-589-1933 p pnate application. mP eted and signed. A completed certificate of death accompanie� this Box 6. Funeral Director/ B b. � c. � He/she verified that this death was from natural causes, that there wastno accident nor other external cause of death, and that certification of cause of death within 72 hours. will complete and sign the medical was contacted on Helshe verified that medical certification of cause of death within 72 hours. , Medical Examiner, wili complete and sign the i1�:---. DireCt Disnnspr �/ -'''�`"" F.E. No./Reg. No. 2294 Date Signed 2/�/n� Permission is hereb BURIAL - TRANSIT PERMIT y granted to dispose of this body. � A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and rant Permit No. � �� _�,�L been contacted by the funeral director and wiil not be able to complete the medical certification of cause-of-death section of the death 72 hours. 9 ed smce the physician has �No extension of time for filing the de th ificate has been requested. certificate within Registrar or Subregistrar Signature Date Date Certificate Issued: �V �� ¢ Due: � // L�n�. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examiner, , gave authorization by telephone to Funeral DirectodDirect Disposer. The Medical Examiner's approval must be obtained before disposal by any of the above methods. Aawaitin required for all cremations. g period of 48 hours after death is Method of Disposition: �Bl'JRIAL �CREMATION Signature of Sexton � or Person-in-Charge �STORAGE �OTHER (Specify) � CEMETERY OR CREMATORY Place of Disposition �� T'f� �� '�r�T;� Date of Disposition / � '. � �-�_ �is permit must be endorsed bv tha Sp„t,,,, „� .,,.____ � «: ---•�•�� -,n-cnarge (or by the Funeral Director/Direct Disposer when there is no Sexton) and retumed s o e ocal County Health Department in the county where disposition occurred. 326, 8/97 (Obsoletes all previous editions) �ck Number 5740-000-0326-2) Distribution: While: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar CITY OF SEBASTIAN 2 4 9 9 CITY CLERK'S OFFICE RECEIPT ' Name S�C� � ( � � � _ � Cash Date � � � ~ �� Check# �� No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualirying Fees 601010 343800 Cemetery Lofs ��`"" �' � o LoUNiche � '� � , gbck ' � . Unit� 001501 343805 Cemetery Fees � '�� 1 ToWI Paid ��' �C Initials White - ept of Origin • Yellow - Fin�nce • Pink • Applicant � � ,, . +� �. �s 1 c �, k. � b �j�Z �no� S�B�►5T� � -,��. �.. NOME OF PEUUN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt �� 3 � 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 p chase O 1� � � h--� � � � (�J r� e. � °-� � I-� v r c r� � � I � �1 �7 P�Y � � Name(s)� � � S�--- �.�, � 1 � � A� r� � -�'� � � f��1 �( , � ( � � � c( / l� Area Code & Phone Number -7 -1 2-- C� C� �( O D Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged 1n the �� l l,c� D 7�'Vl 0 m o� � ru��, lars ($��J��?, O o , on this (S� �� day of ��J , 20� for the purchase of the following described Cemetery Lot(s) and/or Niche(s). 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: Corner Markers (set of 4-$20) Opening & Closing Vase and Ring for Niches (cost) Signature of Purchaser Interment �S- U 0 w o H Circle One Disinterment TOTAL $ aZ � � J . U �� W i of Sebastian Service fees are to be paid at time of need only I:\W W-DATA1Ms-Cemetery\RECEIPT.doc fl1Y OF ��,$As�r�� _� � ,. ��1': HOME OF PEUGN ISUtiND February 11, 2004 Colleen and Laurence Kennedy 506 Seagull Drive Barefoot Bay, F132976 Dear Mrs. Kennedy: :--� � • 0 Enclosed is City of Sebastian Certificate Number 1943 for the purchase of Lot Numbers 1& 2, Block 16, 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 ly, . �" / Sally A. aio, CMC City Clerk SAM:ar enclosure