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Home My WebLink About4-16-13Name -E L� Z p b N c ey Unit Block Lot Date of Mark -out 4 Date of Burial 0Time Name of Funeral Home Authorized by O. C�Y � �►��AS'�'� _ __ w.r ,�.� , HOME OF L PEUUN ISWVD Certificate # 1977 C'�� 0)�'� ��,�i°1��c:�`1 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Lowell J& Elizabeth D. Binckley 1544 Crowberry Lane, 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 plots: Unit_ 4_ Block _16_ Lot(s)_13 & 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 28th day of July, 2004. City Manager A S : `.. �_. . Salj A. Maio, CMC City Clerk .� �'� � • o . HEALT] A. (TYPE) 1. Name of Deceased 2. Place of Death County 1 ndian River 3. Name of Medicai Certifier Raauel y�G � State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 00 First Middie Last Date Month Day Year of Elizabeth Dema Binckley Death Au . 14 2004 City, Town or Location Name of (If neither, give street address) Hosp. or Roseland inst. Sebastian River Medical Center Address Phone Number Iriguez M.D. 7766 Bay Street Medical Examiner Physician Sebastte�l, FL 772-589-0300 4. Name of Funeral Home��Biepeee�+• Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave 5. Check Appropriate Box 6. Funeral Director/ DA'€C�D�s�O's�7' e Home Sebastian, FL 1228 772-589-1000 a. � The medical certification has been completed and signed. A completed certificate of death accompanies this application. b d Barbara was contacted on $/16/04 Helshe verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Rodriques will complete and sign the medical certification of cause of death within 72 hours. �� was contacted on He/she verified that ��/ , Medical Examiner, will complete and sign the cause of death within 72 hours. � F.E. No./Reg. No. 1862 BURIAL - TRANSIT PERMIT Date Signed 8/15//04 Permission is hereby granted to dispose of this body. Permit No. 122$-04-0320 � 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 SubregistrarSignature n� �fZl Issued: 8/14/04 Due: 8/19/04 � - 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 ethod of Disposition: Place of Disposition Sebastian Cemetery BURIAL �STORAGE Date of Disposition $ ° � � ' �� Q �CREMATION Signature of Sexton � o Person-in-Charge �OTHER (Specify) n ,. _ 'his permit must be endorsed by the Sexton or person-in-charge (or by the Funeral DirectodDirect 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, 8/97 (Obsoletes all previous aditions) Yellow: Funeral Director or Direct Disposer itock Number 5740-000-0326-2) Pink: Local Registrer CITY OF SEBASTIAN � O n� CITY CLERK'S OFFICE � RECEIPT . ❑ Cash N�me J��_-`" eck � Date Amount Paid No. p01001208001 Sales Tax 001501322900 Gara9e Sales 001501341920 Cop�� S�• 001501341910 LDC1Code oi Ordinances 001501341930 Electlon G1uaiKying Fees �;L�T �r� 601010 343800 Cemetery Lots LoUNk,h° B� Block l_---� Unit � 001501343805 �emetery Fees . �— �--- --- --_.---- . ----- �--- --- _�— � d� Total Paidl Initiali White — Dep4 of Oriqin • Yellow — Fin�ncs • Pink • Applicmt e 4 � . ..i� � • • - �� . / 1 _ 6�c�°�.�'� � � a d +c.�,ng �C ��.�-�- � . �� 'Ut.,,r,�, � � (3 I l� 1 G, }`,o �- 13 --- �2. ��19��'f � a-�• 3 � P� �� s��' �� ., ,�� ,°• ��d',�► J _�•;;� ' -�+ � iaS;' r�'a/9` ��,°o ��s yo't! cP � �a�-k `a-�.�,> I` CITY OF SEBASTIAN C(TY CLERK'S OFFICE � � 7 � RECEIPT N� �J�I 'L� .rL.- ❑ Cash Dats � eckl�� No. Amount Paid 0010U1'208001 $8189Ta1( 001501322900 Garage Sales 001501341920 CopieslBW Specs. 001501341910 LDC/Cade ot Ordinances 001501341930 Election �uaAfying Fees 601010 343800 Cemetery Lots LoUN�he . Bbdc . Unft _�� 001501343805 Cemelery Fees � � � .�— �. Total Pald 1'�� OU IniUals � White - Depx of Oripia • Ydlow - Fi��nes • Pink • Applioant 5�� ::1::�`'`� HOME OF PELiUN ISWVD City of Sebastian Municipai Cemetery Purchase Receipt +11 � � 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 � Name(s) �s- Address Area Code & Phone Number .��Z-,9�s� Residence Address of Intended Occupant if Other Than Purchaser Office Use Only ' Receipt is acknowledged in the sum of: �— on this � day of described Cemetery Lot(s) d/ Niche(s). a�ey'- �ar1 � Dollars (�/ 4 0' • 4d' ) 200� f�r the purchase of the following 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 .. . itv of Sebastia� Disinterment Service fees are to be paid at time of need only I:\W W-DATA\Ms-CemeterylREC EI PT.doc W O H Circle One � � o , oa fafl' OF �� :�.�:�-� � .V HOME OF PELICAN ISUIND 1225 Main Street, Sebastian, FI 32958 Telephone (772) 589-5330 — Fax (772) 589-5570 July 28, 2004 Mr. & Mrs. Lowell J. Binckley 1544 Crowberry Lane Sebastian, Fl 32958 Dear Mr. & Mrs Binckley: Enclosed is City of Sebastian Certificate 1977 for the purchase of Cemetery Lots 13 & 14, 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 y, t \ � _ Sally A. io, CMC City Clerk SAM: ar enclosure