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Home My WebLink About4-16-25C, CIfY OF 5��'►s��N -�� - .�.. � HOME Of PEUCAN ISLAND Certificate # 1964 � �� : �� i��' � ��1�.� Certificate of interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Ruth M. Coleman (name) 8309 Chinaberry Road, Vero Beach, Fl 32963 (address) in and for consideration of the sum of 1 900.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plots: Unit _ 4_ Block _16_, Niches_ 25 & 26_ 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 14th day of June, 2004 � �R. Moore Manager , FI.ORIDA AT1�ST: .. � �1 /�y, ; t""��/ -;!' �_ Sa A. Maio, CMC - City Clerk .�/. v � ��t ( ' 3 h ��s Name � (5 �`'1 � 9�� VV , C O l � i�) (3 � �-�' �x �3 Unit � Block / � . _. a s� Date of Mark-out � � 1 '� ` � � P Date of Burial T � � � Name of Funeral Authorized by T' u ru �'� ;:%' . Time � , � � � � ��e�� THOMAS W. COLEMAN, JR. Thomas W. Coleman Jr., Ph. D., 85, dled peacefuliy June 13, 2004, after a lengthy illness, at VNA Hos- pice House, Vero Beach. He and his wife of 2i years, Ruth, moved to Vero Beach � in 1995 from Grosse Painte, Mi., and Islamorada, FI. Survived by his loving wife, Ruth, and children, Sharon Radelet (Joseph) of Pfiila- delphia, Thomas W. III (Ma- rjorie) of Grosse Ile, Mi., Mason (Victoria) of Kala- mazoo, Mi. and Susan Kubi- ak (Lawrence) of Sebastian, brother, Bruce, Hudson, Mi., 8 grandchildren, 6 great- grandchildren. Professor Emeritus, Wayne State UnivQrsity, De- troit, Mi., Chairman of th� Dept. of Spec. Educ. and Vo- cationai Rehabilitatioa, Di- ; rector, Coleman Schoot fd� the Retarded, Founding Di•' rector of the Detroit Cere- bral Palsy Clinic, Vice Pres., Coleman Psychological As-. sociates, Clinton Twp., Mi., US Airforce Capt., Asiatic Theatre, WWII, Ph. D. Univ. of Mich. Ph+ Kappa Tau. A private memorial serv- ice will be held at a later date. Interment in S,ebas- tia� Cemetery. Memorials may be sent to VNA Hospice House, 1111 36th St., Vero Beach, FI. 32960. pa/d obltuary HEALT� A. (TYPE) 1. Name of Deceased 2. Place of Death County Indian River f1- !6 �.�5 State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT First Thomas City, Town or Location Vero Beach Middle Last W. Coleman, Jr. Date of Death Month Day Year 6/13/04 Name of (If neither, give street address) Hosp. or Inst. VNA Hospice of Indian River County 3. Name of Medical Address Phone Number Certifier Richard R. Cunningham, DO 2000 38th Avenue Medical Examiner X Physician Vero Beach, FL 32960 (772) 794-2227 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 916 17th Street Strunk Funeral Home Vero Beach, FL 32960 0130 (772) 562-2325 5. Check a. � The medicai certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box 6. Funeral Director/ Direct Disposer B b� Kax'en was contacted on 6/14/04 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr . Cunningham will complete and sign the medical certification of cause of death within 72 hours. c. ❑ was contacted on medical certification of cause of death within 72 hours. �/�Signature F.E. No./ e No. _ . �c.�� w _ , i �i9ir 1 BURIAL - TRANSIT PERMIT He/she verified that Medical Examiner, will complete and sign the Date Signed 6/14/04 Permission is hereby granted to dispose of this body. Permit No. 0130-04—G243 � 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. Registrar or � Date Date Certificate SubregistrarSignature �� ► Issued: 6/14/04 �ue: 6/18/04 .,. 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 ali cremations. �. CEMETERY OR CREMATORY . i Method of Disposition: Place of Disposition �_ C� '. 7 y /' � RIAL �STORAGE Date of Disposition ��., ��, p y� �CREMATION Signature of Sexton 1 or Person-in-Charge j �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. . Distribulwn: White. Cemetery or Crematory �H 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Direclor or Direct Disposer ilock Number 5740-000•0326-2) Pink: Local Registrer � No. 001001 208001 001501 322900 001501 341920 001501 341910 001501341930 601010 343800 001501 343805 CITY OF SEBASTIAN � � � � CITY CLERK'S OFFICE RECEIPT �❑ Cas . � Check #,��— Amount Paid Sales Tax �— Garage Sales --'-- CopiesBid Specs• --- LDCICode ot Ordinances --'-- Election Qualirying Fees � — Cemetery lots / /D� 0 ! LoUNict��='� Bbck � Uni Cemetery Fees �— --- Sa/ Total paid � �� Initials ' a � I�cant White - Dept. ot Ori in Yellow - Finencs • Pink • App ' v " , � \J � I ' .I 'i �', ', '. �. i ., �i, � '� ', . . . , ' '. � � i ' , . . '. , , , ,�. . ' , . � ��, . �. I . I . '. �. . . ��. �. . . , . . ,, , . . . . . . . . �_ i , , � i A , �. �, i �, . � . . . �� . / ':� ', � L/�` . . , ... . . � . � � � �i �� ,'�� C� � ,' re`' `C��►� � ' l� � , ' � �>' �>�`� , ' , '� ir1Q � d r � `�jr • �� . ' i � �. . ...� 'I • ; . � � I` . ... \ �� . � '. ��. � '�. � J +,�� , . � � .•�� ' o �� . �_ �� r o ;�' '.�, �! � ' '° , � � ' , _o S . � �� -�° ' _ W , ,,� 4 � ' � '� ' , , ,2' ��' 'l` ! ''' � , i , ' , � •-'C, O/ • a � � m i 0 � r o. Q � • ! � � � T _ � e, m � � � � s °� e � � ei d r a � °. � �� w 0 0 $ � � S � "' ° o 0 0 0 � 0 0 (,,� W N W w ? A � N O > W N �, OOD lD <D c0 �D O �,n S O O O O � n o � m v o m d � � � � � � � y � � � � � � � � � g � � � x N � � ^ � y � O � a . Tf� � m '" � � C � � • • ^0, V 0 C7 � N � � � � O C w N 4 a n A � � mmT � � N W � O N T � „s I mz � � �� V b �� - _ -��,�� HOME OF PEUCAN ISIAND City of Sebastian Municipal Cemetery Purchase Receipt '�� To enable the City of Seba.stian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purcha.ser or person for whom lot is intended for interment must be p�ed at time of purchase Name(s) Address ' " ' ��. �� —�� - Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office tlse Only pt is acknowledged in the sum of: 0 � Dollars ($ / %� D� ) on this day , 200�%for the purchase of the foliowing describe Cemetery Lot(s nd/or Niche(s). Unit �, Block �_, Lot(s) ��`0?6 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-$ZO) Opening & Closing Vase and Ring for Niches (cost) Disinterment W O H Circle One / ' T TAL $/. �oo. a o . � Signature of Purchaser City of Sebas ' n Service fees are to be paid at time of need only I:\W W-DATA\Ms-CemeterylRECEI PT.doc f11Y OF ��,�AS�� _ �...�� `�: ��ti . ,�,,�.�....,.� H�ME OF PELiCAN ISt�11VD June 17, 2004 Mrs. Ruth M. Coleman 8309 Chinaberry Road Vero Beach, F132963 Dear Mrs. Coleman: Enclosed is City of Sebastian Certi�cate Number 1964 far the purchase of Cemetery Lots 25 & 26, Block 16, Unit 4. Also enclosed is a copy of your receipt and the Rules and Reguladons governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sinc�r-��y, �i i � _ ` � � ��/ � �' Sally A. o, CMC City Clerk SAM:az enclosure c I