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Certificate # 1960
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Claire M. Ranahan 13225 US Highway 1, Lot Al2, Sebastian, Fl 32958
(name) (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 _16_, Niches_ 30 _
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 21 st day of May, 2004
CITY OF
City
TIAN, FLORIDA AT"I'EST: '
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�ore S A. Maio, CMC
� City Clerk
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Name ., ,L K / y � . s�. / .Q
Unit �
Block � �
�ot 3 a
,� �� �,�� <�.
Date of Mark-out �.
._.- S
Date of Burial � ��` //d � Time �b / 6 � �' • C' ��'
Name of Funeral Home �, h ���
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Authorized by , ,
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Name
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No. �
001001 208001
001501 322900
001501 341920
001501341910
001501 341930
601010 343800
001501 343805
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE �� ry� r� �
RECEIPT L C
❑ Cash
heck # f :�
Amount Paid
Sales Tax
Garage Sales
CopieslBid Specs.
LDC/Code of Ordinances
Electlon Qualifying Fees
Cemetery Lots v �� c�
LotlNiche �6 , Block ff�._, Unit �
Cemetery Fees • S L»
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_ Total Paid �`s' ���
initials •
White - Dept. oi Oripin • Yeilow - Finance • Pink • Applicant
HEALT
A. (TYPI
1. Name of
Deceased
?. Place of Death
County
Indian River
3. Name of Medical
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
First Middle Last Date
of
Patricia Ann Ranahan Death
City, Town or Location Name of (If neither, give street address)
Hosp. or
Sebastian mst. 697 Nobles Street
� /� - „�a
Month Day Year
15 2004
Phone Number
Certifier R er Mittieman, M.D., M. . 2500 S. 35th Street
Medical Examiner Physician Fo1"t PlerCe, FL 772-464-7378
l. Name of Funeral Home/Dj�ci-�ie�as�l Address Fla. Lic. No./Reg. No. Phone No. (Area Cade)
Establishment 1623 N. Central Ave.
Strunk Funeral H me Sebastian, FL 1225 772-589�1000
i. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. � 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 d h,u(rithin 72 hours.
c. �
�. Funeral Director/
�eeFBis�eeer
Q
was contacted on
cause of death within 72 hours.
''� F.E. No./Reg. No.
1862
BURIAL - TRANSIT PERMIT
He/she verified that
Medical Examiner, wili complete and sign the
Date Signed
Permission is hereby granted to dispose of this body. Permit No. 1228—O�i-0204
� 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.
R,�gisKxac-� • Date Date Certificate
SubregistrarSignature �` �I'� Issued: 5/17/04 Due: 5/20/04
.. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: Date .
Medical Examiner, , gave authorization by telephone to
Funeral DirectodDirect 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
Method of Disposition: Place of Disposition Sebastian Cemetery
�BURIAL �STORAGE Date of Disposition �� `,�����
�CREMATION
Signature of Sexton
or Person-m-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
ithin 10 days to the local County Health Department in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
i 326, 8197 (Obsoleles all prevlous editions) Yellow: Funerel Direclor or Direct Disposer
tock Number 5740.000-0326-2) Pink: Local Registrer
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S�B�T�►N
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HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery
Purchase Receipt
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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
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Name(s) ' "
,i�o?�.s' �l<.s� �w�: � Lo � �i� ���3� �,� �`�L. ���5'�'�
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Address
77z - ��d9 - � �.5��
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in #he sum of:
�
�� �
Dollars ($ o d . d0' )
on this �� day of , 200�` for the purchase of the following
described Cemetery Lot(s) and/ r Niche(s).
Unit �_, Block /� , Lot(s) �o 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 �%�v� W O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Signature of Purchaser
of Sebastian
TOTAL $ %75� D �
� ��7
Service fees are to be paid at time of need only
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