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HOME OF PELiGN ISWVD
Certificate # 1949
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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:
Peter F. Osterman
(name)
1010 George Street, Sebastian, FI 32958
(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 plot:
Unit 4_ Block 16 , Lot(s)_31 & 32_
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 4th day of March, 2004.
OF
City
I�
FLORIDA ATTEST:
� _
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Sall A. Maio, �MC
City Clerk
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_ - _ _ ---- -----
___ _ _ _
Name C.� � � �. 1 � � `� �i,. E..''. llf'� � 1� . �� X. 1� � �i � •
Unit
Block
Lot
Date of Mark-out " �� �� �
� � _7 l `� � ! o � �� �� r �
Date of Burial� � Time
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� �l.3i...�C . .
`Name of Funeral �iome
Authorized by
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 2 618
RECEIPT
Nam�,��'�- /� _...--
'"� C� ❑ Cash
Date Q __� em•6ff ck#—.���=
No. Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 Copies/Bid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Elecdon oualifying Fees
601010 343800 Cemetery Lots � �f �
LoUN(dw�,���, Bbdc�� . Unit.�
001501 343805 Cemetery Fees �d
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� �_I��vtav
� Total Paid �
loftialt
White - Dept oi Oripin • Ilellow - Fin�nce • Pink • Applieant
a.
FL RIDA DEPARTMENT OF
HEALT
(TYPE)
I. Name of
Deceased
?. Place of Death
County
i ndian River
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
First
Cecelia
City, Town or Location
Sebastian
Middie Last
Osterman
Name of
Hosp. or
Inst.
Date
of
Death
(If neither, give street address)
1010 Geor4e Street
�_;�_.��
Month Day Year
March 2 2004
3. Name of Medical Address Phone Number
Certifier Noor Merchant, M.D. 13060 U.S. #1
Medical Examiner Physician Sebasti7n, FL 772-589-0879
4. Name of Funeral Home/L1ir�6iepeeal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N. Central Ave.
Strunk Funeral Home Sebastian FL 1228 772-589-1000
�. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
Funeral Director/
b. � Kim was contacted on 3/2/04
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
and that Dr. Merchant will complete and sign the medical
certification of cause of death within 72 hours.
c. �
medi ert'rfi tion of
�/ S' ture
�i � G
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
death within 72 hours.
RE. No./Reg. No.
� 1862
BURIAL - TRANSIT PERMIT
Date Signed
3/2/0�
Permission is hereby granted to dispose of this body. Permit No. 1228-04-0090
�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 abie 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.
Rogictca�or Date Date Certificate
Subregistrar Signature /l.l Issued: 3�2��� Due: 3/7/04
�
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
Method of Disposition: Place of Disposition Sebastian Cemetery
�r BURIAL � STORAGE Date of Disposition •_� ,��/D �
�CREMATION
Signature of Sexton �
or Person-in-Charge
� OTHER (Specify)
�/ , _
e
�is 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
thin 10 days to the local County Health Department in the county where disposition occurred.
Dietributbn: White: Cemetery or Crematory
I 326, 8f97 (Obsoletes all prevlous editions) Yellow: Funeral Director or Direct Disposer
ock Number: 5740-000-032&2) Pink: Locel Registrar
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HOME OF PELiUN ISIAND
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 interrnent must be
p�,ed at time of purchase
�
Name(s)
�d �o G�'o _6 E.��f�?" . SE�3.ASf� _�L a'�Z�..s�
Address
77� _
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use On/y
Receipt is acknowledged in the sum of:
C�.•i..Q - �..,���*^�•��
��
iov .�._. Dollars ($f�o . oo )
on this day of �,��..� , 2Qdfl for the purchase of the following
described emetery Lot(s) and/or 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 �zS. o o �) O H
Circle One
Vase and Ring for Niches (cost) Interment
Disinterment
$ / �'Soo
Signature of Purchaser ity of Sebastian
Service fees are to be paid at time of need only
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H�ME OF PELIUN 15WVD
March 12, 2004
Peter F. Osterman
1010 George Street
Sebastian, Fl 32958
Dear Mr. Osterman:
Enclosed is City of Sebastian Certificate Number 1949 for the purchase of Cemetery Lots 31 &
32, 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.
Si y,
, ° � �� �
�
Sally A. M�aio, CMC
City Clerk
SAM:ar
enclosure