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HomeMy WebLinkAbout4-10-15QTY of HOME OF PELICAN ISLAND Certificate No. 2197 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Nancy George Michaud 805 Holden Court, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, dock 10, Lots 15 & 16 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 7th day of November, 2008. CITY ~F SE~/,~~fIAN, FLORIDA inner anager ATT--I : °~ ~_ Sally. .Maio, MMC City Clerk Name f ` '~,'`=- et~~ / ~' ~Tv~~{ 1~~ ~~~ ~ ~ ~ ~~~ ~ Unit flock ~ Lot ~ ~~ Date of Mask-out ~~'` f ~' ~ ' Date of Burial ~ ~~' ''~ =~ Time Name of Funeral Home `~ ~'~"/.,1~° Authorized by ~ ~ , a r ~, e' a • T r g • a ~ -d x i w c 0 __ __ _ O ~ O (O~ (S~ (dam (O~ pO ~ ~ 3y ~ O O O O S ~ 1P ~^ o ~ ~ ~ 1 ^N` '~ ~ m r ~ ~ N .~ ~~ T ~ 3 ~ ~ ~^' ~ ~ ~ Q, ~ ~ ~ ~ ~ ~ ~ ~~ ~ O ~n C ~ n n iM I~ ~ M "~ ,~ ~ cn n ~~~ T ~~ m N N Obituaries ~ Death Notices ~ Newspaper Obituaries ~ Online Obituaries (Newspaper D... Page 1 of 1 CARL JOHN MICHAUD Carl John Michaud, 47, died Jan. 20, 2009, at the VNA Hospice House in Vero Beach. He was born in Bristol, Conn., and lived in Sebastian for nine years, coming from Margate. He was the owner of Reef Construction in Sebastian. He graduated from the University of Florida in 1985. Survivors include his wife of 18 years, Nancy Michaud of Sebastian; sons, Austin and Maxwell, both of Sebastian; daughter, Alexa of Sebastian; father, Jerry Michaud of Sebastian; mother, Laurette Michaud of Fort Lauderdale; and sisters, Elizabeth Michaud of Fort Lauderdale, Chris Ann Michaud of West Palm Beach and Sharon Flinn of Sea Grove, N.C. SERVICES: Visitation will be from 1 to 2 p.m. Jan. 25 at the Strunk Funeral Home in Sebastian. A service will follow in the funeral home chapel at 2 p.m., with the Rev. Terry Neiman officiating. Burial will follow in Sebastian Cemetery. Published in the TC Palm on 1/22/2009 Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact t.egacy.com • Terms of use Powered by Leg~lc'~.~.GOrn. obituaries nationwide Back http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=12312... 1 /22/2009 ~LO`DA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased Carl John Michaud Death Jan. 20 2009 2. Place of Death County Indian River City, Town or Location Vero Beach Name of (If neither, give street address) Hosp. or Inst. VNA Hospice House 3. Name of Medical Address Phone Number Certifier Richard Penly, M.D. 901 37th Street Medical Examiner Physician Vero Beach, FL 772-978-5600 4. Name of Funeral Home/Oiree tBt Address 1623 N . Central Ave. Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment trunk Funeral Home ~ Cremat Sebastian, FL y 1228 772-589-1000 15 o. ~neac a. LJ i he medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ~ Marcia was contacted on 1 /20/09 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Penly will complete and sign the medical certfication of cause of death within 72 hours. c. ~ was contacted on He/she verified that Medical Examiner, will complete and sign the meth rtifi n cause of death within 72 hours. 6. Funeral DiredoN Sig u F.E. No./Reg. No. Date Signed Direet~Dtt~se'r ~J/h~_~ 44048 1 /20/09 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-09-0033 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 cert~cation of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. Aegisharvr-'' Date Date Certificat Subregistrar Signature ~.~,,Q,~, j~,~., M, Issued: 1 /20 /09 DUe: 1 /e25 / 09 c. 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 Examiners approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition f /~ S^/O ~ . CREMATION Signature of Sexton or Person-in-Charge OTHER (Specify) } ~.~ ~ This 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 within 10 days to the local County Health Department in.the county where disposition occurred. DH 326.8/97 (Ottsabtes all prwious editions) Distribution: ~kwr: Funeral Director or D~lred Disposer (Stock Number. 5740~000dXi26-2) Pink: Loeal Registrar y~~ ~ ~ r Y FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ~n S~B~T~N HOME OF PELICAN ISLAND For information contact: Kip Kelso -Cemetery Sexton Sebastian Municipal Cemetery (772)589-2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 ~,. FUNERAL HOME: " ~" "'~ o- '~-"~'~~~ P "- ...:J 9 d (':' i:lui~'. ~ . ti~e..~. ADDRESS: gE~kSI't;=~N., FL ~~9 100U PHONE #: (Che~c`}c One) J OPEN BURIAL LOT Lot ~ 5 OPEN CREMAINS LOT Lot OPEN COLUMBARIUM NICHE Niche BURIAL DATE AND SERVICE TIME: Januar~ FOR DECEASED: Carl John Michaud Name _ Block _ Block _ Block N 2Y 5, 21 10 Unit ~ Unit Unit _S E W 109 2.00 P.M. NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) ~~ •~5 Name Sig r Date I certify that I have determined the ownership of the above described site, that all site fees and administrative fees have been paid and authorize opening of sameM NAME AND SIGNATURE OF LICENSED FUNERBcgDIRPCT Name re i~ .~ Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: _~, C~e ex on Date rY This form to be provided to Clerk's Office by Sexton for permanent record upon completion. €rtY t~ ~l ~'- ~ ~ a" FiUME ©F PELICAN fStAtdF? 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, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Names ' J ~n 5 ~d (d~-1~ C~ t,,~r-t~ ~S~bas ~f ~ a,~ ~L .3z ~ 5 ~ Address C ~ 7 ~- Area Code & ? Co 3 3 ~- ~- I b 0 Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($ Q~~ ~ ~ on this- ~ day of N~t~ , 20~~ for the purchase of the following described Cemetery Lot(s) and/or Niche(s). i Unit ~, Block ~_, Lot(s) ~ JC ~i ~lP 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) Vase and Ring for Niches (cost) Interment /W O H Circle One Disinterment Temporary Marker Preparation & Installation I61 Sin r of Purchaser L•\WlN-DATA1lVls-Cemetery\RECEIPT.doc and The following documents were provided as Proof of Residency: Opening & Closing TOTAL $ oL~O~ , ~~ o City of Sebastian CITY OF SEBASTIAN CITY CLERK'S OFFICE 4 2 O b RECEIPT Name ! 1v(~~~ ' ' 4 ~ ~~ ~ ~°`~~ ^ Cash Date ` [ _ ~ ~ ~ ~ ,Check # No. 001001208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 001501 343805 Amount Paid Sales Tax Garage Sales Copies/Bid Specs. LDC/Code of Ordinances Election Qualifying Fees h `,~^ ~/~ Cemetery Lots t /~ /~j LoUNiche f ~'~ ` Y/, Block ~ ~° ,Unit Cemetery Fees ~~~~~1 ~~~ ~~~ Total Paid Initials White -Dept. of Origin • Yellow -Finance • Pink • Applicant