HomeMy WebLinkAbout4-15-13
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HOME OF PELICAN ISLAND
Certificate # 1946
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Joseph and Martha Hamwey 9035 I01sr Ave., Vero Beach, Fl 32967
(name) (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 plot:
Unit _ 4_, Block _15 , 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 17th day of February, 2004.
CITE' OF SEBASTIAN, FLORIDA
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Terren ' .Moore
City Manager
ATTEST:
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S y A. Maio, CMC
City Clerk
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Name ~4 `, ~~ s:. , f: s ~• ~`-~ ,~. ,:
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Unit
Block
Lot ~,
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Date of Mark-out ^: r .'
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Date of Burial ~$ ~ ti: '•~
Time ~- .~'.-
Name of Funeral Home .~ ~ ;~'~ P ~. ~.r
Authorized by ;^`;~.~- "•~•
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HOME OF PELICAN ISLAND
February 18, 2004
Joseph and Martha Harnwey
9035 101st Avenue
Vero Beach, F132967
Dear Mr, Hamwey:
Enclosed is City of Sebastian Certificate Number 1946 for the purchase of Lot Numbers 13 &
14, Block 15, 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.
Sincerely,
Sally A. Maio, CMC
City Clerk
SAM:ar
enclosure
ITY OF SEBASTIAN
CITY CLERK'S OFFICE 2 5 3 5
RECEIPT
Nam ^ Cash
Dat ~7 O 4
heck # ~ O,L
No. ~ Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copiesl8id Specs.
001501341910 LDCICode of Ordinances
001501 341930 Election Qualifying Fees
601010 343800
Cemetery Lots ~ p
/~~~/v . v c7
LotlNichel_, Block ~, Unit
001501 343805 Cemetery Fees
Total Pai~ 9,x:00
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Initials
White -Dept. of Origin • Yellow - Fina~ncie • Pink -Applicant
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FLORIDA DEPARTMENT OF
HEALT
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State of Florida, Department of Health, Vital Statisti
APPLICATION FOR BURIAL -TRANSIT PERMIT
Name of First Middle Last Date Month Day Year
Deceased Martha Jo Hamwey Death Feb. 10 2004
Place of Death City, Town or Location
County
1 ndian River Roseland Name of (If neither, give street address)
Hosp. or
Inst. Sebastian River Medical
Center
Name of Medical Address Phone Number
Certifier Noor Merchant, .D. 13060 U.S. #1
Medical Examiner Physician Sebastian, FL 772-589-0879
Name of Funeral Home/6irtee!-Bispt~53F Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
1623 N. Central Ave.
Establishment
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
b. ~ Sukayna was contacted on 2/11 /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. Merchant will complete and sign the medical
certification of cause of death within 72 hours.
c. ~ was contacted on He/she verified that
Medical Examiner, will complete and sign the
medical ce ' 1 tion , ca of death within 72 hours.
Funeral Director/ i t F.E. No./Reg. No. Date Signed
~irort nienn .nom 1 862 2 / 1 0 /04
BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-04-0052
~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.
RsgisiraFerr Date Date Certificate
SubregistrarSignature ~,y,rp.,~,~,~,e /~~ ~,~~~ Issued: 2/10/04 Due: 2/15/04
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. Awaiting period of 48 hours after death is
required for all cremations.
ethod of Disposition:
BURIAL
CREMATION
Signature of Sexton 1
or Person-in-Charge !r
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
STORAGE
OTHER (Specify)
Date of Disposition ~~ / /~ ~~
tis 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.
Disfribution: White: Cemetery or Crematory
i 326, 8/97 (Obsoletes all previous ed'Rions) Yellow: Funeral Director or Direct Disposer
ock Number: 5740-000.0326-2) Pink: Local Registrar