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Home My WebLink About4-15-15QIY of SL$�° TN HOME OF PELICAN ISLAND Certificate # 1927 CI OF EBAST1AN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: John H. and Carol B. Graves 398 Benchor Street, Sebastian, F1 32958 (name) (name) (address) (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 15 , Lot(s) 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 17th day of November , 2003 C Y OF SEB: STIAN F ' RIDA 60/ T: ce R. *ore City Manager ATTEST: a Sally A. Iy , CMC City Clerk Name C AW OX l 2( 3 /lies 9 Unit Block 13 Lot /57 Date of Mark -out ` 5---/// Date of Burial 1A.7 / !1 Time 7m�55 ,44 /Ate.6- (35 Name of Funeral Ho e • f net fur 111-4,4-4... 4.' A� OAuthorized by rkAK.� 508£4£ LOSl00 m 1 0 co 0) g °o °o °o °0 0 ° 0 0 0 0 0 — N O N CO O. c0 CO CO CO O S O O O O saouewpJQ ;o apo010a1 O N N 0 e CA v 3 z 3 n -9 O m m ▪ 7C 1 N T ▪ co T_s m Carol Graves March 11, 1931— July 24, 2011 Carol Graves, 8o, of Boca Raton, FL died July 24th, 2011 at her home after a long illness. She was born March 11, 1931 in Worcester, MA and lived in Florida since 1964. For a period of time she also lived in Cleveland, GA. Mrs. Graves was a retired teacher from St. Joan of Arc School where she taught for 25 years. Carol's husband, John H. Graves Jr. died in 2003. She is survived by 5 daughters, Susan McCarthy of Sebastian, FL, Missy Burnett Koopman of Sebastian, FL, Wendy Graves of Lake Worth, FL, Donna Giaquinto of Boca Raton, FL and Jackie Orrizzi of Boca Raton, FL. Mrs. Graves has 14 grandchildren and 10 great grandchildren. FLORIDA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT . Name of Deceased First Carol Middle Last B. Graves Date Month Day Year of Death July 24, 2 011 2. Place of Death County City, Town or Location Palm Beach / Boca Raton Name of (If neither, give street address) Hosp. or Inst. 9584 East Lake Drive 3. Name of Medical Certifier Leonard Hock nMedical Examiner El Physician Address 1489 W. Palmetto Park Rd. Boca Raton, FL 33486 Phone Number 561- 416 -5090 4. Name of Funeral Home /Direct Disposal Address Establishment 3600 N. Federal Hwy. .lick Family Funeral Home Boca Raton, FL 33431 5. Check a. Et The medical certification has been completed and signed. Appropriate application. Box Fla. Lic. No. /Reg. No. F062802 Phone No. (Area Code) 561 -672 -1880 A completed certificate of death accompanies this b. Ej 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 death within 72 hours. c. was contacted on He /she verified that medical certification of cause of death within 72 hours. , Medical Examiner, will complete and sign the 6. Funeral Director/ Direct Disposer B. Signature F.E. No. /Reg. No. F045571 Date Signed 7 -27 -11 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 11-62802-105 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. ONo extension of time for filing the death certificate has been requested. Registrar or Subregistrar Signature Date Date Certificate Issued: 7 -24 -11 Due: 7 -29 -11 C. Approval Number: Medical Examiner, AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Date , 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. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition ` �{, �( �� Age x / • RBURIAL EICREMATION Signature of Sexton or Person -in- Charge } STORAGE LiOTHER (Specify) Date of Disposition /// 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 (Obsoletes all previous editions) (Stock Number: 5740- 000 - 0326 -2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5 S NOME a ?ILION ISLAND ND 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: Y/,ci( f��y1�,(� �,E,�o,�� Ab L • ADDRESS: / PHONE #: / 5''4. 71 - / R d (Check ne) PEN BURIAL LOT Lot /5-- :Block /5---- Unit OPEN CREMAINS LOT Lot __ *Block Unit -OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: 7A 7/ ,3 : oo, FOR DECEASED: (4, % 4 . 'Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) //(A Nam W Signature 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 same NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR. Name Signature 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 Ce ete exton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY or HOME OF ?ELICAN ELAND November 18, 2003 John H. & Carol B. Graves 398 Benchor Street Sebastian, Fl 32958 Dear Mr. & Mrs. Graves Enclosed is City of Sebastian Certificate Number 1927 for the purchase of Cemetery Lots 15 & 16, Block 15, Unit 4. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, f Sally A. Maio, CMC City Clerk SAM:ar enclosure >-)9 SEsignAN HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt 01l 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 corict Caro 1 B. CI raves Name(s) qg 8e0 ch 0 sfi'ee t Sen `�a s -ate F 52 5p AddresC77) J 2 R _ 9 7 7 Area Cde & Phone Number 1 Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: 61 YC„ �/ k 4 �q �D� Dollars ($ % 4160, °° ) on this / 7 day of M0 Ueii be.- , 20 03 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 4 , Block / J , Lot(s) /5 4- I& 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 W 0 H Circle One Vase and Ring for Niches (cost) ure of Purc a Alf 4111 Interment Disinterment TOTAL $ An'L2 y of Sebastian Service fees are to be paid at time of need only 1WW- DATA \Ms - Cemetery\RECEIPT.doc JOHN H GRAVES CAROL B GRAVES 398 BENCHOR ST SEBASTIAN FL 32958 -4202 Pay to the /- OF �+0 %79 order of c_17-, 03/9577-Ri%', � G U6; ?err 704-Ak 'mac) First Union National Bank FON" For U 8 15 73 /_:677L/ � 40530002L91:72?2L379207?" Date 11-- 7 -CJ3 102 66- 21/530 Security teawras '' Dollars abefa °18 Da k. 314 ' 00102 PLANO CITY OF HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 • (772) 589 -5330 — Fax 772 - 589 -5570 October 21, 2004 John & Carol Graves 398 Benchor St Sebastian, Fl 32958 Dear Mr. & Mrs. Graves: Re: Sebastian Cemetery Unit 4, Block 15, Lot 15 It is with regret that we inform you that the marker and /or vase on your Sebastian cemetery lot was damaged during the recent hurricanes. The city has made arrangements with a local monument company to repair the damaged markers at $225.00 per marker and $20.00 per vase. According to the rules and regulations governing the cemetery (copy enclosed), interment site owners are responsible for damage to markers and /or vases, therefore, we are enclosing an invoice for the reimbursement of this fee. Thank you in advance for your cooperation in this matter and I would like to assure you that the upkeep and maintenance of the cemetery is very important to the City. If you have any questions regarding this matter, please do not hesitate to contact me at the cemetery or by telephone at 772 - 589 -2545. Sincerely, Kip G. Kelso, Jr Cemetery Sexton Enclosure tiOM , OF PW *i InesiND INVOICE CITY OF SEBASTIAN TO: John & Carol Graves INVOICE: 05 -059 398 Benchor St Date: 10/25/2004 Sebastian, FL 32958 Amount: $ 225.00 AMOUNT DESCRIPTION DUE 1 Repair of marker at Sebastian Cemetery Unit 4, Block 15, Lot 15 DUE UPON RECEIPT 225.00 TOTAL AMOUNT DUE 225.00 Remit To : CITY OF SEBASTIAN Finance Department 1225 Main Street Sebastian, Florida 32958 Account Numbers: Dr: Cr. 010059 534685