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HomeMy WebLinkAbout4-15-18Name ,rAa 0 d �f /G,e�41AIS) ;Zlt'97 Unit IFA Block Lot �� Ae' 42/ L42 /0:� Date of Mark -out Date of Burial J/L57 Time PF Name of Funeral Ho Authorized by Sebastian, Florida 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfli.com (772) 589-1933 We hereby certify that these are the remains ofp a rTT. n T-PRED D I RUT. .TR # 7617 . The remains were received •.. �� ► .�u u� a - Cremation Permit No.17-72280-5084 IssuedatINDIAN RIVER rC)IMTY Date of Death APRIL 4,201 7 Date of Cremation 971(1� 8v Cremator 00 C °` o (4 O •� " � W � u :d D1 Q a, • v .. CO W W � a Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Funeral Contact Information: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta(o)cityofsebastian.org (`CNhe✓ck) Open Burial Lot Open Cremains Lot Open Columbarium Niche Burial Date and Service Time: 711 Lot Blocker Unit Lot Block Unit Niche_ Block_ Unit_ (Circle) N S E W Deceased Name: I-;,4lc ,C 4 . � / i Zjr C 7� - , Name and Signature of Lot Owner or Representative: (Must provide proffer documentation of owner ip) /&A//w Name �� Sign lure Date I certify that 1 have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorized opening of same. Name and Signature of Licensed Funeral Director: a tl� Print Name Signature Date 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: Cemetery Sexton Certification: y/�y//�r- Cerrktery exton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. _-- ___ _. __ __ _._. :°aI'6' QF ~.. ~~E S3~ P~~.L.RR'd ~~~~ Certificate No. 2070 x Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Paul Diehl 1032 Topsail Lane, Sebastian, F~ 32958 (name) (address) in and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit_4_ Block _15_ Lot(s)Niche(s)_18_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 14th day of March 2006. CITY F SEB STIAN, FLORIDA ATTEST: f ~; .. 1 Minner S , y Maio, MMC ity Manager "' City Clerk --_ __ Name Unit Block Lot ~~ ~ ~n Date of Mark-out ~' j ~ p ~ f Date of Burial ~~ /~ '''~ ~' Time ~~' i'-'z:'6~' ~ ~~ ~ ~~ ~~' .:.. Name of Funeral Home ~ ~ Authorized by ~ - `' ~ f' - ~ `~~'"` ~1T1f f}I r ~`, ~~ ~ , , ~ 5 •-, l ! ~r~1.r, ~, frll~E ~~ lg~l~t~ ~~~~+~ 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589-5330 -Fax (772) 589-5570 March 14, 2006 Paul Diehl 1032 Topsail Lane Sebastian, Fl 32958 Dear Mr. Diehl: Enclosed is City of Sebastian Certificate 2070 entitling you to full interment rights in Cemetery Lot 18, Block 15, Unit 4. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Si~cn'er~ly, ~/P ~ ~ l„r.----. Sally Maio MC City Cl r SAM:ar enclosure ;~ .~ , ~r J ~~ ',~!' ...J l ~ ( '~ '~~ City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be pr at time of p chase ~¢~~ me(s) _ D ~ vt7--. Address Area Code & Phone Numbe Residence Address of Intended Occupant if Other Than Purchaser Ofifice Use Only Recei t is acknowledged in the sum of: ~~ ~ - Dollars ($~~) on this f day of ~~~'f~1' , 20~ for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit , Block ~~, Lot(s)~~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 "'/a~`~-- (J~} W O H Circ a One Vase and Ring for Niches (cost) Interment ,~--°~`~ Disinterment rr-- Signature of Purchaser of Sebastian Service fees are to be paid at time of need only I :\W W-DATA\Ms-Cemetery\RECEI PT.doc °f ~..> in s m i 0 0 m s E 1 7 • ~a ~ `° `~ ° ~ ~ ~ ~ o ~ m ~ ~ ~ m ~ w 'n r c W o: m x ~ ~ ~ ~ ~ y • ~ ~ o ~_ c4 7C V 9' ;, ~ ~ I I I c „ c^i °' ~ 1~ ~ p w ~' \ D ~S~ O ©~ ~ D. n n ~< m m 0 mom ~ N W '.i~N ~ ~ ~ C m Z W w COX-GIFFORD-SEAWINDS FUNERAL HOME sunirRUSreanrc 5553 1950 20TH STREET VEflO BEACH, FL 32963 VERO BEACH, F~ 32960 63-soy>670 3/9/2006 ~' oR~ER oFE City of Sebastian ~ $ **825.00 Eight Hundred Twenty-Five and 00/100**************************************************~ Qo~~ARS ~ `~ City of Sebastian. 1225 Main St. Sebastian, FL 32958 °~, Diehl ------ ---__ ---~-~-~- ~~'005583~~' ~:067006076~: L0000 L737776 2~i' O O O O O O O ~ p O U U p 0 ~ O O O j O A W W W W W N A ~ A j N O W O ~ ~ tD t0 CNO O O 0 0 ° ° v+ 0 0 o MARY KATHLEEN ~ f DIEHL I , Mary Kathleen Diehl ~" (Hickey), beloved wife for 58 years of Paul Diehl, Jr., March 8, 2006y on Thursday, She was born to Sadie (Kane), and Nicholas .Hickey on April 5, 1926. Mary w.as a dedicated wife, mother of Kathleen, Paul and Jim, grandmother, great grandmother, sister, matriarch and friend. She was a student who earned her Bachelors Degree at age. 56. She lived a rich Life and bestowed many blessings on everyone she touched. Friends may call from 2-4 and 6-8 pm Friday at the Seawinds Funeral Home, Sebastian, Florida. A funeral h1ass will be at 1:30 Saturday at St. Sebastian Catholic Church. Burial will follow at Sebastian Cemetery Paidonrruary ~~ ~~S FLORIDA DEPARTMENT OF ~TF. A T .T State of Florida, Department of Health, Vital Statistics ////~~~~~\ ~1~f~~~!'\)\~) w nr,~ /law Tl/1~1 C/1~ o11~1A1 T~AdICIT ~G~11AIT ~ !/ \1 1 ~~l ~ I .-... ~....-..........,............_ ..., ....... _. _..... I ` A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased ~y KATHLEEN DIEHL °f MARCH 8, 2006 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County INDIAN RIVER SEBASTIAN Hosp. or 1032 TOPSAIL LAN E Inst. SEBASTIAN, FLORIDA 3. Name of Medical Address Phone Number Certifier RICHARD CUNNINGHAM, DO 787 37TH STREET 772-794-5227 Medical Examiner Physician VERO BEACH, FLORIDA 32960 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING STREET 2617 772-589-1933 SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958 -- 5. 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 death within 72 hours. c. was contacted on medical certification of cause of death within 72 hours. He/she verified that Medical Examiner, will complete and sign the 6. Funeral Director/ ' attire F.E. No./Reg. No. Date Signed Direct~isposer --'~~__ 2294 NfARCH 8, 2006 g. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 06-2617-047 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 certi~icate`/ahas b en requested. (( />°' 4 ~ Date Date Certificate Registrar or ~ t f~ Subregistrar Signature ~~ Issued: MARCH 8 , 2006 Dye: MARCH 14 , 2006 ~. 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. D. Method of Disposition: ~RIAL ^CREMATION Signature of Sexton or Person-in-Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY .Place of Disposition ,~j ,~ ~-~ ,~ 5 ~,f l~ (- f rr/1,E ~~ /~i/ Date of Disposition ~/t/~c7 7 i 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. Distribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar ~~~~M ~ Pays