HomeMy WebLinkAbout4-15-22
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HOME OF ~ PEUGN ISWYD
Certificate # 1926
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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:
Dianne DeMarco
(name)
(name)
597 Carnival Terrace, Sebastian, F1 32958
(address)
(address)
in and for consideration of the sum of $1, 400 . oo ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 15 ,Lot(s) 21 & 22
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 14th day of November
CITY OF SEBASTIAN, FLORIDA
F. .Oti, ~' d / ,
Terrence R. Moore
City Manager
2003
ATTEST:
Sally A. M ' , CMC
City Clerk
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Name „$ ~ Y
Unit
Block ~~
Lot
~_
Date of Mark-out_
Date of Burial // L~~~o `
Time ~
Name of Funeral Home '' ~ ,
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Authorized by ` f
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HOME OF I PELIUN ISLAND
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
provided at time of purchase
Names
Address
~W V
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars ($ / a 8 , o o )
on this day of , 20~ for the purchase of the following
described Cemetery Lot(s) an /or Nich (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 y,~S,'o ~' ~ w l O H
Circle One
Vase and Ring for Niches (cost) Interme Disinterment
Signature of Purchaser ity of Sebastian
Service fees are to be paid at time of need only
1:1W W-DATA1Ms-CemeterylRECEIPT.doc
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Name
No. o
001001 208001
001501322900
001501341920
001501 341910
001501 341930
601010 343800
001501 343805
Amount Paid
Sales Tax
Garage Sales
Copies/Bid Specs.
LDC1Code of Ordinances
Eleccfion Qualifying Fees
Cemetery Lots ~Q~
LotlNiche(,~„?~ Block ~
~~. Unit
Cemetery Fees T a
~9~G' .
Total aid j'~7~i"
I itials
White -Dept. of Origin • Yellow -Finance • Pink -Applicant
rxx pus
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 2 2 9 6
n RFr`FIDT
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statisti
APPLICATION FOR BURIAL -TRANSIT PERMIT
1. Name of First Middle Last Date Month Day Year
Deceased BESSIE WENNER °f NOVEMBER 10, 2003
Death
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
DARE NORTH MIAZII BEACH Inst. 920 NE 169 ST X610
3. Name of Medical Address Phone Number
Certifier MARY WAECHTER, ~ 999 PONCE DE LEON BLVD #930
Medical Examiner % Physician COARL GABLES, FL 33134 305-442-0028
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 735 PEENING ST
SEAWINDS FONERAL HOME SEBSTLflN, FL 32958 2617 772-589-1933
5. c;necK a. Ua 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 . He/she ver'rfied that
Medical Examiner, will complete and sign the
medical ce~ification of cause of death within 72 hours.
i. Funeral Director/ '~~:~/~ign lure F.E. No.294. No. _ -- D 11/12/03
Direct Disposer ~
3. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 03-2617-142
~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 as been requested.
Registrar or Date Date Certificate
SubregistrarSignature Issued: 11/12/03 Due: 11/21/03
,. 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.
Method of Disposition:
BURIAL
STORAGE
CREMATION
Signature of Sexton
or Person-in-Charge
OTHER (Specify)
CEMETERY OR CREMATORY r
Place of Disposition / ,t</ ~} ~/ ~ ~' ~--
Date of Disposition % ~,`'j~ ~,~~
pis permit must be endorsed by the Sexton orperson-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned
ithin 10 days to the local County Health Department in the county where disposition occurred.
Dishibution: White: Cemetery or Crematory
i 326, 8/97 (Obsoletes all prevbus editions) Yellow: Funeral Director or Direct Disposer
lock Number: 5740.000.0326-2) Pink: Local Registrar