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HOME OF PEUUN ISU~ND
Certificate No. 2027
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Charles H. and Evelyn Royer 1570 Bevan Drive, Sebastian, Fl 32958
(name) (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 Lots 27 & 28
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 5th day of July, 2005.
CITY F S B STIAN, FLORIDA ATTEST:
. (~~-~~~ Gr-c
J~pu+y C ~ fy Clerk
A Minner ~ Sally A. Maio, MMC
City Manager City Clerk
Name '~.~' ~,.. < ,F. ,
,?',~~
Unit i
Block :f ~~
Lot
S ~._ ~~ -
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.Date of Mark-out ~ ~ ~' ~,*
Date of Burial ~ ~ ` ~. a~. +'~~~ l
Time ~ _ F ? , > .,- ° ~
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Name of Funeral Home %' i~ -' ` '` .,.
~~
's
Authorized by F {
G p~
1225 Main Street, Sebastian, F132958
Telephone (772) 589-5330 -Fax (772) 589-5570
July 7, 2005
Ms. Dawn M. Grimmich
1570 Bevan Drive
Sebastian, Fl 32958
Dear Ms. Grimmich:
Enclosed is City of Sebastian Certificate 2027 for the purchase of Cemetery Lots 27 & 28, 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,
~, .,~a L~Sally A. Maio, MMC
City Clerk
SAM:ar
enclosure
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NOME OF PEUUN ISIAND
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
r/.~ /yc/ 9~~,y,~.c,
Name(s) ~ ~
/`570 ~,E'dA.~ ~i2iyr , a~C~•~s,7 e~9~, ~.C , ~02.~®
Address
77Z -- ~8~ - as/y
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
o~
.~irz~,~ o ~ j~~..dQ ~ ~ Dollars ($ / OD- ~ Q )
on this ~~ day of , 20Q~ for the purchase of the following
described Cemetery Lot(s) d/ Niche(s).
Unit ~_, Block ~ , Lot(s), ~' ~ o? 8 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 ~~5. d d
Vase and Ring for Niches (cost) Interment
O H
Circle One
Disinterment
add
Signature of Purchaser
of Sebastian
Service fees are to be paid at time of need only
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fharies Royer Jr., _~
Vero Beach
Charles He "Char- .
~''he" Royer Jr.; 82,.died
June 30 ,2005; 'at Indian River
:Memorial Y-Iospital in Vero
Beach:
He was born in Plymouth,
Pa., and lived in Vero Beach.
for 20=years;coming from
Wilton, Iowa.,
He -was a manager' at
iville,.(;orp; Man-
for;43 years. -
t,o~rps durmg; World War II
and received two Purple
Heats.
He was of the of Presby-
terian faith. ,,
He was,a, past president of
the Sebastian Lions Club;. the.
Wilton Lions Club, the
Johns-Manville Quarter Cen-
fury ~ti and the
Johnsl~Yanville Retirees As-
sociatit~n.
Heyw~s a member of the
First~Marine Division Asso-
ciatiori~ and of American Le-
gion Post 39,~V~ro Beach: ,;
Survivors'.include his wife ~
of 60''years Evelyn Royer; '
sons, Charles K. Royer,ofSe-:
bastian and bavid L. Royer:
of Vero Beach;-three grand-
children; and three
greaf-grandchildren.
He was preceded in death.
by a son, Jack A. Royer.
SERVICES: Visitation will
be from l to 2 p.m. July 5 at '
OBITUAhIES
the Strunk ~tneral~Home
Sebastian. A service`will fo1- 1~
low at2 p.m. in the funeral
home chapel;:with Dr. Ed-
ward H: Riedese`t officiating.
Burial will be iri Sebastian
Cemetery with full military
honors conducted by Ameri-
can Legibri Post 189; Veter- -
ans of Foreign Wars Post
10210 and P.L: V;A. Post 210;
all of Sebastian.
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
C~Oo G'1~
1. Name of First Middle Last Date Month Day Year
Deceased Charles Henry Royer, Jr. J
30 2005
Death une
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Indian River Memoria l Hos ital
3. Name of Medical Richard Handler, M. D. Address 777 37th Street, #C107 Phone Number
Certifier Vero Beach, FL 772-562-3234
Medical Examiner Physician
4. Name of Funeral Home/piwcWispocal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N . Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
a. ~neclc a. LJ I ne meolcal certltication has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~ T~CY was contacted on 7/1 /05
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Handler wal complete and sign the medical
certification of cause of death within 72 hours.
c• ~ was contacted on He/she verified that
J ,Medical Examiner, will complete and sign the
medical ce Ic ion of death within 72 hours.
6. Funeral director/ ig ur F.E. No.lReg. No. Date Signed
~~ , 1862 6/30/05
B. .BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-05-0283
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.
~9'~r"" Date Date Certifcate
SubregistrarSignature ~, Issued: 6/30/05 Dye: 7/4/05
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 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:
BURIAL
CREMATION
Signature of Sexton 1
or Person-in-Charge- J)
STORAGE
OTHER (Specify)
Date of Disposition ~~~p 5
This permit must be endorsed by the Sexton orperson-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 (Dbsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740-000-032&2) Pink: Local Registrar mania `~ tisP
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery