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HomeMy WebLinkAbout4-15-29_.- -_ __ v - - -- ~~ _ --- ~,71f OF ~~u,,~' ~~`JlE f3f PELI~CAeRI 6~i~dJL3 Certificate No. 2086 Certificate! of Interment Rights 1N ACCORDANCE with pr Sebastian, it is hereby certified that: Hector R. Hurtado (name) isions of the Code of Ordinances of the City of 1 SS Chaloupe Terrace, Sebastian, FI 32958 (address) in and for consideration of the sum~f $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for a following plot/niche: Unit 4_ Block _15_ Lots/Niches 29_ of the Seba han Municipal Cemetery, as maintained on f, a in the records of the City Clerk for use in accordance with the cone prescribed therefore by the City of CONVEYED THIS 30~' day of ~~ Minner City Manager FLORIDA ordinances, resolutions, rules and regulations 2006. S Maio, MMC City Clerk ATTE ,~ _ __ - - _ - - _ _ --- ---_ __ _ i -- _----__ _..__- - _ _ ___ --- --- - -_ y,~. 1/ Name ~ .~ ~~-' Block ~ j Lot „,y ... ~ , ~: - ,~ , Date of Mark-out ~J ~ ~ ='~~ _.~, Time ~~ , ~ _ Date of Burial ~' } ~`'~ ~' Name of Funeral Home Authorized by ~~ t , ` *~, t ~ t r ,` ~~ 1-~,~ _...~' _._~ -.._~ ~ '~~ .~ ...~f,:,,...,- --~. 1225 Telephone May 30, 2006 Mr. Hector R. Hurtado 155 Chaloupe Terrace Sebastian, Fl 32958 Dear Mr. Hurtado: Enclosed is City of Sebastian Certificate Block 15, Lot 29. Also enclosed is a col governing the Sebastian Municipal Ceme .~. ~~ ~~ F~1.1~1 1SL~ i Street, Sebastian, F132958 589-5330 -Fax (772) 589-5570 86 entitling you to full interment rights in Unit 4, of the receipt and the Rules and Regulations If you have any questions, please Since , `~~. Sally Mai , C City Clerk our office. SAM:ar enclosure ~~ `~ w.., . ~o~ AF vr=Frr~ ~»~r~ ~~e8~ City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase ~.. Name(s) _ Address " Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Of>~ice Use Only Receipt is acknowledged in the sum of:~ Dollars ($ -• e d ) on thi ~ day of , 20~ for the purchase of the following described Cemetery Lot(s) and/o fiche(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: Comer Markers (set of 4 - $20) Opening 8~ Closing ~~`~ Q W O H Circle One Vase and Ring for Niches (cost) Interment Signature of Purchaser Disinterment _ T A~L($'~JcS . 4 d of Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-CemeterylRECEIPT.doc , - _ ~ ~, ,,. Q ~.-- r Z ~ ~ ~ ~- ~'. tr" i L ~ ~ ~- • ~ ~ ~ ,~ ~ ~ . ~ =~ ~- p ~. ~ ~ -~ ,.- ~P n _l ~- .~ ~ _~ k W ~ AA~ ^~ ~~ /~/~ ..4J ~~r ~ Q~ ~ .iigbgZ 6tit OO~t O0:~9Z 09002 90:~ ~Nne lsnalr~n~ J , .~ , c7 4~ ~~ L-. $ ~/ ~ 1~ ; ~I 0 ^ `1 „~ ~ t~' lclapaoay7o~~fnd .~ J S OC't ,7L 1/UI~StJ17d,5' J~J~11i~ '~l ID~,Id~ G 8 £ ~ OL9-G09-£9 10 O~UJlJI~ ~^ 171~j111y~n >,_ ?~~_ _5'' -"tea __..~:,<..,. n C /A `C S O O w m _' s a r 0 • ~ ~ v ~ 9 ~ ~"! M r a w ~ o $ g g o °o Z 0 ci, o cn cis ci, cn g 0 0 0 0 0 0 ( A A ..~~ ( J~. A A N O ~ O OWD O tD ~ f0 GO O ~ C ~ c 7~ O O m ~ fA ("6 r O d d m ~ ~ ~ ~ ~ fp N n ~ N '~ ~ ~ ~ ~ ~ X T r c M O d (n ~ s T ~p7 W ~ v+ C + ~: ( _ n~ ^~ ~.. C'f O q H ? 7[' 3 o c "`~~~ 'o: n ~ ~~ mm~ y !%! ~ -~O~ T "s ~Z T I~ -o ~ ~, a~ ~ c~ ~ ~ ~ o ~ v; ~ ~c~ °~ ~k`~~~~ai~o~s~ U~ca .v ~ ~ "~ ~+-~ ~ x' s. w - of y S:i •.w' U ~ ~ rp ~ -u~ O .~ ~' 'J, ~- •'~ ~ ~ Lr' • - `~ o s, ~:'~""~ - ~: ~~~°'r~~^-gbh ~" ~ ~f v~ • ~ c~ ,~+~.c'~.~ y:,_ -~ .~ ~. i ..f FLORIDA DEPARTMENT OF HEALT A. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT Opp 1. Name of First Middle Last Date Month Day Year Deceased of Sergio Hurtado, Jr. Death ~Y 2t. 2006 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Fellsmere inst. C.R.512 Eastbound, .25 miles west of S.R. 3. Name of Me 'cal ~Og r Mittleman, M.D., M. ddress 2500 S. 35th Street Phone Number Certifier FL Fort Pierce 772-5$9-1000 Medical Examiner Physician , 4. Name of Funeral Home/DiFeet•9i~esah~ Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N . Central Ave. Strunk Funeral Home Sebastian, ' FL 1228 772-589-1000 5. Check a. © The medical certification has been completed and signed. A completed certificate of death accompanies tnis 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 verified that Medical Examiner, will complete and sign the medical rtifi of a of death within 72 hours. 6. Funeral Director/ ~ .Sig e F.E. No.lReg. No. Date Signed f]uaci..^.icpceer 1862 5 / 23 /06 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-06-0208 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 ofcause-of--death section of the death certificate within 72 hours. ~No extension of time for filing the death certificate has been requested. "Regisharer•-- Date Date Certificate SubregistrarSignature `~A ~~. ~~~ Issued: 5/22/06 Dye: 5/27/06 ~z 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. CEMETERY OR CREMATORY Method of Disposition: .Place of Disposition Sebastian Cemetery BURIAL aSTORAGE Date of Disposition .f `,~ ~~ ^CREMATION OTHER (Specify) Signature of Sexton or Person-in-Charge ~,.~ L-' _ 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. 9 Distribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral DireGOr or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar ~~ i~ ~