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Home My WebLink About4-15-32;0 001 Certificate # 1909 0a SEISAST%N HOME OF PEUUN ISLAND Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Anne & Daniel F. Melia 1434 Tradewinds Way, Sebastian, F1 32958 (name) (address) (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 'Lot(s) 31 & 32 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 13th dayof August 2003 7OfFSTIAN, 70RBDA ATTEST: teaadce R M e Sally A. o, CMC City Mana City Clerk �D O Name�� Unit Block Lot Date of Mark -out Date of Burial `a �2 y s/ Time Name of Funeral Home A-w A Authorized by o° o rn _ g $ O 0 d ° d CO pApp W i_p tNp CO O 1 � C7 f r N n o D 0 ti to 1 00 m m'0 T r m m V T M Mc 0 v Q LN DANIEL FRANCIS MELIA Born: August 25, 1924 - Brooklyn, NY Death: October 22, 2011 - Sebastian, FL Mr. Daniel Francis Melia, 87, died October 22, 2011 at his residence in Sebastian. He was born in Brooklyn, New York and lived in Sebastian for 32 years coming from Long Island, New York. He retired after 30 years of service from the New York City Fire Department as Deputy Chief. He served in the US Navy during the World War II & Korean Eras. He was a member of St. Sebastian Catholic Church; and the Sebastian Municipal Golf Course, both in Sebastian. Survivors include his sons, Michael Melia of Sebastian, Jim Melia of Melbourne, Thomas Melia of Massapequa, NY, Steve Melia of Wilmington, DE, Daniel Melia, Jr. of Rockville Center, NY; daughters, Mary Melia of Wilmington, NC, Eileen McElwee of Indialantic; 21 grandchildren, 6 great - grandchildren. He was preceded in death by his wife, Anne Melia; brother, Thomas Melia; sister, Margaret Hall. FLORIDA DEPARTMEN'C OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased Daniel Francis Melia of October 22, 2011 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Indian River Sebastian Hosp. or 1434 Tradewinds Way Inst. 3. Name of Medical Michael A. Venazio M.D. Address Phone Number Certifier 8005 83rd Avenue Sebastian, Florida 32958 (772) 388 -2110 Medical Examiner hysician 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral Home 1623 North Central Avenue Sebastian, F041870 (772) 589 -1000 and Crematory Florida 32958 5. Check a. F-1 The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box ` b.�� V pcu---� was contacted on 0 1 a- He/she verified that this deal;Ft s from natural causes, that there was no accident nor other external cause of death, and that V 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 me cal certification of cause of death within 72 hours. 6. Funeral Director / r I�Rgnat /i ! F.E. No. /Reg. No. ate Si DkaGLDispeser I C"�" Y �- loo �L -, F022789 I c B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -11 -483 Ive (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. F-1 No extension of time for filing t th certificate- kas-been requested. Rug49trJr'or Date Date Certificate Subregistrar Signature Issued: 10/22/2011 Due: 10/27/2011 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR W, CREMATORts ",, G�� tJC.rrl� Method of Disposition: Place of Disposition C�2t 1� XURIAL STORAGE Date of Disposition M I lt� �" LI nCREMATION EJOTHER (Specify) Signature Sexton or Person-in-Charge e 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 ava FWhi OF "" mAm For information contact: Klp 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 -8294 Fax: (772) 589 -5570 STRUNK FUNERAL HOME & CREMATORY FUNERAL HOME: 1b2rN� ADDRESS: SEBASTIAN, FL 32958 PHONE #: - (Che One) OPEN BURIAL LOT Lot 32 Block Unit OPEN CREMAINS LOT Lot Block Unit 1(,� OPEN COLUMBARIUM NICHE N� ilche Block Unit BURIAL DATE AND SERVICE TIME r��q= j N 1DF2 - -,�E �W l 1 Ob AM FOR DECEASED-� t )l-TCW b S kct 1 a-. Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownershi 2 e-11 Name 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. �ME AND SIGNATURE OF LICENSED FUN REC R: .Pang K Pla,-voll Name Signature Date Cemetery Sexton Certification: certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and th all fees have been paid: /O 1—g /r 5e-metiry Axton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.