HomeMy WebLinkAbout4-14-05o.
Certificate # 1870
an a
5~~°'-~T~-N
___.
~:~~.~~
HOME OF PELICAN ISLAND
~oQ~
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Victor L. Parker
(name)
Pauline R. Parker
(name)
(name)
lT. 0. Box 0273, Roseland, F1 32957
(address)
P. 0. Box 0273, Roseland, F1 32957
(address)
(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 14 ,Lot(s) 5 & 6
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 8th day of January 2003 .
Y OF BAS IAN, FLORIDA ATTE }
~-
_.-
,,~-° ~~.
--__
rrence ore Sally A. M ' , CMC
City Manager City Cler
0
~~ i
n ~
`J J T ~ - ~~
Name ~ ..4 C
unit
------=
Block
Lot
Date of Mark-out
:'' ~~'
Date.of.Burial ~-~ ,~%~s ;°i <~,
Time_~, ~ ~ ~C~' yQ
Name of .Funeral Home 3
Authorized by
- - _ __
. o = ~
O n
~ ~ ~
o ~ o °~
V
J
O
O
``
Q ~ ~~~
p ® c
E
~ ~ ~.
~ `i~~
ti .~~
W
r I
r~.r ~ C
:I
of
O ~ °~'
~ ~ ~
I ... ~.
~ ` D
1 ~
~ fD
I ~ ~'
~ D
` ~
u~
I~
o~ ~~~~<
a~ ybNa~
o rn00~C~
°,~ ~O~rO
`° zxNZ70
vN~m~
rCO~~'G
N ~~
~ 70 m
~„ m ~
J
b
1
°1
d ~
in
~ ~
~s3
5¢6r
& g
0
m
C
p ~
o ~
~ ~ ~
CITY OF SEBASTIAN
CITY CIERK'S OFFICE ~ ~ ~ n
RECEIPT
Nam ~ ~`~ i'~~ ~ ~~'Cf-cLP'' ~ Cash
Date ~ eck #~
AmountPa
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDCICode of Ordinances
001501 362100. Community Center Rent
001501362100 Yacht Club Rent
001501 362150 Non Taxable Rent
~
001501 343800 a ~y~
Cemetery Lots ~~~ ,[~ ~~
~
601010 343800 Cemetery Lots
LotMiche ,Block ,Unit
~° ~
001501 369400 Interment Fee
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800 220683 Riverview Park Security Deposil
~ ~F.G? ~` ~1
~ ~~
Total Paid /~;.,-.
Initials ~/ SS , e
li
A
W hits -Dept. of Origin • Yellow -finan can
pp
ce • Pink -
C ~p~
FLORIDA DEPARTMENT OF / ~~ ~ S
~~
- HEALT State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
4. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Victor L.ee Parker Death Feb. 18 2003
Z. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Roseland Inst. 12960 82nd Court
3. Name of Medical Address Phone Number
Certifier Garrick Kantzler 805 37th Place
Medical Examiner Physician Vero Beach, FL 772-562-2330
4. Name of Funeral Home/Rireel-Bisposat~ 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
Appropriate
Box
a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b. ~ Sandy was contacted on 2 / 18 / 03
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
.and that Dr. Kantzler will complete and sign the medical
certification of cause of death within 72 hours.
c ~ % was contacted on _He/she verified that
/ry ,Medical Examiner, will complete and sign the
medic certi cati n c se of death within 72 hours.
6. Funeral Director/ Si a re F.E. No./Reg. No. Date Signed
~~~~ 1862 2/18/03
B.
BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-03-0087
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.
~~ Date Date Certificate
SubregistrarSignature ~N. Issued: 2/18/03 Due: 2/23/03
--r
c.
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 STORAGE Date of Disposition ,,~ ~ °~~~0
CREMATION
Signature of Sexton 1
or Person-in-Charge 1
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
OTHER (Specify)
This permit must be endorsed by the Sexton orperson-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and r ned
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 Direcl Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar