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HOME OF PELICAN ISLAND
Certificate # 1898
~Op~y
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Donald McManus
(name)
Katherine McManus
(tee) .
581 Glencove Street, Sebastian, F1 32958
(address)
581 Glencove Street, Sebastian, F1 32958
(address)
~in and for consideration of the sum of $1, 400 . oo , ~ purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 14 ,Lot(s) 11 & 12
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 $ th day of MgY
G OF 5 BASTIAN, FLORIDA
enc . oore
City Manager .
2003
ATTEST:
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City Cler
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Name
Unit_
Lot
Date of Mark-out_~f ~ Q
Date of Burial_ `~~~Q 3
Time (~~
Name of Funeral Home
Authorized by .,~~/„~~; ~ ~-
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S~,BAST~AN ~
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NOME OF PELICAN 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
pr Lded at time of porch/ase
~~„ „I B ~ IL ,. .11 nAeAA„ ._
Name(s) ~ - ~~~~~~, ~ 2~Z9~8
5~ I ~ I er, c;~vo
Address `
~-~ Ma~~d~ ~ . IN~tk.~~ s ~
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars ($ 0100 ~ )
on this U '= day of ~ , 20 b 3 for the purchase of the following
described Cemetery Lot(s) and/or he(s).
Unit `T , Block ~, Lot(s) I ~a /~ 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
Vase and Ring for Niches (cost) Interment
W O H
Circle One
Disinterment
TOTAL $
Signature of Purchaser
City of Sebastian
Service fees are to be paid at time of need only
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 1 ~ ~ '"~
RECEIPT ~
Name 0 Cash
Date ~ ~ ~ ~ d~
oZO ~/ /
eck,~
AmoutdPaid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 Copies/Bid Specs.
001501341910 LDC/Code of Ordinances
001501362100 Community Center Rent
001501362100 Yacht Club Rent
001501 362150 Non Taxable Rent
001501 343800
601010 343800 Cemetery Lots
3
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UO
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emetery Lots
~~
LolMiche.~/z J ,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 Deposit
r Total Pald ~ ~~ ~` lJQ
Initials
Whits - Dspt. of Origin • Ysllow - finance • Pink • Applicant
FLORIDA DEPARTMENT 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 of
Matilda D. Watkins Death May 7 2003
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 Memorial Hospital
3. Name of Medical Address Phone Number
Certifier Harish Sadhwani, M.D. 12920 U.S. #1
Medical Examiner Physician Sebastian, FL 772-581-2373
4. Name of Funeral Home/Direel~Bi~peee~ 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. U The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~. Kelly was contacted on 5/8/03
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Sadhwani 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 c ifi at' of cau th within 72 hours.
6. Funeral Director/ Si . F.E. No./Reg. No. Date Signed
DKest~eseF- /. ~ _ _~ 1862 5 / 7 / 03
B. - BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No.1228-03-0206
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
Subregistrar Signature ~y',~"/f~,, ~ Issued: 5/7/03 Due: 5/12/03
~~
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:
~r BURIAL
CREMATION
Signature of Sexton
or Person-in-Charge
STORAGE
OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition ~/~~~~ \~
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. 5740-000-0326-2) Pink: Local Registrar