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Certificate # 1899
QOpy~
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Judith Watkins
(name)
(name)
13225 U.S. Hwy 1, Sebastian, F1 32958
(address)
(address)
in and for consideration of the sum of $700.00 ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 14 , Lot(S) 13
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 ~y of May , 2003
Sally
City C
~o
City Manager
Name ~~ t~„C
~~ ',~ ~
1
Unit_ ~ ~~
Block
Lot
Date of Mark-out 1 ~ ""
Date of Burial --~ - 0~
Time ~~ i Q ~ P~ l' ~/ ~/~'~Q~~~
Name of Funeral Home .~
t 1 n J ~C ---
Authorized by,_
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UAPdAN. ®. SFFE7Y ' •parkeAMerknn eA
Name
No. ® ~
001001208001
001501322900
001501 341920
001501 341910
001501 341930
601010 343800
001501343805
Sales Tax
Garage Sales
CopieslBid Specs.
LDC1Code of Onlinances
Election Qualifying Fees
Cemetery Lots
LoUNiche .Block . Unft-~
~~/
Cemetery Fees
Total Pa7d ' ~~
~~ -
I als
White -Dept. of Origin • Yellow -Finance • Pink -Applicant
CITY OF SEBASTIAN 2 9 7 5
CITY CLERK'S OFFICE
ocPCIDT
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE ~ ~ ~ `~
RECEIPT
c
Name _ ^ Cash
~G ~1 /
Date ~ ~ ~ ~ d-~
eck ~
AmountPakl
001001 208001 Sales Tax
001501322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501362100 Community Center Rent
001501362100 .Yacht Club Rent
001501 362150 Non Taxable Rent
001501 343800 Cemetery Lots
t
UQ
3~'~7v ~" ~'~ ~ ~
601010 343800 t
0 ~
Cemetery Lots
~
~~-
.
LotMichell/z ! ,Block ~, Unit
001501369400 Interment Fee
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800220683 Riverview Park Security Deposit
y Total hid ~/ ~~ ~` UO
Initials
Whits - Oapt. of Origin • Yellow - Finance • Pink -Applicant
FLORIDA DEPARTMENT OF
HEALT
(TYPE)
A.
1.
D
State of Flo ' ent o ealth, Vital Statistics
APPLICATION FOR URIAL -TRANSIT PERMIT
Y~y~~
Name of First Middle Last Date
Deceased of
Judith Ellen Watkins Death
Month Day Year
July 1 2004
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. VNA Hos ice House
3. Name of Medical Address Phone Number
Richard T. Penly .8005 Bay Street, #4
Certifier Sebastian, FL 772-581-9977
Medical Examiner Physician
4. Name of Funeral Home/DireeE~B}s~osaf"' 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 this
Appropriate application.
Box
b. ~i Sandy was contacted on 7/6/04
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Penly" 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 ce cat' n of cause of death within 72 hours.
6. Funeral Director/ n e F.E. No./Reg. No. Date Signed
~ ~. , __~ ~ 1497 7/1/04
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-04-0260
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.
Reg+strarar-r Date Date Certificate
Subregistrar Signature ~_,.. y~ ~ ~~.,~.,~...~ Issued: 7/1 /04 Due: 7/6/04
c.
Approval Number:
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Date .
Medical Examiner, ,gave authorization by telephone to
Funera- 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 Dispositioh Sebastian Cemetery
dBURIAL STORAGE Date of Disposition
CREMATION
Signature of Sexton
or Person-in-Charge
OTHER (Specify)
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.
Distribution: White: Cemetery or Crematory
DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number 5740-000-0326-2) Pink: focal Registrar