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Home My WebLink About4-14-210 =0 I arfOF SE HOME OF PELICAN ISLAND Certificate No. 2040 CITY OF SEBASS IAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Deanna Allan 1366 Valeruis Street, Palm Bay, Fl 32905 (name) (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/Niche 21 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 31th day of August, 2005. CITY VF SE]YOTIAN, FLORIDA Manager ATTEST: Jeanette Williams, CMC Deputy City Clerk - O Name Unit_ L� Lot l` Date. of Mark -out Cam/ Date of Burial / Time Name of Funeral Authorized by No. / 001001208001 001501322900 001501341920 001501341910 001501341930 601010 343800 001501343805 -s—� CITY OF SEBASTIAN CITY CLERK'S OFFICE 3404 RECEIPT ❑ Cash heck #Az Amount Paid Sales Tax Garage Sales CopleVBld Specs. LDCICode of Ordinances Election Qualifying Fees Cemetery Lots Lol/Niche -t/ Block 1.14 Cemetery Fees .00 Total Paid % dd Initials Whits - Dept. of Origin • Yellow - Finance • Pink - Applicant j3 Ic _ 4 • �--o al - (.1&44.R.UAA.0 .�C. TIM NoFUNERAL HOME tral Aw. �ealft X1000 I FLORIDA DEPARTMENT OF IHEALTri Health, StaAPPLICATION FO B BURIAL PERMIT'cs 0:11 A. (TYPE) n 1. Name of First Middle Last Da Day Year Deceased Barbara Bargo Death Aug. 28 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Indian Harbor Beach Inst. 209 Bella Coola Drive 3. Name of Medical Address Phone Number Certifier Martin Isenman M.D. 1130 S. Hickory Street Medical Examiner Physician Melbourne, FL 321 - 725 -4500 4. Name of Funeral Home /D0e&1%3 Jd= 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. F Carolyn was contacted on 8/29/05 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Isenman 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 541catio2 of se of death within 72 hours. 6. Funeral Director/ i atu F.E. 862Reg. No. Date ned S B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -05 -0371 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. FINo extension of time for filing the death certificate has been requested. Registrin-vr —• Date Date Certificate Subregistrar Signature NA. Issued: 8/28/05 Dye: 9/11/05 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 Examinees 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 CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition 9 / / Z- nCREMATION Signature of Sexton 1 or Person -in- Charge Jj OTHER (Specify) r 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, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740- 000 -0326 -2) Pink: Local Registrar RaJdd ` P.P. arfor SJDASTIAN HOME OF PEUUN M AND 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 ame(s) Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only is acknowledged in the sum of: tars ($ on this day of , 20�for the purchase of the following described Cemetery Lot(s) a nd/pf Niche(s). Unit _, Block Lots) 0'91 Niches) 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 Z!5 O H Circle One Vase and Ring for Niches (cost) Signature of Purchaser Interment Disinterment i City of Sebastian Service fees are to be paid at time of need only I: \W W- DATA\Ms- Cemetery\RECEI PT.doc 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 August 31, 2005 Deanna Allan 1366 Valerius Street Palm Bay, Fl 32905 Dear Ms. Allan: Enclosed is City of Sebastian Certificate 2040 for the purchase of Cemetery Lot 21, Block 14, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, i epette Williams, CMC uty City Clerk JW:ar enclosure