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HOME OF tPELICAN ISLAND
Certificate # 1897
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Barbara Muhlbauer
(name)
(name)
918 Cypress Street, Barefoot Bay, F1 32976
(address)
(address)
in and for consideration of the sum of $1,125.00 , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 , Block 14 , Logs) 23
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 2nd day of May , 2003
CI T--' OF SEBASTIAN, FLORIDA
i
Terrence R. ore
City Manager
ATTEST:
Sally A. Mai , CMC
City Cler
01
I
_ ._. Name D
3fg0?- 5:
Unit
Block
Lot
Date of Mark -out
:YZ� I� j
Date of Burial / `� Time �l C)
Name of Fune
Authorized by
Total Pakf /, r11, U
Initlals
whits — Dept. of Origin • Yellow — Finance • Pink - Applicant
i
I
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
1747
RECEIPT
Name
�Sc� " l(
❑ Cash
Date
Amount Pa
001001 208001
Sales Tax
001501 322900
Garage Sales
001501 341920
Copies/Bid Specs.
001501 341910
LDC /Code of Ordinances
001501 362100
Community Center Rent
001501 362100
Yacht Club Rent
001501 362150
Non Taxable Rent
001501 343800
Cemetery Lots
601010 343800
Cemetery Lots
/
Lol/Niche Block , Unit
001501 369400
Interment Fee
%G
001501 369400
Weekend Service
680800 220681
Yacht Club Security Deposit
680800 220682
Community Center Security Deposit
680800 220683
Riverview Park Security Deposit
Total Pakf /, r11, U
Initlals
whits — Dept. of Origin • Yellow — Finance • Pink - Applicant
i
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FLORIDA DEPARTMENT OF
HEALT
A (TYPE)
State of Florida, Department of Health, Vital Statistics (C(apr
APPLICATION FOR BURIAL -TRANSIT PERMIT
1. Name of
First
Middle Last
Date
Month Day Year
Deceased
of
Daniel
Paul Muhlbauer
Death
April 28 2003
2. Place of Death
City, Town or Location
Name of (If neither, give street address)
County
Hosp. or
Brevard
Melbourne
Inst. Holmes Regional Medical Center
3. Name of Medical
Address
Phone Number
Certifier Paul O.
Vassallo, M.D -, M.
1750 Cedar Street
Medical
Examiner Physician
Rockledge, FL
321- 633 -1981
3. Name of Funeral Home /Direct Disposal
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
1623 N. Central Ave.
Strunk Funeral
H me
Sebastian, FL
1228
772- 589 -1000
5. Check a.
Appropriate
Box
b. F1
C. M
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
was contacted on
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that will complete and sign the medical
certification of cause of death within 72 hours.
was contacted on
He /she verified that
Medical Examiner, will complete and sign the
edical rtifi on of cause of death within 72 hours.
i. Funeral Director/ S' ure F.E. No. /Reg. No. Date Signed
Direct Disposer 1862 4/28/03
3, BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -03 -0197
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.
Rte— Date Date Certificate
Subregistrar Signature /�� Issued: 4128/03 Due: 5/2/03
T
1. 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.
�. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition T-'/.2 A 3 ,
RCREMATION
Signature of Sexton
or Person -in- Charge I
OTHER (Specify)
his 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
rithin 10 days to the local County Health Department in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
H 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
Mock Number 5740- 000 - 0326 -2) Pink: Local Registrar