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HomeMy WebLinkAbout4-14-31an or SEXASTL HOME Of PELICAN ISLAND Certificate # 1881 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Suzanne Conners (name) (name) (name) 517 Drawdy Way, Sebastian, FL 32958 (address) (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) 31 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 -17th day of March CITY OF SEBASTIAN FLORIDA Terrence R44do6ie City Manager 2003 . ATTEST: Sally A. Waio, CMC City Cile-rk 00 Unit Block ` Lot Date of Mark -out ' 3- /,3 Date of Burial -5 Name of Funeral Home Authorized by I Time (a p4 p Name Unit Block / Lot 1 Date of Mark -out / �1 Date of Burial l'r 7 f Time !� Name of Fune Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE 2495 RECEIPT Name Date .Z No. 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies /Bid Specs. 001501 341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots ❑ Cash heck# 01,1G2,/ Amount Paid Lot/Niche ,Block , Unit 001501 343805 Cemetery Fees J. k Total Paid /� Initials White — Dept. of Origin • Yellow — Finance a Pink . Applicant Aa /�2" e eatltA- /Uy- Y&J 4- 4all" )-eAZ&- . . Adho /J),k- J- (31 z /V a v 4 VA 4 . . 6mzi2l, Zf 2Q d dAdw, aat L�oF SEBASTL � HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 • (772) 589 -5570 March 24, 2003 Susan Conners 517 Drawdy Way Sebastian, FL 32958 Dear Ms. Conners: (t 4 61k (q You were recently charged incorrectly for a niche opening. I am enclosing a check to refund that amount to you. Please accept my apology for the error. Sincerely, Je nette Williams Deputy City Clerk Encl. ff D A DEPARTMENT OF EALT A (TYPEI State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT �_ 3 1 6 1 L1 u Lt 1. Name of First Middle Last Date Month Day Year Deceased of William Connolly Death March 11 2003 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Green Gables 3. Name of Medical Address Phone Number Garrick B. Kantzler, M. D, 805 37th Place Certifier Medical Examiner Physician Vero Beach, FL 772 - 562 -2330 4. Name of Funeral Home/ posa 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. Sandy was contacted on 3/11/03 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 Medical Examiner, will complete and sign the ed cal ce ,Offica.Wo f cause of death within 72 hours. 6. Funeral Director/ ig re F.E. No. /Reg. No. Date Signed Qiiieei ,ese 1862 3/11103 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-03 -0126 ❑ 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. F�No extension of time for filing the death certificate has been requested. P.@,@i48tF8F SP -.e Date Date Certificate Subregistrar Signature fok- � Issued: 3/11103 Due: 3/16/03 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. 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 3 CREMATION OTHER (Specify) Signature of Sexton or Person- in- Charge 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 Name Conners 3 -17 -03 CITY OF SEBASTIAN _ CITY CLERK'S OFFICE 15 J RECEIPT ❑ Cash ❑XCheck 0 117 Amount Pall Sales Tax Garage Sales Copies/Bid Specs. LDC /Code of Ordinances Community Center Rent Yacht Club Rent Non Taxable Rent Cemetery Lots Cemetery Lots Lot/Niche 31 , Block 14 Unit Interment Fee Weekend Service Yacht Club Security Deposit Community Center Security Deposit Riverview Park Security Deposit jW M Total Paid Initials White - Dept. of Origin a Yellow - Finance • Pink • Applicant 20.00 125.00 845.00 C(OPY L1111�Z CITY OF SEBASTIAN CHECK REQUEST Accounting Use Only Input Date Fiscal Period Document # Entered By Document Amount # of Lines Total HC Hash Due Date To Be Completed By Department 3/21/2003 Single Check y Y Vendor Number IN TC Document Reference Organization Code Object Code Project Code Amount $20.00 Description Number of Lines Amount $20.00 Strunk Funeral Home instructed the family to pay $20.00 interment fee and it wasn't nec( Family has paid applicable fees to bury loved one ISSUE CHECK TO NAME Suzanne Conners ADDRESS 517 Drawdy Way CITY Sebastian STATE FL ZIP 32958 Check Drawr B APPROVED IWA JLU DATE 3 BUDGET APP R AL (534000 AND 535450 ONLY) D © AYAIL ATTACHED DOCUMENTATION (Except for remit slips, requesting department should attach a copy of documentation along with the original) Please give check to Jeanette CITY OF SEBASTIAN _ CITY CRECEIPT FFICE 15 7 J Name Conners ❑ Cash Date 3 -17 -03 117 C3�Check # 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC/Code of Ordinances 001501362100 Community Center Rent 001501362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010 343800 Cemetery Lots Lot/Niche 31 Block 14 001501 369400 Interment Fee 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 680800 220683 Riverview Park Security Deposit ]W AmountPak1 700.00 Unit 4 20.00 125.00 845.00 Total Paid Initials Whits - Dept. of Origin - Yellow - Finance - Pink - Applicant The Sebastian Cemetery City ®f Sebastian., Florida Receipt is acknowledged in the sum of: AA / (-0 Dollars ($ '700, 0 0 ) From: D U 2 O ! e, C p n n e cis 517 ._8 rra�w cf u WQ V 5e baStja yj FL 32g5c ' � -7 7 a - 5Y 1 - o2,595 on this 1 �+� day of M arch , 20o3 for the purchase of the following described Cemetery Lot(s)/Niche(s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)/Niche(s) 31 Block 114 Unit 4 Purchase Price:JPrnJn JWA&& � �� Dollars ($ 7 0. 0'9 ) Terms and Condition of Sale: This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. 1, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: Purchaser signature Purchaser signature The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. ty of Sebastian itness