The URL can be used to link to this page

Home My WebLink About4-14-35- - - -- - - - - _ -- - - - - - - -- Certificate # 1890 arra SEBASTIAN HOME OF PEUCAN ISLAND CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Gwendolyn A. Perry 8885 126th Street, Roseland, Fl, 32957 (name) (address) (name) (address) Gwendolyn A. Perry (interred name - if known at time (address) of sale) 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) 35 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 3rd dayof April 2003 qI Y OF S AS , F ORIDA ATT T: Terrence "o&e Sally A. Lo, CMC City Manager City Clefk I 0 - -- — - - -- - - Ma SEBASPAN HOME OF PEUCM ISLAND Certificate # 1890 12PA Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Gwendolyn A. Perry (name) (name) Gwendolyn A. Perry (interred name — if known at time of sale) 8885 126th Street, Roseland, FL 32957 (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) 35 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 3rd day of April City Manager 2003 ATTEST: Sally A. io, CMC City Clefk U i Name /ENd4� -yN pgRI*R Unit Block fi Lot Date of Mark-out- 3- Date of Burial Name of Funeral Home Authorized by I 'x 1 o') Time d. 00 Pfr ,3A /2s FLORIDA DEPARTMENT OF HiAc A (TYPE) L 35 5 ILA u4 State of Florida, Department of Health, Vital Statistics . APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased GWENDOLYN A. PERRY of MARCR19, 2003 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County INDIAN RIVER FORT PIERCE Hosp. or INTEGRATED HEALTH SERVICES Inst. 3. Name of Medical Address Phone Number Certifier ROSS GLIDER, M.D . 2401 FRIST BLVD Medical Examiner % Physician FT. PIERCE, FL 34950 772/464 -0033 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FISHING ST. SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772/589 -1933 5. Check Appropriate Box a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. ❑ 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. C. was contacted on He /she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ ignatuj F.E. No. /Reg. No. Date Si ned Direct Disposer 2294 3/20/b�3 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 03- 2617 -035 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 th eath certificate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 3/20/03 Due: 3/24/03 C. A Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. Method of Disposition: BURIAL STORAGE CREMATION OTHER (Specify) Signature of Sexton or Person -in- Charge CEMETERY OR CREMATORY Place of Disposition 5 - A.4 57Zl is d Date of Disposition 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 (Obsoleles all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740- 000 - 0326 -2) Pink: Local Registrar 1,-, o0 b�A�t CITY OF SEBASTIAN CITY CLERK'S OFFICE 1616 RECEIPT Name SE a F n ds ❑ Cash Date 7 Check d� AmountPald 001001 208001 001501 322900 001501 341920 001501 341910 001501 362100 001501 362100 001501 362150 001501 343800 601010 343800 001501 369400 001501 369400 680800 220681 680800 220682 680800 220683 Sales Tax Garage Sales Copies/Bid Specs. LDC /Code of Ordinances Community Center Rent Yacht Club Rent Non Taxable Rent Cemetery Lots Cemetery Lots I-ot/Niche 35 Block Unit 4 Interment Fee Weekend Service Yacht Club Security Deposit Community Center Security Deposit Riverview Park Security Deposit s 75 I 4 to Total Paid �775�T�' Initials White - Oapt. of Origin • Yellow - Finance • Pink • Applicant CITY OF SEBASTIAN 1225 MAIN STREET SEBASTIAN, FLORIDA 32958 SC 'R OL r I i 7 TtF POSTAGr 1 5 1 0 P 8 5 5 4 4 3 6 1 5 1 1 is 00.370 APP 03 2,01 070 MAILED FROM ZIP CODE '13 2 9 5 8 e=,Tzj-. tk*Mdble An mnwmpw UAaft To F.'" kftftleftf Add,.n 13 Moved, Loft NO AddMU C) Llhelffirmed 12 Perused 17 Attempted - Not K,00* 1) 40 Such Str" ri f3 VSCGM 0 Iflegibre t) "0 Wit fleceptecio t3 %bm" F01 &Mer AWm" D ftamp D" Apr 02 03 04:00p Seawinds Funeral Home 7725891939 p.l 735 Fleming Sb+eet Sebastian, Fbrida 32958 (772)589 -1933 Fax. (772)589 -1939 lfl� 7& To: Jeanette Williams From: Jim Young Fa)c 589 -5570 Pages; 1 Phan Drste: 4/2103 Re: Gwendolyn Peny CC: Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle HERE IS THE INFO THAT YOU REQUESTED.... GWENDOLYNN A. PERRY DOB: 6/18121 DOD: 3/19/03 017 - 125681 8885126' STREET ROSELAND, FL 32957