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Home My WebLink About4-14-36QIY of SIEBASTIAN HOME OF PELICAN ISLAND Certificate # 1934 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Fidel Ernesto Marte, Sr. 138 Admiral Circle, Sebastian, F1 32958 (name) (address) in and for consideration of the sum of $700.00, has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit _ 4_, Block —14—, Lot(s) 36_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 7t' day of January, 2004. OF SEBASTIAN, FLORIDA City L-It Q I Sally . Maio, CMC City Clerk Name J. "7 Unit Block 4 Lot Date of Mark-out Date of Burial Name of Funeral Home Authorized by Time �3 SEBAST" HOME Of PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase 'Fl o e L c g,� & -s—r6 flr P TE 51? Name(s) TXz Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only ReceipffA acknowledged in the sum of: Dollars ($ d� ) on this day , 2%Zfor the purchase of the following described Cemetery Lots n /or e(s). Unit , Block , Lot(s) Niche(s) 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 - $20) Opening & Closing . W) O H Circle One Vase and Ring for Niches (cost) Interment Disinterment AL$ % %�y� Za / ov� Signatu a of Purchaser City Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEIPT.doc /, No. / j 001001208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 001501343805 CITY OF SEBASTIAN CITY CLERK'S OFFICE 2430 RECEIPT ❑ Cash ckyCj Amount Paid Sales Tax Garage Sales Copies/Bid Specs. LDC /Code of Ordinances Election Qualifying Fees Cemetery Lots 7 LotMiche f-6 Block Unit //Cemetery Fees /)/-/ Total Paid Initials white — Dept. of Origin a Yellow — Finance • Pink - Applicant FLORIDA DEPARTMEN ' HEAL' t of Florida, Department of Health, Vital Statistics j PLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of FIDEL ERNESTO MARTE, SR Death DEC 23, 2003 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER VERO BEACH Inst. INDIM RIVER MEMORIAL HOSPITAL 3. Name of Medical Address Phone Number Certifier CHARLES A. DIGG, MD 2500 S. 35STREET Medical Examiner IlPhysician FT- PIERCE, FL 34981 772 - 464 -7378 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FLEXING ST SEAWINDS FUNERAL :HOME SEBASTIAN, FL 32958 2617 772 - 589 -1933 o. cnecK a. IJ The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box 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. B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 03- 2617 -164 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 cerIfficate has been requested. Registrar or D / Date Date Certificate Subregistrar Signature Issued: 12/26/03 Due: 12/31/03 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. Method of Disposition: 0 Z2 BURIAL CREMATION Signature of Sexton o erson -in -Char I STORAGE MOTHER (Specify) CEMETERY OR CREMATORY Place of Disposition S`f� As �,�_ jj CEM Ere Date of Disposition ).4-30-63, 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: Local Registrar