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HomeMy WebLinkAbout4-14-38Name Unit Block Lot 3 6 Date of Mark-out 6 �f Date of Burial�� Time Name of Funeral Home Authorized by 4r, I ayyoF SIEBASTILM HOME OF PELICAN ISLAND Certificate No. 2021 IT ' 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: Jeff Prin cipe 970 S. Easy Street, Sebastian, Fl 33015 (name) (address) in and for consideration of the sum of $700.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 4_ Block _14_ Lots _38_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 3rd day of June, 2005. OF SWASTIAN, FLORIDA A "Minner Sally City Manager [aio, MMC Clerk N U 5100 0 • affof SEBASTKN HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Name(s) ' 70 S ,tA.�y ,��T e�.FeJ�9,sfiAn� � •�•Z9S� Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receeiipt is acknowledged in the sum ofd: Ilars ($ 7ia . ao ) on this s,7',. -,� day of— , 20 *X—for the purchase of the following described Cemetery Lot(s) d /or Niche(s). Unit , Block /_, Lot(s) .38 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 - $20) Opening & Closing �%� G O l w ) O H Circle One Vase and Ring for Niches (cost) Interment Disinterment Signature of Purchaser T L$ of Sebastian Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEI PT.doc Permission is hereby granted to dispose of this body. Permit No. 1228 -05 -0244 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. Regi9iF8F OF Date Date Certificate Subregistrar Signature � Issued: 5/27/05 Dye: 6/1/05 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 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 �r BURIAL STORAGE Date of Dispositions CREMATION Signature of Sexton 1 or Person -in- Charge J OTHER (Specify) 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 Regda! `S• P,Pff DEPARTMENT OF iORIDA iX[ State Ha Statistics APPLICATION FOR BURIAL TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Lester Gerald Pafford Death May 27 2005 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 Biggs, M. D. 1344 Apollo Blvd., #A Medical Examiner Physician Melbourne, FL 32901 321- 956 -0122 4. Name of Funeral Home /Dimet-0icpesel Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 North 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. Amanda was contacted on 5/31/05 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Biggs 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/ Signature F.E. No. /Reg. No. Date Signed GgaGt-P rNaeor. 1862 5127/05 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -05 -0244 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. Regi9iF8F OF Date Date Certificate Subregistrar Signature � Issued: 5/27/05 Dye: 6/1/05 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 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 �r BURIAL STORAGE Date of Dispositions CREMATION Signature of Sexton 1 or Person -in- Charge J OTHER (Specify) 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 Regda! `S• P,Pff 6- G "� m8C zIl lip r"D m Qn t �- w M ou oll i w cd c 0 o S o 0 0 $ 2 O 2 0 d D+ A a � N O j W N m d C> u g o 0 0 o g A in a m 0 n m v o m m a ` N N o i Cn no m a CD o d 2, fnn N n �• N m m m M Om n CO) ca N N m ;,:, m A p H � T � � mz m o t y' d ° m CA) W °o w o 2 E� > �§ $/� ■\ � (D % k k 2@ O =_ /§§ k}7 § � _ E © )] �■ m 0 o »w 17 cn 2 �} � ■ ■ �\ � � w \Ck . 4 2 �. CD �§ g% . a �mi §� ;� $� . �� A } , \ 2 &2# E � _ 0 g ] 2 �PoE \/ _ \��� 7M2§ E� C. = w >\ �)� ® kcn % k k 2@ 3 =_ /§§ ;§ _ § d§ � _ E © )] _ C) .. 0 o »w kCD w R§ cn _ � w aQ'n o 0% C. 2$) OCR k 2@ 7' �§ � I ! 7 coo .. 0 o »w kCD w cn co 00 2 \Ck . 4 2 �. CD 04 . Q�� �mi §� -b 46 Lester Gerald Pafford, Palm Bay Lester Gerald "Jerry" Paf- ford,. 51, died May 27, 2005, at Holmes Regional Medical Center, Melbourne. He was born in Waycross, Ga., and lived in Palm Bay for three years, com- ing from Micco. He was a line techni- cian for the Palm Bay Utilities De- partment for 10 years. Survivors include his wife of 26 years; Wenonah Paf- ford; sons, Jeff and Jimmy Bass; both of Vero Beach, Jerry Pafford of West Mel - bourne and Carson Pafford of Trenton; daughter, Wanda Yates of Micco; brother, Terry Pafford of Atlanta; sis- ters, Sue French and Candy Vickers, both of Atlanta, Joann' Buckelew. of Talla- possa, Ga., Treva Grimes and Lorene Powers, both of West Melbourne, and Lanell Jones of Melbourne; and seven 'grandchildren. SERVICES: Visitation will be from noon to 2 p.m. June l at the Strunk Funeral Home, Sebastian. A service will fol- low at 2 p.m. in the funeral; t home chapel, with the Rev. Buddy Johns officiating. Burial will be in Sebastian . Cemetery. 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 June 3, 2005 Mr. Jeff Principe 970 S. Easy Street Sebastian, Fl 32958 Dear Mr. _Principe: Enclosed is City of Sebastian Certificate 2021 for the purchase of Cemetery Lot 38, 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. :Sinc Sally A. Maio, MMC City Clerk SAM:ar enclosure