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Certificate No. 2204
C��� � �'� ���������.�
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Lawrence G. Barnes 8345 96th Court, Vero Beach, FL 32967
(name) �address)
In and for consideration of the sum of $4,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Blk 10, Lots 27 & 28
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 30t" day of January, 2009.
OF�BASTIAN, FLORIDA
� �
j AI Minner
City Manager
ATT �S"�, : � _, , -
- .R!' ��;' j ;r;' \ .� f -�_-
'; � ��L,� �� �" �"�
�_
Sall A. Maio, MMC
City Clerk
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Name E �
Unit
Block � ��
Lot � °� '
� y .. � '`�
Date of Mark-out � ' !�� ` �� I
Date of Burial „�` �.� �? f � � Time � � ' �-' � � `-` �`'�f � '' /".� }
�
Name of Funeral Home =' � '` !'�''�� ��
;
Authorized by � ; r ��: `}`��t �..'`~" �'�V �.,�[.-�,-G'f.� • yt'L`;�-
A
B4 • SCRIPPS TREASURE COAST
Obituaries
VERO BEACH
�Rlla B�CIleS
Lena J. Barnes died Jan.
28, 2009, at Sebastian River
Medical Center, Roseland.
She was born in Wil-
mington, Ohio, and lived
in Vero Beach for 12 years,
coming from Homestead.
She retired
from Veter-
ans Affairs in
' Miami as , a
� F :,
,,, � �; program as-
sistant after
20 �years of
service.
Survivors include her
husband of 55 years, Larry
Barnes of Vero Beach; son,
Rick Barnes of Goldvein,
Va.; three giandchildren;
and five �eat-grandchil-
dren.
SERVICES: Visitation
will be from 9 to 10 a.m.
Jan. 31 at the Strunk Fit-
neral Home in Sebastian.
� service will follow in the
funeral hame, chapel at 10
a.m. Burial will follow in
Sebastian Cemetery in Se-
bastian.
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
.m x
$�"'�� �
HOME OF PELICAN ISLAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
� L c W�:9�'.",�a ��a'��'�'��. i L�'.'�: �
FUNERAL HOME: 5c^3 t�c�_ C��n r�,! r�v�.
ADDRESS: s� �Te�• FL32a58
.9-59�100A
PHONE #:
(Check One)
XX OPEN BURIAL LOT Lot 28 Block �� Unit �
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: January 31, 2009 1�.M.
FOR DECEASED: �na J. Barnes
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESE TA .
(Must provide proper documentation of ownership)
�,CJ i'�, •�1.e'��v .
Name Signature Date
I certify that I have determined the ownership of the above describe
admiristrative fees have been �a;d and auth�rize operirg cf sarr�'
NAME AND SI NATURE OF LICENSED FUN L I OR:
� / �,��,���,� .
Name Sia a ure
, that all site fees and
,,��.��
Date
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid:
�d o�,
Cem tery�Se on Date
This form to be provided to Clerk's Office by Sexton for permanent record upor. completion.
FLORtDA DEPARTMENT OF
HEALT
�.
1. Name of
Deceased
2.
3.
Place of Death
County
I ndian River
Name of Medical
Certifier Mich
4. Name of Funeral h
Establishment
5trunk Funeral
5. Check
Appropriate
Box
6. Funeral DirectoN
Direct Disooser
State of Florida, Department of Heaith, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
First
Lena
City, Town or Location
Sebastian
Middle last Date Month Day
J. Barnes oeatn �an. 28
Name of (If neither, give street address)
Hosp. or
�nst. Sebastian River Medical Center
ea,�.e�� Phone Number
Year
2009
�el Venazio .D. 8005 83rd Avenue 772-388-2110
ledical Examiner Physician Sebastian FL
me/ �sposal Address Fla. Lic. No.lReg. No. Phone No. (Area Code)
1623 N. Central Ave.
Home � Cremato y Sebastian, FL 1228 772-589-1000
a. � The medicat certification has been completed and signed. A completed certificate of death accompanies this
application.
b, b L�Z was contacted on ��28�09
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
and that Dr. Venazio will complete and sign the medical
ceRification of cause of death within 72 hours.
�
was contacted on He/she verified that
, Medical Examiner, will complete and sign the
of death wfthin 72 hours.
F.E. No.lReg. No.
�4048
Date Signed
1/28/09
B. BURIAL - TRANSIT PERMIT
Pertnission is�hereby granted to dispose of this body. Permit No. � 228-09-0048
� A frve (5) day extension of time for filing the death ceRificate (exGusive 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 cert�cation of cause-of-death section of the death certificate within
72 hours.
�No extension of time for filing the death certificate has been requested.
�.� Date Date Certificate
SubregistrarSignature ��• Issued: ��28�09 Due: 2�� �09
�, AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: Date _
Medical Examiner, , gave authorization by telephone to
Funeral DirectodDired Disposer. Date
The Medical Examiners 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.
p_ CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
�BURIAL
�CREMATION
Signature of Sexton �
or Person-in-Charge
�STORAGE
�OTHER (Specify)
Date of Disposition ��� / /� �.
/ � i
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.
Disttibution: WhiM: Cemetery or Crematory � m`Q
DH 326, 8197 (Obsobtea all prsvious edkions) Yeiiow: �uriera� Dire..-tw cr Qir°� _'•",_�_f
(Stodc Number 5740-000-0326-2) Pink: Local Registrer �� `� �