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HomeMy WebLinkAbout4-10-33CITY OF HOME OF PELICAN ISLAND Certificate No. 2209 C 3TY O' TI Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Claudio & Linda Cristofori 486 Seagrass Avenue, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Blk 10, Lot 33 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 27th day of February, 2009. CITY O SEB TIAN, FLORIDA ATTEST: I Minner Sall A. Maio, MMC City Manager City Clerk Name �c• <� ? .�% �a� �` ✓ k }� f C� �� ✓/� Unit — Block Date of Mark -out `o _s Date of Burial Time Name of Funeral Ho e Authorized by TA VAhL l Seawinds ♦ Funeral Home 735 Fleming Street, Sebastian, Florida 32W "Ip`: ice, . y©�AOF9 Stg C=—A\ vru;,.h, Total Paid 160 . ov Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4234 vz "/�` I J t%1(,t �o Name / T .'rd Cash Date .3 6 � XCheck# No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots 1 �/ L Lko Lot/Niche 33 , Block , Unit 001501 343805 Cemetery Fees �a. r'no-,rker /O.U� Total Paid 160 . ov Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant FLORIDA DEPARTMENT OF HEALT A_ (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT q- (0 -33 1. Name of First Middle Last Date Month Day Year Deceased ROBERT A. YOUNG of 02 27 2009 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Inst. 3 Name of Medical Address Phone Number Certifier DAVID DEPUTRON, DO 13836 US 1 Medical Examiner X Physician SEBASTIAN, FL 32958 581 -6900 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 S FLEMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 32958 2617 772 - 589 -1933 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. DR DEPUTRON was contacted on 03/02/09 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that HE will complete and sign the medical certification of cause of death within 72 hours. c. El 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/ q4rature F.E. No. /Reg. No. Date Signed Direct Disposer FO 44126 03/02/09 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 09- 2617 -063 ® 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 as b requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 03/02/09 Due: 03/13/09 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 Methcd of Disposition Place of Disposition SEBASTIAN CEMETERY ®BURIAL STORAGE Date of Disposition 313 9 CREMATION MOTHER (Specify) Signature of Sexton 1 or Person -in- Charge J} 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 325, 6/97 (Obsoletes ail previous editions) Yellow. Funeral Director or Direct Disposer �} (Stock Number 5740- 000- 0326 Pink Local Registrar Obituaries I Death Notices I Newspaper Obituaries I Online Obituaries I Newspaper Death Notices I Onli... Page 1 of 1 y -/o - 33 Donate Now Robert A. Young, 82, died Feb. 27, 2009, at Sebastian River Medical Center in Sebastian. He was born in Chicago and lived in Sebastian for six months, coming from Orlando Park, III. He served in the Army during World War II and the Korean War. He worked for the Yellow Trucking Co. as a dock worker and was a member of Teamster Local 710. Survivors include his brothers, George Young of Tinley Park, III., and Joseph Young of Chicago. He was preceded in death by his brothers, Harold Young and Charlie Young; and sisters Florence Bolster and Elsie Hosek. Memorial contributions may be made to American Diabetes Association, PO Box 11454, Alexandria, VA 22312. SERVICES: Visitation will be from 5 to 8 p.m. March 2 at Seawinds Funeral Home Chapel in Sebastian with a service at 10 a.m. March 3. Burial will follow in Sebastian Cemetery with military honors by the Sebastian Area Military Honor Guard. A guest book may be signed at seawindsfh.com/obit.php. Published in the TC Palm on 3/1/2009 Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact ie9acy.com • Terms of use Powered by Legacycom obituaries nationwide Back http:// www .legacy.com/tcpalm/Obituaries. asp? Page= LifeStoryPrint &PersonID= 124722785 3/3/2009 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY (MCI AN QRSOW OF nucm Isuwa 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 FUNERAL HOME: ADDRESS: —7 3 PHONE #: 56q-(C13_? (Check One) PEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME FOR DECEASED: Name �cxt Lot Block Unit Lot Block Unit Niche Block Unit N S E W lo. ooh NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) C rJ CR l s 17 r7 tD Name Si nature Date 1 certify that I have determined the ownership of the above described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERA DIRECTOR: 4-o -5•Ann tn.t:A `o uU� l/ !f o,0� Name ignature 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 th t I fees have been paid: 3 A/ �. Cemet SeWon Da e This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SERNS�.n-NN HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 (772) 589 -5330 — Fax 772 -589 -5570 March 3, 2009 Mr. & Mrs. Claudio Cristofori 486 Seagrass Avenue Sebastian, FL 32958 RE. Interment Rights to Unit 4, Block 10, Lot 33 Sebastian Cemetery Dear Mr. and Mrs. Cristofori: Enclosed is City of Sebastjan Certificate 2209 entitling you to full interment rights in Unit 4, Block 10, Lot 33. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Sally A. Maio MMC City Clerk SAM /dc Enclosures aiy of 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, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. (,fQ.udlo ,- kinda CP-isf-oFri Name(s) 41 S-Co <SC -ate f1'cLe, tit- 3 yq 5 Addr ss L/ C-7 7 - 0, Area Code & hone Number -- Name & Residence Address otIntended Occupa r Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: SVlc� 4 /rop Dollars ($ 600o,�o ) on this. )_7 day of FCb YLka , 2005 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit_, Block / 0 , Lot(s) 33 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 Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser % I : \WW- DATA \Ms - Cemetery \R EC E I PT. d oc Interment /W O H Circle One Disinterment TOTAL $ / 0'0 0, 00 Pty of Sebastian The following documents were provided as Proof of Residency: and Prw( of re5(6tev1cy Monthly vrj� -) n Aug 23 - Se p 22, 2008 ROBERT A YOUNG Page 1 of 2 486 SEAGRASS AVE Account Number 708 349 -9454 309 6 SEBASTIAN, FL 32958 -4947 Billing Date Sep 22, 2008 Web Site att.com CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4232 1 Name e r o ft 6 r i ❑ Cash ' 7 VCheck# Date 92 No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche 3-3 Block Unit 1 001501343805 Cemetery Fees W Total Paid 000 O'D Initials White - Dept. of Origin a Yellow - Finance • Pink • Applicant