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SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
C(DPY
INVe, WILt_i,AM L w AnE 5g , Grantee(s) of City of Sebastian
Cemetery Deed # y� or City of Sebastian Cemetery Certificate No. NIA , do hereby transfer my /our
interest in the following:
Lot(s)/Niche(s)_l n Block 51 Unit a of the Sebastian Municipal Cemetery
to: N 6 Qte'El
3a\ FLEm\%)6 ST 5f ejt &r yN0 FL
in accordance with Section 34 -13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation."
I hereby certify that I have received no remuneration for this transfer. I request the consent of the City of
Sebastian.
Signature of Original Grantee
Signature of Original Grantee
State of
County of / /',
Before me, on thiso�c tl�y of - 700 r personally appeared " and
`known to me or who produced
identification, who acknowledged to me that he /she/they executed the same for the uses and purposes herein set
forth. �...._.., _.
EVELYNBENNETTARMSTRONG
r MY COMMISSION # DD 171749
Nota �n
Public Signature nted Name: ? al EXPIRES: January 30, 2007
U My Commission Expires: 1400-3-"OTAF!y F:LNmy8- 1m&ema u1-
Notary Stamp:
The City of Sebastian hereby consents to the transfer of burial rIghpf_or)iIvhIch no remuneration has been
received accordance with ection 3443 of the City of Sebastian of Ord-
es:
By: ATTES .
term City an , James A. Davis Sally A. Maio,WC - City Clerk
to KQrm and Legal Sufficiency:
Rich Stringer, City
Name s Y Ax,;
�t
Unit y
Block
Lots
Date of Mark -out f
Date of Burial_ �. �,%.
Time ` {
Name of Funeral Home
Authorized by s -.» f -A A-L -iAel :T Yi,! i
1225 Main Street, Sebastian, FL 32958 • (772) 589 -5330 — Fax 772 - 589 -5570
]une 2, 2005
Mrs. Ruth Albee
321 Fleming Street
Sebastian, Fl 32958
Dear Mrs. Albee:
I hope you and your family are doing well during this very sad time in your lives.
I have enclosed two (2) copies of the signed transfer of interest form for your records.
I have also forwarded a copy of the form and a copy of this letter to Mr. Wade at his
address in Fort Pierce. If you have any concerns or questions, do not hesitate to call
me at 388 -8212.
ncer lFe�au nn Ro
En closures (2)
Cc: Mr. William Wade
6032 Indrio Road
Fort Pierce, Fl 34951
RAYMOND A.,ALBEE s .
„Raymond A.-'A Ibee,`'83,,.of
3Sebas�ti an, �FL,�pas�sed�awayP
de a�Fiealt 5&.,J; T n_
"u n�e�FL'�af�t'e
ness. Born. -' e. on,
Mame, Raymond move Ito
Seba'st an �n''a983 f_ro. i +
aleah,-FL 4He" as ,,a tW1Nal
Army vet, a foremah with,
Weste$i nUnion, andertjoyed
garden4n` and trave !hd.
Survivors include his wife of 'I
59 yeatsR„uth Albee,; niece's
andfriepFiewss and sister in
Maw 'PIiy , PIrs 41 bee: • Calling
hour$:1are� Wednesday,; May:
25� ,ODS ,from t 6 =8 at Strunk ,
Fu nteral ,Home'; in Sebastian. j
Fuieral Services will be
Thursi`ay, May 26, 2005
at 10
AM sFa "t" the First Baptist
Church of Vero Beach, with
burial to follow at Sebastian
Cemetery. Donations `,may .
be made to'!:the Hdmane S_o-
ciety of. ",�1V,ec:o Beach.
Fount'amhead "Memorial is
handling arrangements.
Paid Obituary
S4 Treasure Coast Newspapers
Raymond A. Albee,
Sebastian
�� Raymond A. Albee, 83,
died May 23, 2005, in
Tandem Health Care in Mel-
bourne.
He was born in Lewiston,
Maine, and lived in Sebas-
tian since 1983, coming from
Hialeah.
He served in the Army
during World War H.
He was a foreman with
Western Union.
He enjoyed gardening and
traveling.
Survivors include his wife
of 59 years, Ruth Albee.
Memorial donations may
be made to the Humane Soci-
ety of Vero Beach,.470141st
St., Vero Beach, FL 32967.
SERVICES: Visitation will
be from 6 to 8 p.m. May 25 at
Fountainhead Memorial Fu-
neral Home in Palm Bay. A
service will be at 10 a.m. May
26 at the First Baptist
Church of Vero Beach.
Burial will be in Sebastian
Cemetery, Sebastian.
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State of Florida, Department of Health, Vital Statistics C(OPYy
APPLICATION FOR BURIAL - TRANSIT PERMIT
Name of First
Middle Last
Date
Month Day Year
Deceased RAYMOND
A. ALBEE
°f
MAY 23, 2005
Death
Place of Death City, Town or Location
Name of (If neither,. give street address)
County
Hos Hos p. or
BREVARD MELBOURNE
TANDEM HEALTH CARE
Name of Medical
Address
Phone Number
Certifier GARY SILVERMAN, M.D.
1265 36TH STREET GROVE PARK PLACE
Medical Examiner XX Physician
VERO BEACH, FLORIDA 32960
772 - 567 -6340
Name of Funeral Home /Direct Disposal
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
7303
BABCOCK STREET SE
FOUNTAINHEAD MEMORIAL
PALM BAY, FLORIDA 32909
FH1442
321 - 727 -3977
Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ® 1)F.RRTR was contacted on .5 -24 -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. SILVERMAN 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
dical certification of cause of death within 72 hours.
Funeral Director/ I nature �j \ply F.E. Nd. /Reg.No. G n -1 ateS_gned
Direct Disposer 1t VUt U ? f Uf ��Clt ���t T'?.0 I p `V L
I. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. FH1442- 181 -05
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.
X No extension of time for filing the eath rtificate has been requested.
—R�� Date Date Certificate
Subregistrar Signature Issued: Dye:
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.
�. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition
BURIAL STORAGE Date of Disposition �? 5
CREMATION OTHER (Specify)
Signature of Sexton j
or Person -in- Charge J) Q
Phis 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
vithin 10 days to the local County Health Department in the county where disposition occurred.
Distribution: White: cemetery or crematory
)H 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
1x1
Stock Number: 574110-0326 -2) Pink: Local Registrar r -Akd %I p„-
R