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Date of Mark -out 11//e//6
Date of Burial 11M/
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Vero Beach Crematory, LLC
Strunk
Funeral Home Crematory
(Funeral Home in Charge)
02245
(Cremation ID Number)
1830 Wilbur Avenue
Vero Beach, Florida 32960
We hereby certify that these are the cremated human remains of:
Phyllis Baker
November 12, 2010 November 17, 2010
(Date of Death) (Date of Cremation)
Vero Beach, Florida
(City and State)
By: )/w,4)►
(Cremator Signature)
FUNERAL HOME:
ADDRESS:
PHONE
vl tke-1-1-1 ke r
Name Signa
Cepnet efy Sexton
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBA-
NOME 0 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
f ,,f4; /1
(Check One)
PEN BURIAL LOT Lot Block Unit
PEN CREMAINS LOT Lot JO A. Block liR Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: /7//it;' 1/2
FOR DECEASED: Li;5 /4 )e, 5/44) zi valve
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
I 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 FUNERAL DIRECTOR.
Name Signature
//9/v
Date
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
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
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