HomeMy WebLinkAbout1-39-02a\ V ,
Certificate # 1888
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HOME OF PELiGN ISLAND
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Diane & James Acker, Jr. 8095 126th Street, Sebastian, FL 32958
(name) (address)
(name)
(interred name - if known at time
of sale)
(address)
(address)
in and for consideration of the sum of ~~- ~ 400 , oo ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 1 ADD. ~ Block 39 ,Lot(s) 1 & 2
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 1st day of April 2003 .
CITY OF SEBAST ,FLORIDA
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City Manager
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Sally aio, CMC
City Clerk
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James H. Acker, Jr.
~.
February 14, 1947 -May 12, 2009
James H. Acker Jr., 62, of Sebastian, FL died Tuesday, May 12, 2009 at his home.
Mr. Acker was born February 14, 1947 in Vero Beach, FL, when he retired, he and his
wife, Diane, moved to Sebastian from Clyde, NC.
He graduated from Vero Beach High School and completed his Bachelor Degree from
University of Florida in Gainesville. He received a Masters Degree from Florida State,
Tallahassee, FL. He worked as Vocational Rehabilitation Counselor in Florida and North
Carolina. He was a member of The Knights of Columbus, and past Grand Knight of the
Vero Beach Council..
Survivors include his wife Diane; sons John Acker and Christian Acker both of North
Carolina; parents James and Jean Acker of Vero Beach; brothers David Acker of
Waycross, GA and Mark Acker of Nashville, TN; sister Melissa Acker of Asheville, NC.
Services: The family will receive friends 4-5 PM, Sunday, May 17, 2009 at Cox-Gifford-
Seawinds Funeral Home. A mass will be celebrated 12:00 Noon, Monday, May 18, 2009
at St. Helen Catholic Church in Vero Beach. Interment will follow at Sebastian Cemetery
in Sebastian, Florida.
Memorial Contributions may be may to St. Helen Catholic Church, 2000 20th Street,
Vero Beach, FL 32960.
FLORIDd DEPARTMENT OF
HALT
A. (TYPE}
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
1. Name of First Middle Last Date Month Day Year
Deceased JAMES H. ACKER, JR. °f MAY 12 2009
Death
2. Place of Death Gity, Town or Location Name of (If neither, give street address)
County INDIAN RIVER/ SEBASTIAN Hosp. or 134 MAGGIE WAY
Inst.
3. Name of PAedical Address Phone Numoer
Certifier TIMOTHY S . TRUITT, MD 5305 BABCOCK STREET NE
Medical Examiner X Physician PALM BAY, FLORIDA 32905 321-676-9009
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment COX-GIFFORD-SEAWIN S 1950 20TH STREET 2214 1-772-562-2365
FUNERAL HOME & CREMATORY VERO BEACH, FL 32960
5. Check a.
Rppropriate
Box
' 6. Funeral virector/
Direct Disposer
B.
was contacted on
He/she verified that
Medical Examiner, will complete and sign the
F.E. PJo./Re~y. No. Dare Signed
F042919 05/14/2009
BURIAII-TRANSIT PERMIT
Permission is hereby grante to, spose of this body. ~ Permit No. 09-2214-203
A five (5) day extension of e for filling 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 filin de ce ifi ~e~as been requested.
Registrar or ~ Date Date Certificate
Subregistrar Signature Issued: 05 / 12 / 2009 Doe: 05 / 22 / 2009
c.
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. Awaiting period of 48 hours after death is
required for ail cremations.
D
Methcd of Disposition:
BURIAL
CREMATION
Signature of Sexton
or Peron-in-Charge
b.
c.
®STORAG E
®OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition SEBASTIAN CEMETERY
Date of Disposition _ ~/~~ ~~
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Cirector/Direct Disposer when there is no Sexton) and returned
within 10 days to the local County Health Department in .the county where disposition occurred.
Distrbuliorc. While Cemetery cr Cremato,ry
DH 326, 8/9? !Ob<_o!etes all previous ediLersl Yellcw. Funeral Director er Direct Disposer
(Stock Number 5740-000-0326-2) Pink Local Registrar x.~,d~a ~~ r„v,+
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
DR. TRUITT was contacted on MAY 14, 2009
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.
medical certification of cau~sb,ofd ath within 72 h
Signature
1.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA