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HomeMy WebLinkAbout4-11-08rrl • Certificate No. 2225 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Bonette Sablick 925 Gardenia Street, 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, Bilk 11, Lot 8 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 6th day of July, 2009. CITY OF SEB GTIAN, FLORIDA �/A Minner City Manager ATTEST: Sa A. Maio, MMC City Clerk Name �l��ANNA4 e, C: rtr✓ t Unit Block - Lot Date of Mark -out " , 5 A0 Date of Burial C Time ..i Name of Funeral Home Authorized by � � { t M14 t CITY CLERK'S OFFICE 4 RECEIPT Name' ( �n,( Cash y 1 Date -7 �' 0 Check# No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees / 00• 0 601010 343800 Cemetery Lots 1 Lol/Niche , Block �_, Unit 4 001501343805 Cemetery Fees D �e& p mcy -kc,r 00 Total Paid 10,100 Initials White - Dept. of Origin • Yellow - Finance • Pink . Applicant -- - ► = -- CZGc, In Memory of Lilianna Christina Cantu May 26, 2004 - June 28, 2009 Lilianna Christina Cantu, 5 of Vero Beach, FL passed away Sunday, June 28, 2009 at Arnold Palmer Hospital in Orlando, Fl. She was born May 26, 2004 in Orlando, FL and was a lifetime resident of Vero Beach, FL. Lilianna was considered a miracle baby by the staff of Arnold Palmer Hospital. Survivors include her parents Cayetano and Sarah Cantu; brother Rocky Cantu; sister Kaylie Cantu; grandmother San Juana Rivera all of Vero Beach, FL; maternal grandfather James Kreger of Lappire, MI; maternal great - grandparents Diane and Gene Crowe of Sebastian, FL; paternal great - grandmother Zapopan Rivera of Fellsmere, FL. She was preceded in death by her great - grandfather Eulalio Rivera; paternal grandfather Cayetano Cantu; maternal grandmother Tamara Crowe. p FLORIDA DEPARTMENT OF A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT rvame or First Middle Last Date Month Day Year Deceased LILIANNA CHRISTINA CANTU of 06 28 2009 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) Count y p ORANGE ORLANDO Inst. or ARNOLD PALMER HOSPITAL 3 Name of Medical Address Phone Number Certifier JOHN ARTHUR TILELLI, MD 92 W. MILLER ST. Medical Examiner X Physician ORLANDO, FL 32806 407- 841 -5111 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 S. FLEMING ST. SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 772 - 589 -1933 5. Check a. F� The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box - -- - -- b. © DR. TILELLI was contacted on 06/30/09 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. was contacted on He /she verified that Medical Examiner, will complete and sign the medical ertification of cause of death within 72 hours. 6. Funeral Director/ Si nature F.E. No. /Reg. No. Date Signed Direct Disposer FO 44126 06/30/09 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 09- 2617 -156 FXJ 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. Ej No extension of time for filing thidea e ate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 06/30/09 Dye; 07/10/09 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 Method of Disposition: Place of Disposition � ERBURIAL ❑STORAGE Date of Disposition z! z 4 CREMATION ❑OTHER (Specify) t Signature of Sexton or Person -in- Charge{ Q , 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 110 days to the local County Health Department in the county where disposition occurred. Distribution: white: Cemetery or Crematory DH 326, 6/97 (Obsoletes ail previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 57x0 -000- 032E -2) - Pink: Local Registrar RKFI'd %— r.,� dLL' Total Palo 1 D Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4568 I Ck [ash Name Date — ❑ CheckN No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Block, Unit LotlNiche_ 0�-- v=— 001501343805 Cemetery Fees —r dLL' Total Palo 1 D Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant Tamara R. Rondeau Tamara R. Rondeau, 47, died July 11, 2005, at VNA Hospice House in Vero Beach. She was born in Marlette, Mich., and lived in Sebastian 13 years, coming from Columbiaville, Mich. She was the former head cook at the Vero Care Center. Survivors include her son, Joshua Kreger of Columbiaville; daughters, Sara Cantau and Cynthia Rondeau, both of Vero Beach; parents, Eugene and Diane Crowe of Sebastian; sisters, Cindy Mclaughlin of Davison, Mich., and Bonnie Sablich of Sebastian; brother, Victor Crowe of McMinville, Ore.; and one grandchild. SERVICES: There are no memorial services planned at this time. Arrangements are by Seawinds Funeral Home and Crematory, Sebastian. Condolences may be registered at www.seawindsfh.com. Published in the TC Palm on 7/22/2005 Name Unit y Block Lot ��` /N./ iC i .�/ ��✓�1%,z• �. ( .rt.✓ /. A ) Date of Mark -out 6r6Lr16(M041xeK 4D Li nna cQn+t' Date of Buriat Time Name of Funeral Home Authorized by zz� (/`✓ �itct •yi1/� a, t FUNERAL HOME ADDRESS: PHONE #: FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SE�i�AN 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 .�SeAwi►J p s - U. 735 rl tr /yvi/J 54Q- N33 (Chec One) OPEN BURIAL LOT Lot g Block 1 Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: -7' 4- O�J 114 FOR DECEASED: � /'l1 "-,ICJ Cilrl7fLt Name AME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signature Date 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 ECTOR: AJ '7 6 -o S 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 that all fees have been paid: e. — '7 rl, Cer ete Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Wfiffifill SIESASTAN 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. 8oreate Satoh Names) qd,-5 f ian FL Address . ( Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY. Receipt is acknowledged C^n" int�he sum of: v (�''� � d. - � Dollars ($�� ®�. OD ) on this / Sr day of J l - I Cemetery Lot(s) and /or Niche(s). Unit_, Block _, Lot(s) 206� for the purchase of the following described 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: j0�do Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation L c b Signature of Purchaser I: \WVV- DATA \Ms - Cemetery \P EC F I PT_ r1 oc Interment /W O H Circle One Disinterment Tf1T A l l (o Q v o 1 V 1 1-% .� 4�2� ��j j—b;6UI r V 1 1 of Sebastian The following documents were provided as Proof of Residency: and City of Sebastian tiehaslian Cenielery Pit M It 772) 569 - 2545 Fax k 1(772) 228 - 9927 Nulc This Is for Infurmatioml purposes re2uarding N)onuments al Sebu%flan Centeler% Jule : '116% is for Single Markers under 2 ft. S oser 2 fl.l u.cr 2 11. is a puui cd foundation ) I'Irase return Io City Of %eba+tian Sebastian Venletrrs 1921 North ('entral A►c. Foundation lxlurcd 32958 I)v : Brian C. Attention : ('emetery Scrtou d:1fc 3/19/10 %imit- installed h� : Brian C. Sipe : Rase: 2 -11x1 -1 - x0 -6 Die: 2- 9x2 -0x0 -6 date: 3/19110 Name & Date - His Lilianna C. Cantu D.O.R. D -O. R. 2004 D.O.D. D. 0. D, 2009 Unit - 4 Rlk : 11 Lot 8 Square Ft. Approved by: K.G.K. Checked by : K.G.K. Date By: Brian C. Example: 13" 6"