HomeMy WebLinkAbout4-11-24CRY OF
HOME OF PELICAN ISLAND
Certificate No. 2226
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Winsle Newcomb 868 Waterway Drive, Barefoot Bay, FL 32976
(name) (address)
In and for consideration of the sum of $4,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Bilk 11, Lots 23 & 24
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 SEBASTIAN, FLORIDA
JAI Minner
City Manager
ATTEST:
G
Sally . Maio, MMC
City Clerk
Name P r� v,*
Unit
Block
Date of Mark -out j_�J
Date of Burial Time
Name of Funeral Home
Authorized by-
L.4-
Ann Elizabeth Newcomb
Ann Elizabeth Newcomb, 74, died June 28, 2009, at Holmes Regional Medical
Center in Melbourne. She was born in Chicago and lived in Barefoot Bay for
three years, coming from Phoenix. Survivors include her husband, Winsle
Newcomb of Barefoot Bay; son, Robert Newcomb of Glendale, Ariz.;
daughters, Elizabeth Ann Smith of Sebastian, Hazel Garcia of Phoenix, and
Sandra Finnigan of Cicero, III.; and seven grandchildren. SERVICES: Private
services were conducted and burial was in Sebastian Cemetery. Arrangments
were by Strunk Funeral Home and Crematory in Sebastian.
Published in the TC Palm on 7/1/2009
FLORIDA DE/PPARTMF,NT OF
HEALT State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Ann Elizabeth Newcomb Death June 28 2009
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Melbourne inst. Holmes Regional Medical Center
3. Name of Medical Address Phone Number
Certifier Giovanni Lupo, M.D. 720 E. New Haven Avenue, #11
Medical Examiner FtPhysician Melbourne, FL 32901 321 - 724 -4545
4. Name of Funeral Home /DipeeH9is� Address Fla. Lic. No. /Reg. No. Phone No. (Area Code)
Establishment 1623 N. Central Ave.
trunk Funeral Home >; Cremato Sebastian, FL 1228 772 - 589 -1000
5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b.
am
Linda was contacted on 6/29/09
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Lupo will complete and sign the medical
certification of cause of death within 72 hours
was contacted on
He /she verified that
Medical Examiner, will complete and sign the
m9diol cerljftoo of c of death within 72 hours.
6. Funeral Director/ F.E. No. /Reg. No. Date Signed
Direct Disposer 44048 6129/09
B
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -09 -0303
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 has been requested.
RIV913TIV-076 Date Date Certificate
Subregistrar Signature ,rp�„�'/y,,. Issued: 6/29109 Dye: 7/3109
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 Sebastian Cemetery
BURIAL
CREMATION
Signature of Sexton
or Person -in- Charge
STORAGE
l
Date of Disposition /� /sue
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.
DH 326, 8197 Obsoletes all previous editions Distribution: White: Cemetery or Crematory
( P ) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740 - 000 - 0326 -2) Pink: Local Registrar
u-,ad 40 ry.
�verlast-in9
cStonetivorks
1207 US Hwy 1 * Sebastian, Fl. 32958
Phone: 772 -599 -9311 Fax: 772 -589 -9312
ATM: Kip
Cemetery Sexton
City of Sebastian
For Sebastian Cemetery
Phone: 772 -589 -2545
Fax: 772 - 228 -9927
Size: 3 - e> 06 X 2
Names & Dates:
Legal Description
Section: 4(K ,T ll
Block: I r WAIAI '
Lot: ';7'
Space:
Replat:
Square Ft.:
Approved:
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Checked By: X • Qi • /C . Date: / , X/ a
i hereby certify that the original of the foregoing was faxed to the
Sebastian Cemetery on \ \ \ -5k)
Everlasting Stoneworks
By: Jamie Hicks
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