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HOME OF PELICAN ISLAND
Certificate No. 2229
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Joseph &/or Delores Acanfora
837 Gladiola Avenue
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 44dsa
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.
CONVEYEQ THIS 10t" day of July, 2009.
BASTIAN, FLORIDA
� AI Minner
City Manager
ATT �T:
% �� v
Sally . Maio, MMC
ity Clerk
Name s�f �Z�2,E' S h`I �l G' Ahl �O�14 ( G.�p ,r�i��wS � ����
Unit
BloCk `�O
Lot �� 7 d /JT'S ��
�-
Date of Mark-out
�8 //� � _ (... �4V Se
Date of Burial % Time '�a
Name of Funeral Home � r� �-� )/� �� S —
Authorized by�/�'�'��--""` � .
CITY OF SEBASTIAN
CITY CLERK�S oFF��E . 4 7 7 4
RECEIPT
' Name W� 1 �-F� rd �fle.C�.n rG, ❑ Cash
I Date ��� � ��J ljl(Check# JG���
No.
001001 208001
001501 322900
001501341920
001501 341910
001501341930
Sales Tax
Garage Sales
CopieslBid Specs.
LDCICode of Ordinances
Election Quali(ying Fees
601010 343800 Cemetery Lots
LoUNiche y��{s�, Block �' , Unit �
001501 343805 Cemetery Fees
� /�
Amount Paid
i sc�.vo I
� ' Total Paid 5U, i.�L
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant
DELORES M. ACANFORA
Dolores M. Acanfora, 79, Sebastian, FL passed away
December 25, 2012 at VNA Hospice House, Vero Beach, FL.
Mrs. Acanfora was born June 3, 1933 in Bridgeport, CT. She
was a resident of Sebastian for the past 18 years having come
from Bridgeport, CT. She attended St. Sebastian Catholic
Church and was a member of the Elks Club in Sebastian, FL.
She is survived by her husband of 56 years, Joseph Acanfora,
Sebastian, FL, son, David J. Acanfora, Bridgeport, CT, daughter,
Sherry Ruohomaki, Grant, FL, sisters, Florence Caribe, TX,
Bobbi Gaddis, Stratford, CT, Beatrice Briglia, Trumbull, CT,
Gloria Torreso, Stratford, CT, brothers, John Sherry, Stratford, CT,
Donald Sherry, Oxford, CT and one grandchild.
Cu3laFiiSII'�tRCGt�vT4F'� ,� State of Florida, Department of Heaith, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: December 28, 2012 TRACKIN(i NUMBER: 2012178265
�• DECEDENT INFORMATION
Name of Deceased Date o1 Death
DOLORES MAE ACANFORA �ecember25 20�2
Wace of Desth - CouMy City, Town or Locatlon
INDIAN RIVER VERO BEACH
Name and Add►ess of Funeral Home/Direct Disposd EstabNshmertt
SEAWiNDS FUNERAL HOME 8 CREMATORY F041662
735 SOUTH FIEMING STREET
SEBASTIAN, FLORIOA, 32958
Fur�ral Director/Dtrect Dlsposer
ANTHONY C,ABBARD
Name of facility, or st►eet address if not a taclllty
VNA HOSPICE HOUSE
Pla. ttc. No./Rep. No. Phone Number
F041682 {772)589-1933
Pla. Uc. No./Rep. No.
F044749
2• BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vitai Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Pertnit Number: 2012-F0416825152
. 4G� �•T ' D8b@ Issued: Decemb� 26, 2012
.J �
Meade C3rigg, Stabe Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Aufhorization given by Medical Examiner District 19 Approval Number: C12-1s-12-313
4.
Place of Disposition:
Method of Disposition:
CEMETERY OR CREMATORY
SEAWINDS CREMATORY
CREMATION
Da� of Disaosition:
OH 326E, t/11
84V-1.011, Fbrida AdminisVative Code
rw seutonj
8 i3
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
B��
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i�oeu c� rtucsN �sun�
For intormation contact:
Kip Ke�so - Cemetery Sexton
Sebastian Mz�nicipal Cemetery
(772) 589-2545
Cify Clerk's Oflice
CityHall, ?225M<�inStreet
Sebastian, FL 32958
plfice (i72J 388-8215 or 388-8214
Fax: (772) 589-557(1
FUNERAL HOME: j^ p�, �,/� S
ADDRESS�
PHONE #: / ��??. � 5� � � �' � � 3 -3 .
(Cherlc One)
OPEN BURIAI. LOT �of Block Unit
�PEN CREMAINS LOT Lct __ Biock Unit
��JPEN COLUMBARIUM NICHE Niche� D�s�ock �Unit �—
W
BURIAL DATE AND SERVICE TIME: 'oo �0���5 �p�
. . /
FOR DECEASED. f���' S- �'l• `a'e�'
Ev�me
f�AME AND SIGNATURE OF LOT OWNER OR REPRESENTA7IVE:
(Must provide proper docume�t��tior� of ownership)
� �� � Date
Name Signature
I certify that I have determined the ownership of the above described site ihat all site fees and
administrative fees have been paid and authorize open���g ot same
NA��-1E AND SIGNATURE OF LICENSED FUNERAL DIi�EC7C�R.
Name � /� Signature Date
--------------------------------------------------------------------------------------------
Cemetery Sexton Certifical�on:
! certify that i have checked the ownership infonr:�t�on by viewing ihe owner's deed and conf+rming
with Clerk's office <�nd that al! fees have been pa�d
�� -
Cemete y Sexto ���
7his forrn �o be provided to Clerk's Oifice by Sexton for perr��anent record upon compi�i�on.
fIlt` t�F
�� _ �
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-� _ ,�� � '
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Ht?aIAE �F PEiif�.N (5I,R2*1B
City of Sebastian Municipal Cemetery Purchase Receipt
��
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�
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.
�o s e.a h c�v�.d/o r D�( o�- e s� ca� -� r a
Name�s)
� 3�7 C� l c2.c( i o(c� t'�-u e��,(� Q-S fr'�v� �[- 3zg 5�
Address
( 7`7 �. ) 5� 9- 4��t U
Area ode & hone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
Receip# is acknowledged in the sum of:
� , �. v�.� /
r' ,
on this day of
Cemetery Lot(s) and/or Niche(s).
Unit 3 , Block � L, Lot(s)
OFFICE USE ONLY
Dollars ($ o�U��..�o
20 for the purchase of the following described
Niche(s) �� G� S 0.
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:
Corner Markers (set of 4-$20) Opening & Closing
Vase and Ring for Niches (cost) �(D% Interment
Temporary Marker Preparation & Installation
�
gna re of P cha r
f:\v�IV�-DATA\Ms-Gem ete ry\REC E! PT. ci oc
/W O H
Circle One
Disinterment
-�o�a� � � � C� Co, � o
i of Sebastian
The following documents were provided as Proof of
Residency:
�pL 61�L and
Mr. Acanfora is still thinking about whether to put Reservist on his
plague. He will call me Monday or Tuesday to let me know what
he wants.
Jeanette
CITY OF SEBASTIAN
CITY CLERK�S oFF��E 4 5 6 7
RECEIPT �
Name � �• ' `C�- h'� �Q ❑ Cash
Date � � � U ` � � �Check #�
No.
001001 208001 Sales Tax
001501322900 Garage Sales
001501341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees
Amount Paid
601010 343800 Cemetery Lots
LoUNiche `r"'►aS�l,, Block�, Unit�
001501343805 CemeteryFees ��.��
1/(;:5e, � Yin� (cG,,i?b
Total Paid �d�G. °U
Initials
White - Dept. of Origin . Yellow - finance • Pink - Applicant
D�;CEASED
NAME: ��
(Fi rst )
nATE OF BIRTH:
PLEASE PRINT
(Month)
DATE OF DEATH:
-----�
(Month)
S[GNATURE
PR.[IVT
SIGNATURE:
DATE:
� �,
(N1iddle) (Last)
(Day)
(Day)
FOR OFFICE USE ONLY
Uoit 3
Double / South / A
COLUMBERIUM: , °� � .
i������n�
NICH �
NUMBER �
t Y ear )
(Y�-)
DECEASED
NAME:
PLEASE PRINT'
o�. L"�
(First)
.�
(Middle)
��� ��
(I.ast)
nATE OF BIRTH; �d (� � � � � ���
(Month) (Day) (Year)
DA7�E OF DEATe:
(Month) (DaY) (Year)
S[GNATURE:
PRINT
SIGNATURE:_ �GS C,-�/�j�
DATE:
FOR OFFTCE USE ONLY
Unit 3
Double / South / A
COLU MBERIUM: 4�,�y�.
i��,�,�i�i
N1CH
NuMa�.x: 'j� .
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