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Home My WebLink About4-11-26CITY OF HOME OF PELICAN ISLAND Certificate No. 2230 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: Harry E. & /or Donna Brock Post Office Box 87, Roseland, FL 32957 (name) (address) In and for consideration of the sum of $6,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Blk 11, Lots 25, 26, 27 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 14th day of July, 2009. CITY OF S ;Manager TIAN, FLORIDA A Al ner City Sall A. Maio, MMC City Clerk Name Unit Z Block Lot Date of Mark- out !!`�?,� Date of Burial of ! Time 3o ' Name`of Funeral Home Al' Authorized by Justin Michael Brock Justin Michael Brock, 20, died July 5, 2009, at Holmes Regional Medical Center in Melbourne. He was born in Sebastian, and was a lifelong resident of Roseland. He was an avid baseball player, golfer and member of the Florida Trail Riders. Survivors include his parents, Ed and Donna Brock of Roseland; brothers, Eddie Brock Jr. and Jason Beck; and grandparents, Dot and Warren Weaver of Roseland. He was preceded in death by his grandparents, Jake and Geri Brock. SERVICES: Visitation will be from 6 to 8 p.m., July 10 at New Hope Ministries, Winter Beach. The funeral will be at 3:30 p.m. July 11 at New Hope Ministries with Pastor Jack Hart off=iciating. Interment will follow in Sebastian Cemetery, Sebastian. Arrangements are by Strunk Funeral Home, Vero Beach. r �-K, ry ,r, -� ®0nna rO0(- Ra 5(�7 K 0 S ela.nd 3 Z g 5 7 Sep 26 2008 2:45PM HP LRSERJE:T 3200 FUNERAL DIRECT( FOR BURIAL OPEW K� Sa FJNERAL HOME: ADDRESS: PHONE #: ,R'S REQUEST TO CITY OF SEBASTIAN G IN SEBASTIAN MUNICIPAL CEMETERY S h0A1 V PILICANI MD For information. contact: > Ke!so - Cemetery Seytvn jastian Municipat Cemetery (772) 589 -2545 City Clerk's Ullice 'y Nall, 1225 Main Street Sebastian, FL 32958 (772) 398 -8215 or 3841-6214 Fax: (7721588.5570 k Funeral Home 6 Crematory Beach, FL 32960 (Check One) `` OPEN BURIAL LOT L I _'Block Unit .OPEN CREMAINS LOT L t._._Block Unit OPEN COLUMBARIUM NICHE N che�W Block '-'Unit_ BURIAL DATE AND SERV!CE TIME: 1/11 /09 3:30 P.M. W FOR DECEASED: Justin Michael Brock :NAME AND SIGNATURE OF LOT OW ER OR REPRESENTATIVE: (Must provide proper documentation of wnership RRy �Rdex Sign ure d 9 i Date 1 certify Vial I have detennined the owne ship of the above described site Plat all site fees and Urninistrative fees have been paid and uthorize opening of same N ME AND SIGNATJRE OF LICENSED FUN AL DIRECTOR. i !ll Name ._. Date Cemetery Sexton Certification: • -`- - "" I certify that I have ;,heeked the owners ip inforn;at,on by viewing the owner's deed and conflrming Clerk's office and ha II fees have been paid Cemetery Sexton, D to This form to be provided to Clerk's Off.ct by Sexton for permanert record uFon cornpietion. p.I FLORIDA DEPARTMENT OF HEALT 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 of Justin Michael Brock Death 7/05/2009 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 Krzystof Podjaski 1750 Cedar Street Medical Examiner OPh ysician Rockledge, FL 32955 321/633 -1981 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral 916 17th Street Homes & Crematory Vero Beach, FL 32960 FO 41804 772/562 -2325 5. Check a. Appropriate Box b. ❑ M' The medical certification has been completed and signed. A completed certificate of death accompanies this application. was contacted on He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. was contacted on medical ceatification of cause of death within 72 hours. He /she verified that Medical Examiner, will Complete and sign the 6. Funeral Director/ att r F.E. No. /Reg. No. Date Signed Direct Cisposer (tj ��._ FO 26900 7/8/09 B C. A BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 0130 -09 -0317 ® 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. Registrar or Date Date Certificate Subregistrar Signature �, ^" Issued: 7/5/2009 Dye: 7/9/2009 Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. Method of Disposition: BURIAL OCREMATION Signature of Sexton 1 or Person -in- Charge J) ❑ STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition % /j,, Z. F-- 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. Distribution: white: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow. Funeral Director or Direct Disposer (Stock Number. 5740 - 000 - 0326 -2) Pink: Local Registrar R-rW L P.Pc, Golf cart passenger dies after cart hit by van in Indian River County : TCPalm.com Page 1 of 1 T FLORIMASTREASURE COAST AND PA1MBEACHES READ MORE ATWWW.TCPALM.COM Golf cart passenger dies after cart hit by van in Indian River County By Lamaur Stancil V— t Tuesday, July 7, 2009 INDIAN RIVER COUNTY — A Sebastian man died from injuries he received when the golf cart he was riding in was struck by a van, Florida Highway Patrol troopers said Tuesday. Justin Brock, 20, was hospitalized after the 12:30 a.m. Sunday accident. Troopers are still investigating the crash, which happened near 125th Place on Roseland Road. Brock's family said Tuesday they were making funeral arrangements. Brock ran his own landscaping business, played baseball for Sebastian River High School and participated in numerous youth golf tournaments. Chantel Partlow, 21, of Sebastian, was driving the golf cart north on Roseland with Brock as the passenger, according to the FHP. They were struck from behind by a Ford van with four occupants, FHP spokesman Lt. Tim Frith said. The golf cart was shoved onto the west shoulder of the road, according to the accident report. Partlow was not seriously injured. Frith would not identify the driver of the van Tuesday, but the passengers were identified as Russell Scheer, 49, Jenny Lee Maxwell, 22, and an 8-year-old girl. No one in the van was seriously injured. Troopers indicated alcohol and darkness were factors in the crash, but Frith would not say which of the drivers they suspect had been under the influence. The golf cart did not have lights, troopers said. ® ® 2009 Scripps Treasure Coast Newspapers http:/ /www.tcpalm.com/news/2009 /juU07 /golf -cart- passenger- dies -2 -days- after - cart- hit -... 7/9/2009 16: 25 :'z__92 FlYIEPA'L HOME. 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