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Unit
Block
Lot
Date of Mark -out 7 / 16 / / (-,
Date of Burial ��i Time
Name of Funeral Home,,.,
Authorized by
CITY OF SEBASTIAN 10077
ADMINISTRATIVE SERVICES RECEIPT
Name de-dF ❑ Cash
116
Date4)Ono Check # %4
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees
Total'Pai 400
itial
Security Dep Held - Amount $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. - Pink - Applicant
CHRISTEL DIETRICH FALLDORF
October 29, 1934 - April 15, 2016
Mr. Christel Dietrich Falldorf, 81, died April 15, 2016 at
Sebastian River Medical Center in Sebastian.
He was born in Schwarme, Germany and lived in Barefoot Bay
coming from Bellmore, New York
in 1999
Survivors include son, Peter Falldorf
and his wife, Francesca of Colorado Springs, Colorado;
grandchildren, Calvin and Amelia; sister, Therese Michels of
Germany; nieces, Gisela and Petra.
He was preceded in death by his wife, Annegret in 2009.
A Graveside Service will be held 2:00 PM Friday, April 22, 2016
at Sebastian Cemetery, Sebastian.
Born: October 29, 1934
Death: April 15, 2016
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
71-A�w
p , City Clerk's Office
I" City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
For information contact:
Kip Kelso .Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
FUNERAL HOME: Strunk Funeral Home and Crematory- SEBASTIAN
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
xxxx OPEN BURIAL LOT Lot-36—Block 11 Unit 4
OPEN CREMAINS LOT Lot—Block—Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: 2:00 pm, Friday, April 22, 2016 - GRAVESIDE SERVICE
FOR DECEASED: Christel Falldorf
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Peter Falldorf Peter 1=a,Ad " f 4/18/2016
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 DIRECTOR:
Tim Marvin
Name
cjl►n 6q qui. ul akuln 4/18/2016
Signature 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:
Cemetery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
State of Florida, Department of Health, Bureau of Vital Statistics
BURIAL TRANSIT PERMIT
HEALTH DATE PRINTED: April 18, 2016 TRACKING NUMBER: 2016061714
1. DECEDENT INFORMATION
Name of Deceased Date of Death
CHRISTEL DIETRICH FALLDORF April 15, 2016
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER
Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
STRUNK FUNERAL HOME. SEBASTIAN F041870 F041870 (772) 589-1000
1623 N CENTRAL AVE
SEBASTIAN, FLORIDA, 32958
Funeral Director/Direct Disposer Fla. Lid. No./Reg. No.
TIMOTHY W. MARVIN F022789
2. BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: April 1 , 2016 -5059
�— Date Issued: April 15, 2016
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 19 Approval Number:
4. CEMETERY OR CREMATORY1
Place of Disposition: SEBASTIAN CEMETERY I 2_1 0 r —I >.{. as
Method of Disposition: BURIAL Date of Disposition.
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E, 10/12
64V-1.011, Florida Administrative Code
Certificate No. 2242
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:
Christel Falldorf 415 Loquat Drive, Barefoot Bay, FL 32976
(name) (address)
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 lot:
Unit 4, Block 11, Lot 36
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 28th day of December, 2009.
CITY OF SEBASTIAN, FLORIDA ATTEST:
7 AI Minner Sall A. Maio, MMC
City Manager City Clerk
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To. SEEIAS -iW4 C -APEL
DAVID HINCEMAN
1823 NORTH CEN -RAL AVE
5EBAS 'iAN, FL 32959
Phr,ne 772.589.10001
Fax 7 ":•589.2583
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Eshn•ateu Ship Date 0447/10
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STRUNK FUNERAL HOME PAGE 04
(FAX) F.00I tool
Order Acknowledgement
Acknowledgeirent No 731.0
Sales Order Date. 0309110
Page 1
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To 5. RUNK FL -NERAL HOME
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916 17TH S-.
VEPO BEACH, Ft_ 32960
Phone 772.466 -1955
pax:
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