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HomeMy WebLinkAbout2-43-10i 3��� � r - -- -� ,_� CEMETERY DEED # 483 Paid by ¢togfa Receipt No. .. 2 9.8...... .... Dated.... F e b r u a r y.. 3 ,, , , �,9 8 2 HULSE, MORGAN OR CLARA List Price $...4.50.•0.0•.. Maximum No. Burial spaces ...2.......9660 .RI'VERVI'EW' DRIVE "MICCO" Discount $.t.. A. Total area in square feett..*...*.. * ... *.. SEBASTIAN, FLORIDA 32958 Net Paid $., 450.,00..... Monument permitted ... FLAT ...... ....•UNIT 2 ADDN. , BLK. 43 LOT 9 &1 R & R ISSUED WITH DEED (Data above this line for City Record only) Name Unit Block Lot /v Date of Mark -out Date of Burial a /// /-� , Time —© 0DX- /c ,j Name of Funeral Home X V Y A i Authorized by - Z�A N O- = W QOr mtoa Ca ]C0 Uj LL O_ W � r V t= V •o � a 0 0 Q cc �I m r U V •� M M M N c LL tin `o 0 aLL �i m to 's Ci 0 H rn U c a� m ?� L° n C) 't E E w C7 U 0 W U 0 U 1� °o O m o rn 0 0 o Lo N rn rn 0 coo M cT Co N M M M c! "I c2 m O O O O O O O E N O Lo Ln tc') O to a is G 00 o Z C Z o 0 0 o Co 0 q A a 'Q, O C d v c a W 3 m e o` CL 0 CL O • L w3 A c CLARA M. HULSE Mrs. Clara M. Hulse, 93, died February 23, 2013 at Palms Rehabilitation and Healthcare Center in Palm Bay. She was born May 27, 1919 in Jersey City, NJ and moved to Little Hollywood in 1966. She was the Owner /Operator of Gina's Restaurant from 1966 - 1978 having retired after 12 years of service. She attended the St. Sebastian Catholic Church, Sebastian. She was a member of the Little Hollywood Homeowner's Association. She was survived by several nieces and nephews. She was preceded in death by husband, Morgan Hulse and sister, Amelia Dernbach. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ma HOME OF PEucAN ISLAM 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 STF ,,i'.? i FUNERAL HOME & FUNERAL HOME: 1623 No. Central Ave. ADDRESS: (772) 589.1000 PHONE #: (Check One) OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: L I CuV-CL, N Name Lot Q Block _ J Unit . 2--4. Lot Block Unit Niche Block Unit -V2A �LAM N ___31 _Ft-fD_e Co jjM . I-W SiL b-) Ltru,- NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) 13 Name gnature 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 FUNE L DIR TOR: I m New / 212Lo I 13 Name Signature Date Cemetery Sexton Certification: certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office nd t t all fees have been paid: 4811�. e ete Se ton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. FLQRMA'kk 'ARCbm4r OF State of Florida, Department of Health, Bureau of Vital Statistics HEALT BURIAL TRANSIT PERMIT DATE PRINTED: February 26, 2013 TRACKING NUMBER: 2013030860 1. DECEDENT INFORMATION Name of Deceased Date of Death CLARA M HULSE February 23, 2013 Place of Death - County City, Town or Location Name of facility, or street address if not a facility BREVARD PALM BAY PALMS REHABILITATION AND HEALTHCARE 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. Lic. No. /Reg. No. R. MARSHALL VOYLESJR F043488 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: 2013- FO41870 -5040 7 r i Date Issued: February 26, 2013 J J Meade Grigg, State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY F12i () J I f 12-02 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