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Home My WebLink About2-44-07w s Ju Yl i Name t��V`�'p J t L'"Y `1I7J Unit 9 r 19 Block 7 Lot r Date of Mark -out �%' ` 03 Date of Burial _ + Time � • 0 0 PM Name of Funeral H ne' Authorized by r DEED #467 CEMETERY Paid by (K4W Receipt No. . 27 ?............ Dated R9!1 st .l2 ,1.981 • • • .... Elwood F. and /or Mary Jo Shepard List Price ;..$6Q0* OQ• • •„ , Maximum 'No. Burial spaces ..6.:...... Mary Joanne and /or Richard M. Shepar (Sister and Brother) Discount . *. *.. *. *. *. *.. *. *.. *. *. *.. Total area in square feet ..t. * * * ** • • • • • • • 321 S. W. Pine Street Net Paid 6. 5600.00• .. • • . Monument permitted ..flat ............. Sebastian, Florida 32958 R Issued with Deed (Data above this line for City Record only) UNIT 2addn, B1k.44, Lots 3,4,5,6,7,8 a FIARIDA DDEP`�RTMENT OF ) HEALTH State of Florida, Department of Health, Vital Statistic D APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month DaY Year Deceased Elwood Franklin Shepard °f June 22 ' 2003 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 321 Pine Street 3. Name of Medical Address Phone Number Certifier Farhat Khawaja, .D. 7754 Bay Street Medical Examiner Physician Sebastian, FL 772 -589 -3000 4. Name of Funeral Home /Qkeet- 9iepeael Address 1623 N. Central Ave. Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Sebastian, FL 1228 772- 589 -1000 Strunk Funeral Home 5. unecK a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Pat was contacted on 6/23103 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Khawaja will complete and sign the medical certification of cause of death within 72 hours. C. was contacted on He /she verified that Medical Examiner, will complete and sign the ical gertffiVion of cause of death within 72 hours. 6. Funeral Director/ tur F.E. No. /Reg. No. Date Signed/ DMeet- Bispeew 1862 6/22103 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-03-0269 r] 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. F1 No extension of time for filing the death certificate has been requested. Reg+streref -f Date Date Certificate Subregistrar Signature Issued: 6/22103 Due: 6/27/03 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 1 or Person -in- Charge Jr STORAGE MOTHER (Specify) Date of Disposition _ & /,22— -03 This permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) within 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 6197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740 - 000 -0326 -2) Pink: Local Registrar returned Note to File — Unit 2, Block 44, Lots 3, 4, 5, 6, 7 & 8 Date: 7/14/04 On this date, Kip Kelso received a phone call from Joanne Shepard, who is the daughter of Elwood F. and Mary Jo Shepard. She was concerned because she knew that Lot #4 was purchased by her parents for the wife of her brother, Richard M. Shepard. At the time Richard was married to Karen. Richard and Karen divorced approximately 20 years ago and Richard has remarried a girl named Gayle. Kip asked that I look up the information and call Joanne Shepard at 589 -4975 and let her know the status of the lots. After reviewing the information it was determined that the names appearing on Deed #467 are Elwood F., Mary Jo, Mary Joanne and Richard Shepard. I advised Joanne Shepard of the information and also let her know that the named Deed holders would be the ones to make the decision as to who is interred in the lots. She was satisfied with this information. Ann Rousseau( „1 �.. STRUNK FUNERAL HOMES, P.A. 3137 CASH ADVANCE ACCOUNT - SEBASTIAN 916 - 17TH ST. VERO BEACH, FL 32960 1205/670 PH. 772-562-2325 DATE PAY TO THE ORDER OF "Fl V 4, ILLARS "S 2ft Ph= AIRIM" Vem Be" Rod& 32M 1kd=R1rwNadwdR=k FOR - 4S 0003 13 7111 :1:0670 L 20571: A�01210000 ii copy 44 Ar 0 20 6 lu 200 1 CITY OF SEBASTIAN CITY CLERK'S OFFICE 1892 RECEIPT it WCUh 1" pd;;00Stfk_� AmuntPold 001 Sales Tax 900 Garage Sales 920 Copes/M Specs. 910 LDC/Code of Ordinances '100 Community Center Rent '100 Yacht Club Rent ...... LU L2 -IP3_-150 Non Taxable Rent --------- ---am Cemetery Lots Cemetery Lots Lot/Niche Block Unitao 1400 Interment Fee Weekend Service 'v*1 681 Yacht Club Security Deposit 1682 Community Center Security Deposit 683 Riverview Park Security Deposit Aw NIV 11su3 T otal, Paid Whits - Dept. of Origin • Yellow - Finance • Pink • Applicant