HomeMy WebLinkAbout4-11-33IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Mack G. & /or Jeanne Ficke
186 Main Street
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 lots:
Unit 4, , Block 11, Lots 32, 33
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 21St day of April, 2010.
CITY OF SEBASTIAN, FLORIDA ATTEST:
'7 LAI Minner Sally A. Maio, MMC
City Manager City Clerk
Name 46 14 Co
Unit A/
Block /l
Lot ,33
I/
Date of Mark -out � � �
Date of Burial -5 3 Z� Time
Name of Funeral Home 5 ��u i✓ �'
A- /. i. o n
Authorized by
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MACK G. FICKE
Mr. Mack G. Ficke, 86, died April 30, 2012 at VNA Hospice House,
Vero Beach.
He was born November 28, 1925 in Elmwood Place, Ohio and
lived in Sebastian for 26 years coming from Dayton, Ohio.
Mr. Ficke was a Paramedic for the Dayton Fire Department in
Dayton, Ohio.
He served in the US Navy during WWII.
He was a member of Sebastian United Methodist Church,
Sebastian.
Survivors include his wife of 65 years, Jeanne Werline Ficke of
Sebastian; daughter, Barbara Brown and her husband, Don of
Sebastian; brother, Albert Ficke; sister, Shirley Ficke both of
Cincinnati, OH; granddaughters, Mindi Casella of Richmond Hills,
GA, Shelli Grose of Oviedo, FL; great - grandchildren, Lyndsi,
Zachary and Blake Grose Garner and Grant Casella.
T A DEPARTMENT OF
A /TVPI =\
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
-1. Name of
First
Middle Last
Date
Month Day Year
Deceased
Mack
G. Ficke
of
April 30, 2012
Death
2. Place of Death
City, Town or Location
Name of (If neither, give street address)
County
Indian River
Vero Beach
Hosp. or
VNA Hospice House
Inst.
`3. Name of Medical
Address
Phone Number
Certifier
Melissa Dean M.D.
1345 36th Street, Suite B Vero Beach, Florida 32960
(772) 567 -1500
Medical Examiner
Physician
__
4. Name of Funeral Home /Direct Disposal
Address
Fla. Lic. No. /Reg. No.
Phone No. (Area Code)
Establishment
Strunk Funeral Home
1623 North Central Avenue Sebastian,
F041870
(772) 589 -1000
and Crematory
Florida 32958
Check a. Lj
Appropriate
Box
®A
The medical certification has been computed and signed. A completed certtticate of oeam accompanies inls
application.
/}
was contacted on t� I ( 11 L—l./ `��"�
i
He /she verified that t s ath was from natural causes, that there was no accident nor other external cause of death,
and that Cc will complete and sign the medical.
certification of cause of death within 72 hours.
was contacted on He /she verified that
, Medical Examiner, will complete and sign the
medical certification of cause of death within 72 hours.
6. Funeral Director / � SiKt u � F.E. No. /Reg. No. �� � a Or '
a' ,+ r, �r�l>er (/l/ �. F022789
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -12 -201
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.
Regiati;a or re--w Date Date Certificate
Subregistrar Signature Issued: 4/30/2012 Due: 5/5/2012
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.
Method of Disposition:
URIAL
CREMATION
Signature of Sexton
or Person -in- Charge
® STORAGE
®OTHER (Specify)
CEMETERY OR CREMATO n
Place of Disposition f� all()
Date of Disposition S 1 1 1� H O X4 5 .4-0
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.
DH 326, 3/97 (Obsoletes all previous editions)
(Stock Number: 5740 - 000 - 0326 -2)
Distribution: White: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
UnR
NOME OE PELICAN ISLATD
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 -8294
Fax. (772) 589 -5570
STRUNK FUNERAL HOME & CREMATORY
FUNERAL HOME: 1623 No. Centrat Ave.
SEBASI -IAN, FL 32958
ADDRESS: (772) 599 -10A0
_
PHONE #:
(C, hpelc One)
3J'
OPEN BURIAL LOT Lot Block I I
Unit
OPEN CREMAINS LOT Lot Block
Unit
OPEN COLUMBARIUM NICHE Niche Block
Unit
N S
E W
BURIAL DATE AND SERVICE TIME:
_
FOR DECEASED:I
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of own hip}
co Jzcrnn ec �'►G�Z�, o 0-nr V 5124 2012
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.
__�.AME AND SIGNATURE OF LICENSED FUNEJR41- DIRECTOR:
Name 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:
CerAete Seiton Dat
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.