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HomeMy WebLinkAbout4-12-17Name Unit Z: Block eg Lot / Date of Mark -out Date of Burial �J �a Time 0 %o'D - % Name of Funeral Home Authorized by Total Paid �. Uu 4 I Initials White - Dept. of Origin . Yellow - Finance • Pink • Applicant AV 11/11• CITY CLERK'S OFFICE / O 4 RECEIPT Name Doj e 'S I M('A 1 C ❑ Cash Date - Z-7- 10 XCheck # 2 No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots �o LotfNiche I l %L I J, Block 12- Unit 4 001501 343805 Cemetery Fees „�5 p. vC Total Paid �. Uu 4 I Initials White - Dept. of Origin . Yellow - Finance • Pink • Applicant Certificate No. 2263 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Dale Simchick & /or Joseph Cipriano 766 S. Easy 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 12, Lots 17 & 18 of the Sebastian Municipal Cemetery, for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 27th day of July, 2010. CITY OF SEBASTIAN, FLORIDA ATTEST: City Manager K Sally . Maio, MMC City Clerk Strunk Funeral Home & Crematory: Obituaries Strunk Funeral Home & Crematory DOROTHY IRENE "DOTTY" CIPRIANO (November 19, 1927 - July 29, 2010) DOROTHY IRENE "DOTTY" CIPRIANO Mrs. Dorothy Irene "Dotty" Cipriano, 82, died July 29, 2010 at VNA Hospice House, Vero Beach. She was born in South Boston, MA and lived in Sebastian for 8 years coming from Hauppauge, NY. She was a Case Examiner for Child Support in the State of New York. She attended St. Sebastian Catholic Church, Sebastian. She was a member of the Republican Party and a N.R.A. member. She earned her Associate's Degree from Suffolk Community College, Suffolk County, NY. Survivors include her husband, Joseph Cipriano of Sebastian; son, William (Evelyn) Cipriano of Huntington, NY; daughter, Dale I. (Ed) Simchick of Sebastian; brothers, Robert Kelly of New Symrna Beach, Eddie Kelly of Dorchester, MA; 1 grandchild, Eddie. Memorial contributions may be made to Visiting Nurse Association & Hospice Foundation, 1110 35th Lane, Vero Beach, FL 32960 in memory of Dorothy Cipriano. SERVICES: Visitation will be 6:00 -7:00 PM on August 2, 2010 at Strunk Funeral Home, Sebastian followed by a Funeral Service at 7:00 pm in the Chapel with Father Michael Martin of St. Sebastian Catholic Church, officiating. Burial will be at Sebastian Cemetery. Back Page 1 of 1 http: / /www.meaningfulfunerals .net /fhlprint. cfm ?type= obituary &o_id = 676212 &fh_id =1... 8/2/2010 Sep 26 2008 2:45PM HP LRSERJE:T 3200 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBAST hOMt U /IIKAh &AND Fo, information contact: Ki,7 Ke,13o - Cemetery Sexton Se astian Municipal Cemetery r (772) 589 -2545 I ' City Clark's U.'f,ce ity Ralf, 1225 Main 8freet i S©bastian, FL 32958 Offfc� (772) 388 -8215 or 383 -8214 Fax: (772) 589.5570 FJtiERAL HOME: ADDRESS: PHONE #: (C� One) ._..OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COL'JMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASE=D: Mane I ' L I l 1 1 Block 2 Unit 4 L�t Block Unit Niche Unit :DAME AND SIGNATUF�� OF LOT OW�ER OR R (N,1usl provide proper d curnantation b( wners Nairne lure ENT, Date I certify that I have determined the ovwne ship of the above despe b d site that all site fees and administrative fees have been paid and uthorize opening of a e AND Si ATJRE OF LICEN Erb FUN L GK rvarne Sign to e �� v Cemetery Sexton Certification - - - -- --- -- �- - - -- - - - - -- • - --- - - - - -- Date __._. I certify that I have checked the oviners�jiP inforn ;anon by viewing the owner's deed and confirming with Clerk`s office •mn hat all fees have een paid Ce eler S Mon, Date This form to be provided to Clerk's Off.c by Sexton for permanert record upon completion. I p.1 CITY Of SEBASTMN HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. 90-) t 5j mehi C -d-/or n a Name(s) 7&)& _5. � 5 �� S freet , S ebas h art �L 3Zg� Address (-� --7)- ) Area Code & Phone Number n.Sf,e h+ Tin r o +li v C► n rci-n c Name & Residence Address of Intended Occupant if Othel Than'Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($_,)=O _ ° D ) on this o J 4�k day of Tck 20 10 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 0 , Block (Z , Lot(s) 1 7 *%- I & Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: i Corner Markers (set of 4 - $20) Opening & Closing �5U • D D /W to H Circ ne Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signs ure of Purchaser I: \WW- DATA\Ms- Cemetery\RECEIPT.doc Interment Disinterment TOTAL $ o2oZJr • v [a (Iy of Sebastian (� The following documents were provided as Proof of Residency: and CITY OF SEBASTIAN CHECK REQUEST Accounting Use Only Input Date Fiscal Period Document # Entered By Document Amount # of Lines Total HC Hash Due Date To Be Completed By Department 8/6/2010 Single Check YIN Y Vendor Number IN TC Reference Organization Code Object Code Project Code Amount $100.00 Description Number of Lines Amount $100.00 Refund to family for overpayment of burial fees for Dottie Cipriano Unit 4, Blk 12, Lot I w 17 (see attached) ISSUE CHECK TO NAME Joseph Cipriano ADDRESS 583 Willow Court CITY Sebastian STATE FL ZIP CODE 32958 DRAW CHECK FROA4 SEE BELOW APPROVED BY ; ATE - 3 — J 0 BUDGET APP CJ MAIL TTACHED DOCUMENATION (Except for remit slips, requesting department should attach a copy of documentation along with the original) OTHER INSTRUCTIONS Please give a copy of the ch eck to Clerk's office 251 Joseph Cipriano 100.00 75569 63 -643 CITY OF Ss IASTEwM,, CITY OF SEBASTIAN WACHf2 �A CHECK N°. 075569 670 - #225 MAIN STREET "1 75569 SEBASTIAN. FL 32958 °- >.__.,_ =•w- ''� GENERAL ACCOUNT HOME Or �EIICAN IS�ANE . VENDOR CHECK DATE CHECK AMOUNT 251 08/06/2010 $140.OQ * * * * * ** *3:00 DOLLARS AND NO CENTS PAY Josepph Cipriano. �V466 IP NOT OAID WITHIN 90 DAYS 58.3 t1illow Court w S ebastian FL 32958` NP ^THE ORDER, TWO SIGNATURES REQUI RED 1100 ?556911' ':06 ?0064321:200002 ?3L629611' 75569 :I i Y OF SEBASTIAN SEBASTIAN, r-I. 32958 080610 075569 N'JOSCE DATE INVOICE NU146ER I ' NET INVOICE P.MdUNT - POND VOUCHER INVOICE DESCRIPTION 08/03/10 Refund: Unit Burial Fee for Dottie Cip 100.00! 178274 251 Joseph Cipriano 100.00 75569 FLORIDA DEPARTMENT OF ALI A (TYPFI 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 Dorothy Irene Cipriano Death 07/29/2010 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. VNA Hospice House 3. Name of Medical Address Phone Number Certifier Melissa Dean 3745 11th Circle Suite 105 Medical Examiner FX1Ph ysician Vero Beach, FI 32960 772/567 -1500 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral 1623 N. Central Avenue Homes & Crematory Sebastian, FI 32958 F041870 772/589 -1000 5. Check Appropriate Box a. The medical certification has been completed and signed. A completed certificate of death accompanies tnls application. b. XX Dana was contacted on July 30, 2010 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death. and that Melissa Dean, M.D. will complete and sign the medical certification of cause of death within 72 hours. C. R was contacted on He /she verified that Medical Examiner, will complete and sign the med' I certif atio cause of death within 72 hours. o. Funeral Director/ Si at F.E. No. /Reg. No. Date Signed Direct Disposer F044048 07/30/2010 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -10 -0580 :nA 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. ElNo extension of time for filing the death certificate has been requested. MI-or Date Date Certificate Subregistrar Signature i_W�,/� Issued: 07/29/2010 DUe 08/02/2010 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: BURIAL ®CREMATION Signature of Sexton or Person -in- Charge I ® STORAGE FIOTHER (Specify) CEMETERY OR CREMATORY Place of Disposition �- Date of Disposition o ' 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 A—W w City of Sebastl?aH Sebastian Cemetery Pb. N It 772) 589 - 2545 Fax t1 1(772) 228 - 9927 �utc Tbi% Is for inrurmational purpose% reguarding Monuments at Sebastian Centeterw . Note. This is for a Double Marker under 2ft. & over 2 ft. ( over 2 ft is a poured foundation) Please return to City Of sebal.tian Sebastian Cemetery 1921 North Cenirai Awe. 32958 Attention Cemetery Sexton Size : Base : 4-6 x 1 -2 x 08 Die : 3-6 x 08 x 1 -8 Names & Dates His Iler : Dorothy I. Cipriano D.O.B. D.O.B. 1927 D• D.O.D. 2010 Unit: 4 Wk.: 12 Lot : 17,18 Square Feet: Approved: K.G.K. Checked By: Date : By: quality vaults 14" wide Foundation lmured by ; quality vaults date 3/= 3/i, %tune installed by : quality vaults date