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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Anthony & Rose Masi 851 Dunn Terrace, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $3,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niches:
Unit 3, Columbarium, Niches 42dnb & 32sn
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 July, 2010.
CITY OF EBASTIAN, FLORIDA ATTEST;
1 r � �
� AI Minner
City Manager
� �� �
II�R. Maio, MMC
City Clerk
Name
Unit
Block
�/ � �
Lot /�f � ��
�-
Date of Mark-out
Date of Burial /`L� � Time �� a � 5�
Name of Funeral Home S�«,�L� S
Authorized by t� ��'�� - `" �
EDWARD K. CASTELLANO
Edward K. Castellano, 49, of Sebastian, FL died Friday, September
14, 2012 at his home. Edward was born January 15, 1963 in Bay
Shore, NY.
Survivors include his mother and step-father Rose and Anthony Masi
of Sebastian, FL; father and step-mother Edward and Julia
Castellano; sisters Loraine Maples of Long Island, NY, Denise Adams
of Long Island, NY, Arlene Buck of Massachusetts; several nieces
and nephews; many uncles and aunts.
•- -�,
F�"� ps�a'�'r °E'� ,�� State of Florida, Department of Health, Bureau of Vital Statistics
I�EALT BURIAL TRANSIT PERMIT
DATE PRINTED: September 18, 2012 TRACKIN(3 NUMBER: 2012126040
�, DECEDENT INFORMATION
Name oi Daceased Date ot Death
EDWARD K CASTELLANO September 14, 2012
Place of Death - County Clty, Town or Locatlon Name of tacfiity, or street address If not a taclNty
INDIAN RIVER SEBASTIAN 851 OUNN TERRACE
Name and Address ot Fart�a! Mome/Dtrect Dlsposa! Establishment Fla. Lic. NoJRep. No. Phone Number
SEAWINDS FUNERAI tiOME & CREMATORY F041682 F041882 (772) 589-1933
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 3295B
Funeral Direcbor/Direct Dlsposer Fla. Lic. No.lReg. No.
ANTHONY GABBARD F��`�
2, BURIAL - TRANSIT PERMIT
The Florida Department of Health, Bureau of Vitai Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2012-F047682-5086
. Q.G / �• T` Date (8sU�d: SePtember 14, 2012
��� ...i ,,,�,
Meade Origg, State Registrar
3. AUTHORIZATION for CREMATION, DfSSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
AuBwrization given by Medical Examiner Dist�'ict 19 Approva! Number: C12-19-o9-t93
4. CEMETERY OR CREMATORY
Place of Disposition: sE oRv
Method of Disposition: CREMATION Date of Disposition: /� ��'
Signa re of , n or person-in rge (or by the funeral directorldirect disposer when there is no sexton)
DW 326E, 1/11
64V-1.011, Fbrida Administrative Code
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SE� .
naa� v� rttxN+nuwo
For informafion contact:
Kip Kelso - Ceinetery Sexton
Sebastian M��nicipal Cemetery
(772) 589-2545
Cily Clerk's Of(ice
Cily Half, 1225 Main Sireet
Sebastian,. FL 32958
Office (772J 388-82t5 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME: SE�9[..,�� aO.S /`. /� -
ADDRESS�
PHONE #: �/C 1'�� 5 S �� / � 3 � .
(Check One)
�PEN BURIAL LOT Lot � Block Unit
PEN CREMAINS LOT Lot,��Block Lo , U�it �
�PEN COLUMBARIUM NICHE Niche Biock Unit
� W
BURIAL DATE AND SERVICE TIME: �. !z• !O :,�O ,
FOR D�CEASEO: e�'���S�D�
L`n cv �� n �• C Q,S ���.� a. �
ivame
lJAME AND SIGNATURE OF L07 OWNER OR REPRESENTATIVE�
(Must provide proper docume�tatior� of ownership)
C—
�ose ��t-s r � � ' 9-a�-i�
Name ` Signature Date
I certify that I have determined 1he ownership of the above described site that all site fees and
administrative fees have been paid and authorize opening of same
NAME AND SIGNATURE �F �ICENSED FUNERAL DIREC7GR.
%/ /%� '
Name ^ Signature Oate
-------------------------------------------------------------------------------------------------------------------- --
Cemetery Sexton Certification:
I certify thal I have checked the ownership inforrr�at�on by viewing the owner's deed and confirming
with Clerk's office �3nd that all fees have been pa�d
, � .
e ete Se ton Date
This foriTi to be provided to Cle�k's Office by Sexton for permanent record u{�on complet�on.
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