HomeMy WebLinkAbout4-04-10CITY OF
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Certificate No. 2273
CITY OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Charles Rowan
8485 103rd Court
Vero Beach, FL 32967
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 lot:
Unit 4, Block 4, Lot 10
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 10 day of November, 2010.
CITY OF SEBASTIAN, FLORIDA
Al Minner
City Manager
ATTEST:
Sally Maio, MMC
ity Clerk
Name LA/%L4. S ,e0,-4 5 /9, j //es
Unit 1
Block 7
Lot 1
Date of Mark -out /1/0
/e oa �i l7'`� il.
Date of Burial (D Time
Name of Funeral Home S A4
Authorized by r W4 thairY1A-
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LINDA SUE ROWAN
(November 7, 1942 November 4, 2010)
LINDA SUE ROWAN
Mrs. Linda Sue Rowan, 67, died November 4, 2010 at
Sebastian River Medical Center, Sebastian.
She was born in Point Washington, FL and lived in Vero
Beach for 3 years coming from Plantation, FL.
She was a partner in the Rowan Construction Company in Broward County, FL.
Survivors include her husband of 53 years, Charles Rowan of Vero Beach;
daughters, Cindy (Larry) Marsh of Okeechobee, Carol (Warren) Jewell of
Valkaria, Robin (Bob) Schaffer of Vero Beach; brothers, Willie Ray Infinger,
Edwin Infinger and Charles Wayne Infinger all of West Palm Beach, Cleston
Infinger of Point Washington; 11 grandchildren, 7 great grandchildren. She was
preceded in death by her sister, Helen Fay Infinger.
1.
Name of First Middle Last
Deceased
Linda Sue Rowan
Date Month Day Year
of
Death 11/04/2010
2.
Place of Death City, Town or Location
County
Indian River Sebastian
Name of (If neither, give street address)
Hosp. or
Inst. Sebastian River Medical Center
3.
Name of Medical
Certifier Michael Venazio, M.D.
11 Medical Examiner fr3Physician
Address
8005 83rd Avenue
Sebastian, FI 32958
Phone Number
772/388 -2110
4.
Name of Funeral Home /Direct Disposal
Establishme 5trunl Funeral
iiiomes rema ory
Address
1623 N. Central Avenue
Sebastian, FI 32958
Fla. Lic. No. /Reg. No.
FO41870
FO44048
Phone No. (Area Code)
772/589 -1000
A.
FLORIDA DEPARTMENT OF
HEALT
5. Check
Appropriate
Box
6. Funeral Director/
GlirataLlaielitiraff
B.
(TYPE)
b.
c.
DH 326, 8/97 (Obsoletes all previous editions)
(Stock Number: 5740 -000 0326 -2)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL TRANSIT PERMIT
a. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
Paige was contacted on November 5, 2010
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Michael Venazio, M.D. will complete and sign the medical
certification of cause Of death within 72 hours=
medical certification of cause of death within 72 hours.
was contacted on
r
Sign tue F.E. F0440$
G2) V L. thin CJ�t�ul1
BURIAL TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 10-0696
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.
O No extension of time for filin the death certificate has been requested.
Registrar-or Date Date Certificate
Subregistrar Signature Issued: 11/04/2010 Due: 11/08/2010
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.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition
Distribution: White: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
He /she verified that
Medical Examiner, will complete and sign the
Date Signed
11/5/2010
OBURIAL STORAGE Date of Disposition
DCREMATION DOTHER (Specify)
Signature of Sexton
or Person -in- Charge
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.
FUNERAL HOME:
ADDRESS:
PHONE
Name
Name
C
ete
A/%
PIA?
Sexton
/C
FUNERAL FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
9 goo 6 /s- i
SEBAsTu\N
MOMS Qi PELICAN ISLAND
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
(Check One)
lC OPEN BURIAL LOT Lot /o Block X Unit
_OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: i(�8 .eI W /74
FOR DECEASED: 4/4 5 A E ,e.,,gA/
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
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 FUNERAL DIRECTOR.
Signature Date
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
Date
CQaa
W
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
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For Evaluation Only.
tw_L. ,; 94
j
City of Sebosrion
so).. n Cemetery
Ph.•1(772)5119-2545
Vat H 1(772)223-9927
volt' c This Is for Informational purposes re:uarding Monuments at Stbustian('entelrn
\ulc. rhis is for a Double Marker under 211.&over 2 ft.(nser 2 ft.is a poured foundation)
Please return to - (*it) Of ftlijst+jn
Stbasfian ('entetrrs
1921 ♦urlh Central.�sc. foundation (Krum)
32958 by : quality vaults/c/i,j
Attention Cemetery scum' date ,Aaf//,
■utnt. tgst.tllyd
AS : quality vaults
sut Base: 6-0x1 -2x0-8 Die: 4-0x2-0x0-8 date _ /�yii
Ills : Charles Rowan 11i : Linda S. Rowan
D.O.B. 0.11. 1942
D.O.U. ).O.U• 2010
Unit: 4
B/k. : 4
tot: 9, 10
Square Feet: -
Approved: K.G.K. _
—
_
Checked By : K.G.K.
Date: 5/;-.3//I __
By: quality vaults
I v s%tri.i.: . ( Picture A/O Monument in question )
I
6" N 24"
wide 48
/ \ / 14"
I II wide
thick 8 72
t 1