HomeMy WebLinkAbout4-04-15CITY OF
HOME OF PELICAN ISLAND
CITY OF SEA STIAN
Certificate of Interment Rights
Certificate No. 2294
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Victoria Kawas /or Karen VanDeVoorde
482 Avocado Avenue
Sebastian, FL 32958
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 4, Lot 15
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 20 day of April, 2011.
CITY OF SEBASTIAN, FLORIDA
Al Minner
City Manager
ATTEST:
c 1
Sally A�,/Maio, MMC
City Clerk
Name 14 /0.i.14
Unit
Block I f
Lot
Date of Mark -out
Date of Burial
Name of Funeral Home
Authorized by
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1. Name of First Middle Last
Deceased
VICTORIA AGNES KAWAS
Date Month Day Year
of
Death 04/29/2011
2. Place of Death City, Town or Location
County
INDIAN RIVER VERO BEACH
Name of (If neither, give street address)
s or ROYAL PALM CONVALESCENT CENTER
nt
3. Name of Medical
Certifier Farhat Khawaja, M.D.
Address
7754 Bay Street Suite 7
Sebastian, FL 32958
Phone Number
772/589 -3000
El Medical Examiner Physician
4. Name of Funeral Home /Direct Disposal
EstablishmentStrunk Funeral
Homes 8 Crematory
Address
1623 N. Central Avenue
Sebastian, FL 32958
Fla. Lic. No. /Reg. No.
F041870
Phone No. (Area Code)
772/589 -1000
A
5. Check
Appropriate
Box
6. Funeral Director/
r
B.
C.
D.
FLORIDA DEPARTMENT OF
HEALT
.Registrar or
Subregistrar Signature
Approval Number:
Medical Examiner,
TYPE
Method of Disposition:
likIBURIAL
DCREMATION
Signature of Sexton
or Person -in- Charge
a.
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b. p Paige
DH 326, 8/97 (Obsoletes all previous editions)
(Stock Number: 5740- 000 0326 -2)
and that Farhat Khawaja, M.D.
certification of cause of death within 72 hours.
medical certification �l� 1 joffccauusseofdeath within 72 hours.
gnatu l aim l /yit1 F.E. No./Reg. No./Reg. No.
F044048
W rvt��
DSTORAGE
DOTHER (Specify)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL TRANSIT PERMIT
was contacted on
Funeral Director /Direct Disposer. Date
was contacted on May 1, 2011
He /she verified that this death was from natural causes, that there was no accident nor other external cause of death,
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA
Date
gave authorization by telephone to
will complete and sign the medical
He /she verified that
Medical Examiner, will complete and sign the
Date Signed
05/01/2011
BURIAL TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228 -11 -0210
IKKA 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 ha been requested.
Date Date Certificate
Issued: 04/29/2011 Due: 05/03/2011
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.
CEMETERY OR CREMATORY
Place of Disposition 50/5
J
Date of Disposition 5 y/
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
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
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.
ctori0. Kawas OM r Karen 1fa.n DeVoo rde
Name(s)
2 Avocado /J e_ 5e-be_sfi ccn FL 32q5
Address
C 1 7 Z 5 Rq 9 co
Area Code Pho e Number
V( Cte r
Name Residence Address o Intended Occup Other Than Purchaser
Receipt is acknowledged in the sum of:
ihetwafta. aid. /o-o
on this ;t0 44- day of Apr;
Cemetery Lot(s) and /or Niche(s).
Unit
Vase and Ring for Niches (cost)
Temporary Marker Preparation Installation
nature of Purchaser
&/k
I \WW- nATA \.Ms- Cemetery \R F CE I PT. d oc
HOME OF PELICAN ISLAND
OFFICE USE ONLY
Dollars 1000. 00
20 I 1 for the purchase of the following described
Block Lot(s) 15 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:
Corner Markers (set of 4 $20) Opening Closing W 0 H
Interment
ty of Sebastian
Disinterment
Circle One
TOTAL /000 00
and
8\s
The following documents were provided as Proof of
Residency:
Indian River County, Florida Property Appraiser Property Data http: /www.ircpa.org/Data.aspx ?ParcelID= 31380100002013000002.0
Data For Parcel 31380100002013000002.0
Base Data
Parcel: 31380100002013000002.0
Owner: VICTORIA A (H)* KAWAS
Site 482 AVOCADO AV, SEBASTIAN, FL 32958
Address:
Mailing Address Property Information
Address: 12470 ROSELAND RD Tax Code: 2
Legal Description Click here for full
legal description
SEBASTIAN HIGHLANDS SUB UNIT 01
BLK 13 LOT 2
PBI 5 -14
Photos
Click to enlarge.
Notes
Map this property.
Property Use:
City State SEBASTIAN, FL
Zip: 32958 -3507 140010.00
Neighborhood: NORTHERNMOST
SEB HIGHLAND
Real Appraiser CH CHARLIE
Date:
Report Discrepancy
GIS parrel shay de last updated 4/18/2Q1112:16:04 AM.
Secondary Owners
No additional owners found.
Notes: Click here to view oblique imagery through Bing Maps.
0100 SINGLE
FAMILY IMPROVED
HEATH 3/20/2006
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
Name VI CtD r) Ck KO W c S Cash
Date 4 pZ) (1 [XCheck# 91.12--'
Amount Paid
No.
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC /Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
Lot/Niche 15 Block
001501 343805 Cemetery Fees
Wale
Q.rn 4
4 Unit 4
Initials
White Dept. of Origin Yellow Finance Pink Applicant
4295
1000
Total Paid /000. DO