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Home My WebLink About4-04-22Cm OF �E AI �" HOME OF PELICAN ISLAND Certificate No. 2301 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: Kathryn M. Willms 472 Fleming 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 4, Lots 22 & 23 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 28`h day of June, 2011. CITY OF SEBASTIAN, FLORIDA Al Al�- Minner City Manager ATTEST: Sall A. Maio, MMC City Clerk Name Unit Blockn� Lot - Date of Mark -out .f [)ate of Burial 76 /N Time �(1 X00 4�S�SCp Name of Funeral Authorized by VIRGIL APPLING "VIRG" WILLMS Mr. Virgil Appling "Virg" Willms, 86, died June 27, 2011 at VNA Hospice House, Vero Beach. He was born in Royal, Illinois and lived in Sebastian for 18 years coming from Miami, Florida. He obtained his Associates Degree from Emory- Riddle located in Miami, FL. He was an Aeronautical Mechanic employed with Eastern Airlines in Miami for 25 years. He was a member of St. Sebastian Catholic Church, Sebastian and a member of the Eastern Airlines Retirement Association. Survivors include his wife of 63 years, Kathryn "Katie' Willms of Sebastian; brother, Albert Willms of Urbana, IL. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Data Month Day year Deceased Virgil Appling Willms of June 27, 2011 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Indian or Indian River Vero Beach ,— VNA Hospice House 3. Name of Medical Address Phone Number Cannier Richard T. Penly M.D. 1265 36th Street Vero Beach, Florida 32960 (772) 567 -6390 Medical Examiner Physician 4. Name of Funeral Home /Direct Disposal Address Fla Lis. No. /Reg. No. Phone No (Area Code) Establishment Strunk Funeral Home 1623 North Central Avenue Sebastian, F041870 (772) 589 -1000 and Crematory Florida 32958 5. Check a. ❑ The medical certification has been completed and signed. A completed cartifcate of death accompanies this Appropriate application. •�� Box l0 I LV n b. Qntl ^� � was contacted on Z(� � b He /she variftedi death.e(as ro� natural causes, that there was no accident nor other external cause of death, and that •�� l will complete and sign the medical certification of cause of death within 72 h s. c El was contacted on He /she verified that , Medical Examiner, will complete and sign the 6. Funeral Director / �� rgi natur�}.,�/fq .,,� F.E. No.IReg. No. e l Diraei..Diseeeer 1 ilA��(U �• l 1N tIYA 11� _ F044048 U ( k e. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this hotly. Permit No. 1228 -11 -305 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- chceath section of the death certificate within 72 hours. o extension of time for filin death certificate has base requested. ReryieMer or Data Date Certificate Subregistrar Signature_ Issued: 6/27/2011 Due: 7/2/2011 C. Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. Method of Disposition: ,09U-RIAL STORAGE CREMATION nOTHER (Specify) Signature of Sexton j or Person-in- Charge J CEMETERY OR CREMion Place of Disposition /11 /y Date of Disposition P I I (�(�t /I y ✓k�l� -- 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. omnnulmtt wear, neraheryo,crematory re Ws, are mrsoleRe all nrerbus sonars) yellow Funeral Dai or o red nsins ar (Souk Nari 57400no -09262) Plnle meal k.,trer Total Paid nd'uls While - Dept. of DriBin • YMlow - Finance • Pink Applicant CRY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4310 �/�/��({,J/�� Name K6L) %V'V11 1 IA/ ('I M 1, uCash Data 1t�—I1) VCheckA SS'',1'' No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopievBid Sp . 001501371910 LDG /Code of Ordinances 001501341930 Election Qualifying Fees 2DOO. 00 601010343800 Cemetery Lots LoVNiche 22413 Block 4 ,, 11 , Una N 001501 343805 Cemetery Fees C) A, 0.00 Total Paid nd'uls While - Dept. of DriBin • YMlow - Finance • Pink Applicant Sep 20 2008 2:45PM HP LRSERJET 3200 I FUNERAL DIRECTOR'S .4EQU EST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SE �Fo: informatlor contact: K! Ko.'ac - Cemere.y Sexton So )nstian Municipal Cemetery (772) 589.2545 Clfy ClerkY U'Gce 'y Hall, 1225 Main Sfn at Sobaaoan, F4 31958 (772) 388 -8215 or 388 a214 Far: (772) 589.5570 FUNERAL HOME. STRUNK FI ADDRESS. PHONE N' (Ch94 One) OPEN BURIAL LOT —_OPEN CREMAINS LOT —_.OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME pCR DECEASED. :JAME AND SIGNATURE OF LOT OWNER OR ("dust provide ProPeldocumentation of dwnersh CREMATORY Blcck _ Unit 4 BIOck Unit BIOck Unit —W P. 1111 r Name Signature ❑ate I celtify Leal I have delen»ined the oonu�shlp of the abe Ye described Sile Itlal all Site fees and acministrative lees have been paid and i authorize opening of same NAME AND SIGNATJRE OF LIOENSEO FUNEE L I OR. Signature Date Cemeler Sexton Certification -. --- .-..-- . - - -- I,lerti( that I have -racked the owrlars ...__.._ Y Y - - Ip MI MI no❑ b7 viewing the owner's deed and r.Onllrming with Clerk's orflce =Intl that all fees have een paid Cemetery Sexton - Date This form to be Provided to Clerk's Oftc by Sexton for permanert record upon completion. .A a5pl ma zw HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589 -5330 Phone (772) 589 -5570 Fax July 5, 2011 Ms. Kathryn M. Willms 472 Fleming Street Sebastian, FL 32958 RE., Interment Rights to Unit 4, Block 4, Lots 22 & 23 Sebastian Cemetery Dear Ms. Willms: Enclosed is City of Sebastian Certificate 2301 entitling you to full interment rights in Unit 4, Block 4, Lots 22 & 23. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sin 7rely, \ Sally A. Mato, MMC City Clerk SAM:dwc enclosures 12/27/2011 10:58 aC 11� NSA ,A 241 NO �y M N VI z E Plot Location Section '--r Block'_ Lot 22 Name CemetE 1 #0627 F.002/0'11 trunk Funeral Home Monument Installation Request 0 4 LU M CD �o W Z 0 N x N Monument Type Grass Marker X X Slant Marker X X Base X X Bevel X X Base —X —X Upright Marker 2-10 X 0-10 X3- Base 5�j- X) -D Xis D -� x o- ts Foundation Hp o X No Vase 0 -� X 0 -(p )� I — b 'Y'es No Vase Descriptionn�� Installation Re qu es ted By blc l -1-1 � 5$�i - I OLO Date Requested, Installation y Completed B ��• p Date (Upon completion fax to Strunk Funeral &me 779-A936) 1 12/27/2011 10:58 10627 P.0031011 �� n.yiwcoaruwa P.VUlI0V1 t� t� LLI Z �V'aQD Z -� i° �ccoo gn U) 4 b 0 • C 12/27/2011 10:58 Star Granite Co., Inc. (,aa Sow gmns*.tZsm w) e. 0. 4K 159 T. 1.800.2417242 T.- 706'-283 -70 3 Sold To: SEBASTIAN CHAPEL DAVID HINCEMAN 1623 NORTH CENTRAL AVE. SEBASTIAN, FL 32958 Phone: 772- 589 -1000 Fax: 772 -589 -2583 Ship Via POOL TRUCK Ship Date 12/07/11 Terms NET 30 DAYS Freight PREPAY Shipping Instructions Sales Order - Shipping Copy 80827 P.004/1011 Acknowledgement No. S0114265 Sales Order Date: 11/02/11 Page: 1 Ship To: STRUNK FUNERAL HOME JUANITA 916 17TH ST. VERO BEACH, FL 32960 Phone: 772466 -1955 Fax: Customer ID _ 4.199 P.O. Number P.O. Date 11/02/11 Vendor SalesPerson KB,TR Quantity Item No. Color Dejeriptlon 1 DIE STAR BLUE 2 -10 X 04 X 3-8 Pol.5 ALL POLISHED STACKED HEART CARVE 8 LETTER PER D -938, BLACK LITHO REF; VIRGILA. KATHRYN M. 1 PED STAR BLUE 1 -6 X 0-8 X 04 ALL POLISHED LETTER PER ATTACHED, BLACK LITHO REF: WILLMS SEND DRAWING FOR APPROVAL CHRISTMAS ORDER 1 BASE STAR BLUE 5-4 X 1 -0 X 0-6 PFT BRP Transferred to page 2 ... ............................... 341 12/27/2011 10:59 'Stan Granite Co., Ina (aia seas 9MWts Q 0mur) 4'Q 00C 1S9 7.• 2- 800-241724? i1 706- 283.7043 Sold To: SEBASTIAN CHAPEL DAVID HINCEMAN 1623 NORTH CENTRAL AVE. SEBASTIAN, FL 32958 Phone: 772 -589 -1000 Fax: 772- 589 -2583 Ship Via _..,. POOL TRUCK Ship Date 12/07/11 Terms NET 30 DAYS Freight PREPAY Shipping Instructions 1 10627 P- 005/611 Sales Order - Shipping Copy Acknowledgement No, S0114265 Sales Order Date: 11/02111 Page: 2 Ship To: STRUNK FUNERAL HOME JUANITA 91617TH ST, VERO BEACH; FL 32960 Phone: 772 -466 -1955 Fax: Customer ID 4199 P.O. Number P.O. Date 11/02/11 Vendor 341 SalesPerson KB,TR Quantity Item No. Color Description Transferred from page 1 .............................. 1 VASEP5 STAR BLUE 0 -8 X 0.8 X 1-0 Polished 5, Taper Ends Order Weight: Shipping copy 1,725.33