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HomeMy WebLinkAbout1-29-08HOME OF PELICAN ISLAND Certificate No. 2307 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: Robert & /or Kemberly Martin 744 Holden 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 1, Block 29, Lot 8 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 6t" day of October, 2011. CITY OF SEBASTIAN, FLORIDA t 'Al Minner City Manager ATTEST: Sally X. Maio, MMC City Clerk r Name, Unit ` Block Lot Date of Mark -out / 0 /1 Date of Burial _/�� Time &D C z5x,4, ) Name of Funeral Home _�,�[ f Authorized by J(64�� , c� Cf1VOF HOME OF PELICAN ISLAND SEBASTIAN MUNICIPAL. CBETERY 1921 N. Central Avenue, Sebastian, FL 32958 ■ (772) 589 -2545 ■ Fax (772) 228 -9927 October 12, 2011 Jim Young Cox - Gifford Seawinds Funeral Home 1950 20th Street Vero Beach, FL 32960 RE: Wallen Service Dear Mr. Young: You may be aware that fees outlined in City of Sebastian Resolution No. R -08 -27 provide that services past 3:30 p.m. are charged at $250.00. Please remit an additional $100.00 at your earliest convenience. Thank you for your attention. Sincerely, 4 Kip G. Kelso, Jr. Sexton KGK /jw Enclosure CITY OF SEBASTIAN CITY CLERK'S OFFICE 4 4 1 9 RECEIPT Name Coy- � 61 ZI• All e n [I Cash Date 10-31-11 Y-Check: No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 CopiesBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche IR , Block Unit 001501 343805 Cemetery Fees Q /(, 4 A ff Total Paid 00 • d0 Initials White — Dept. of Origin • Yellow — Finance • Pink - Applicant ZOA ELLEN WALLEN Thursday February 25th 1915 - Tuesday October 4th 2011 - Jupiter, FL Zoa Ellen Martin Wallen went home to be with the Lord on October 4, 2011. She was 96 years old. She was a resident of St. Joseph's Assisted Living facility in Jupiter, FL for the past 5 years and a previous resident of Fort Lauderdale, FL for 52 years. She spent her summers at the family home place in Elnora, IN since 1989 and really enjoyed it. She was born February 25, 1915 in Daviess County, Indiana to George A. and Florence O. Cunningham. She was one of six children. Surviving are her loving family: daughters, Cynthia (Lewis) Perry, Moore, SC and Elnora, IN and Pamela (Robert) Root, Jupiter, FL and son, Robert (Kem) Martin, Sebastian, FL., sister, Ava Cunningham, Indianapolis, IN and nephew, George (Sandy) Johnson, Allons, TN. Treasured grandchildren, Steve (Diana) Perry, Terrell, NC, Deborah (Evan) Rainwater, Spartanburg, SC, Laura Root Evans, Jupiter, FL, Jennifer Root, Jupiter, FL, Timothy (Virginia) Perry, Lexington, SC, Jessica (Douglas) Maruzzella, Grant, FL, Khristina (Ralph) Elswick, Port St. Lucie, FL and beloved great - grandchildren, Brittany Jackson, Spartanburg, SC, Justin Perry, Terrell, NC, Cameron Maruzzella, Grant, FL, Rebecca Rainwater, Spartanburg, SC, Caleb Maruzzella, Grant, FL, Summer Elswick, Port St. Lucie, FL, Matthew Evans, Jupiter, FL, Ava Grace Perry, Lexington, SC. She was predeceased by her parents, three sisters, Ada Ann Cunningham, Grace Cunningham and Suzie Johnson, one brother, Woodrow Cunningham. Her husbands, Earle P. Martin, Norman E. Crews and Edward N. Wallen. Zoa loved traveling, painting, crafting, sewing, shopping and spending time with friends and family. She graduated from Elnora High School in 1933 and from Indiana Central College with a BS degree and Methodist Hospital, Indianapolis, IN as an RN. She worked many years in various hospitals in Indiana and Florida, did private duty nursing in Florida and taught school for 2 years in Indiana. She was very active in the Plantation Community Church in Plantation, FL and the United Methodist Church in Elnora, IN. where she was a member. She enjoyed bible studies, Sunday school and all the women's programs. She was a very active senior citizen. Iri.�xwn unrnximnrvi yr State of Florida, Department of Health, Vital Statistics HEALTU IAPPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of ZOA ELLEN WALLEN DeattOCTOBER 4, 2011 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or JUPITER /PALM BEACH Inst.ST.JOSEPH'S ASSISTED LIVING COMMUNITY 3. Name of Medical Address 533 NORTHLAKE BLVD, SUITE 2 Phone Number Certifier DR.ALAN MARCUS,M.D. Medical Examiner X Physician NORTH PALM BEACH FL 3 408 4. Name of Funeral Home /Direct Disposal Address 1950 20TH STREET Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment COX GIFFORD SEAWIND FUNERAL HOME & CREMATORY VERO BEACH,FL 32960 40816 1772-562-2365 5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. ® DR.ALAN MARCUS, M.D. was contacted on 10 -4 -2011 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that HE will complete and sign the medical certification of cause of death within 72 hours. c• F-1 was contacted on He /she verified that Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ Signature F.E. No. /Reg. No. Date Signed Direct Disposer ,�✓ F057650 10 -4 -2011 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 11- 40816 -442 ® 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 di or 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 eath certifi to has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 10 -4 -2011 Due: 10 -17 -2011 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 SP_bos -{-k prn P-i -erV injBURIAL nSTORAGE Date of Disposition L- r }0 1De [- 11 CREMATION EJOTHER (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. DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740 - 000 - 0326 -2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar Oct 0711 03:02p DATE: jim young Eagle e �I!)illl)11CI)I.S� ble. TO: CITY OR SEBASTIAN 1225 MAIN ST. SEI3A9171AN, PT I.. 3295.8 ATTN: CEMETERY SEXTON SIZE v �cp°fI�1' - or NAMES AND DATR?S I US: D.O.B. D.O.D. Cu M 0j-Le r, D.O.B. U.O.D. UNIT / i1LOCK LOT SQUARE FEET APPROVED G'l__,_r. CIIRCKED BY DATE EXAMPLE OR I'ICI'URfs OT' MONUMI3NT IN QUESTION: 772 -465 -7949 Tim, Aur•.A's ONI.v Fmi. tii_kvin: Sly -mmi -T COMPANY SINCH 1962 905 BARREL Avi:., 1'*L)Vr hlikCE, FLU1011A 34982 i P.1 Z) Al y "�� FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY NDME Oi 11"AN 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 FUNERAL HOME: �o x — , F�oe77:) 15 or 1,vo 5 ADDRESS:, PHONE #: (Che ne) _fJPEN BURIAL LOT Lot _ -> lock Unit ----OPEN CREMAINS LOT Lot Block Unit —1JPEN COLUMBARIUM NICHE Niche Block Unit W BURIAL DATE AND SERVICE TIME: /o Z, , Z—/, 'Oe FOR DECEASED: Zo,.Ie Name NAME AND SIGNATURE OF LOT OWNER OR R RES WEATIVE: (Mu provide proper documentation of ownersl Name Si nature Date 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 DIRECTGR. Qv Na 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 /5A Cem tery ex on Date This f0nT1 to be provided to Clerk's Office by Sexton for permanent record upon completion. 7 d 0 IL i T e 3 0 CD 0 0 c °0 ° 0 0 °O $ 0 p e0i d (1 O CT wow O O W O O O N O N N O O O w O O O 0 3 MFT N 9 n lO IT1 v o d m cc; CD -� T c w p �p aj///fff - 0 • fjTX 0) c V1 .Q •O o n Cl) = d x D 0 c M V. �mr O H T < mz CD co o O 0 3 MFT N V 1 G► � 1 n o � c i i � a n m` _ CD 0 Q can 0 0 0 co airoF �4 HOME OF PELICAN ISLAND 1�p'jj I Iili 1921 N. Central Avenue, Sebastian, FL 32958 - (772) 589 -2545 - Fax (772) 228 -9927 October 12, 2011 Jim Young Cox - Gifford Seawinds Funeral Home 1950 20th Street Vero Beach, FL 32960 RE: Wallen Service Dear Mr. Young: You may be aware that fees outlined in City of Sebastian Resolution No. R -08 -27 provide that services past 3:30 p.m. are charged at $250.00. Please remit an additional $100.00 at your earliest convenience. Thank you for your attention. Sincerely, , Kip G. Kelso, Jr. Sexton KGK /jw Enclosure LOT AVAILABLE FOR SALE UNIT I , BLOCK a°I , LOT � wJ U aff of SEJSASTIAN HOME OF PELICAN ISLAND Certificate No. 2060 CITY OF SERA' Certificate of Int IN ACCORDANCE with prov' of the Sebastian, it is hereby certified that: L. B. Brown (name) in and for consi Sebastian Muni for use i e prescribed the CONVEYED THIS 1 CITY OF $EBASM nt R nit lock 29_ L Niche(s)_8 of the al Cemetery, aimed on ecords of the City Clerk e conditions, ordinances, resolutions, rules and regulations ity of Sebastian. 8t' January, 2006. N, FLORIDA ATTn i I04 aio, MMC Clerk inane the Ci )f �l 329J interment rights in the My cc 1 �W H E OF PELICAN ISUND Certificate No. 2 4j 'v 060 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: L. B. Brown (name) P. O. Box 510, Roseland, F1 3295 7 (address) in and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1_ Block _29_ Lot(s)Niche(s)_8_ 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 18th day of January, 2006. CITY OVEBA�T AN, FLORIDA AA I1 Y�= /Maio, MMC ity Clerk =I aiYOF SEBASTim, HOME OF PELICAN ISLAND Certificate No. 2060 UV 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: L B. Brown P. O. Box 510, Roseland, F132957 (name) (address) in and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1_ Block —29- Lot(s)Niche(s)_8_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 18'h day of January, 2006. CITY OF 9E Ay B IAN, FLORIDA A Sall aio, MMC -"Citv Clerk I■ +1411 sp ut to o----------- N-7 Lq) 0. Sep 04 2009 2:13PM FUNERAL Ni ADDRSSS: PHONE #t: COS CEMETERY 7722289927 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN DR 6URIAL OPENING IN SEBASTIAN MUNICIPAL. CEMETERY no w WEAK A" For information contact: x/p 1(e180 - Cemmtery Sexton Sebastian Municipal Cemetery 772 6M -2605 /b \� p City 01W*Is office City Hall, 1225 Main Strset (i(� Sebastlen, FL 32958 1 OrNce7?138&8�? 5 or 388.9214 Fern l7T11 '�8� -$�7t) P.2 7 :%- a 3 4OOnne) ,--" PEN BURIAL LOT Lot Block Unit _ —.DPSN CREMAINS LOT Lot --Block Unit PEN COLUMBARIUM NICHE Niche_ /Block — ��Unit BURIAL DATE AND SERVICE TIME: FOR DECEASED: ALI rvame NAME AND SIGNATURE OF i.OY OWNER OR RE91RE4NTATIVE: /,0- (Must provide proper documentation of ownership) .1 • ,CS , RD W-1 Date Name Qnature I certify that I have determined the ownership of the above described $ite that all site fees and administrative fees have been paid and authorize opening of serve NAME AND SIGNATURE.OF LICENSED FUNERA IRECiOR• �© a 3 d 1 gature D to Cemetery Sexton Certification' I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid Corn ter a ton This form to be provided to Clerk's Office by Sexton for permanent record Upon completion. my of iv - HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 January 18, 2006 Mr. L. B. Brown P. O. Box 510 Roseland, Fl 32957 Dear Mr. Brown: Enclosed is City of Sebastian Certificate 2060 entitling you to full interment rights in Cemetery Lot 8, Block 29, Unit 1. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. I have also enclosed a copy of Certificate No. 2000 for your records. If you have any questions, please contact our office. S Sally Maio, MMC City Clerk SAM:ar enclosure 25 CnYor SiBASTIM HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase S) Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Dollars ($ on this 1 day of , 20 D(c for the purchase of the following described Cemetery Lot( d /or Ni e(s). Unit _, Block , Lot(s) �7 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 Vase and Ring for Niches (cost) Interment Signature of Purchaser of Sebastian Disinterment Service fees are to be paid at time of need only I: \WW- DATA\Ms- Cemetery\RECEIPT.doc W O H Circle One � O LO CV) U, co LU u� k .... .. . . .. . . # m � E - � « 2 � u \ c - 2 § � _ � i k » 0 R / a I $ D § f ■ i \ § I o a B C-4 K R k k c k 2§ k k ■ k k k k k k .. .. . .. $ � _ a � ■ | � I 0 � �& � � 41YOF HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, Fl 32958 ...Telephone 772 - 589 - 5330... Fax 772 -589 -5570 January 17, 2006 CERTIFIED MAIL 7ooSJ /tlzi - o 7- 8 7/,s— Mr. L. B. Brown P. O. Box 510 Roseland, F132957 This is a follow -up letter to the one we sent you on August 11, 2005. According to our records, you requested we hold the following cemetery lots for you: Unit 1, Block 29, Lot(s) 6, 7, 8 & 10 The city does not accept credit cards or installment payments, therefore, as a courtesy it does agree to hold lots for thirty (30) days to allow family members time to exercise their financial options or think of their future needs. Since we have not received a response from you, these lots will be made available for sale to the public 30 days from the date of this letter. If we do not hear from you before February 17, 2006, we will assume you are no longer interested in the purchase of the lots. If you have any questions regarding this matter, please contact Cemetery Sexton Kip Kelso at 589 -2545. Thanks for your attention to this matter. Since ly, Sally A. aio, MMC City Clerk ■ Complete items 1, 2, and 3. Also Item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space Permits. t • Article Addressed to: 3a�s 7 2• Article Number — (Transfer from service /ems PS Form 38111 February 2004 --. �•,•� aenvery address below: II Express Mail ❑ Return Receipt for Merchandise ❑ C.O.D. e►y7 (Extra Fee) n ., -- 7005 1820 0005 5817 Domestic Return Receipt 8 715 102595 -02 -M -1540 U.S. Postal Service,, CERTIFIED MAIL, RECEIPT (Domestic Mail Only; No Insurance Prodded) information visit our website at www•usps.com:•, For delivery Y" � M r ■ Complete items 1, 2, and 3. Also Item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space Permits. t • Article Addressed to: 3a�s 7 2• Article Number — (Transfer from service /ems PS Form 38111 February 2004 --. �•,•� aenvery address below: II Express Mail ❑ Return Receipt for Merchandise ❑ C.O.D. e►y7 (Extra Fee) n ., -- 7005 1820 0005 5817 Domestic Return Receipt 8 715 102595 -02 -M -1540