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HomeMy WebLinkAbout4-05-26Cf1YOF HOME OF PELICAN ISLAND Certificate No. 2309 CITY OF SEB smug Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Lucia Jandreau 9340 101st Avenue 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 5, Lot 26 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 17th day of October, 2011. CITY OF SEBASTIAN, FLORIDA Al Minner City Manager ATTEST: Sally . Maio, MMC City Clerk Name Unit y Block Lot 24 • Date of Mark -out / 0 Mit/ Date of Burial /0 A©/ /r' Time Jo !004. ( (1CG2 ) Name of Funeral Home S 1 q -( /C. Authorized by WROAAA.Y1A-- . I EMILE "BUD" JANDREAU Born: December 12, 1938, St. Francis, ME Death: October 14, 2011, Vero Beach, FL Mr. Emile "Bud" Jandreau, 72, died October 14, 2011 at VNA Hospice House, Vero Beach with his wife and friends by his side. He was born in St. Francis, Maine and lived in Vero Beach for 13 years coming from Meriden, Connecticut. He worked as the Traffic & Warehouse Manager for Claremont Company for 25 years prior to retiring in 1998. He served in the US Army during Peace Time. He was a member of St. Sebastian Catholic Church, Sebastian. He was a life member of the VFW Post #10210; member of the Italian American Club both in Sebastian and was a 4th Degree Knights of Columbus member in CT. Survivors include his wife of 50 years, Lucia Jandreau of Vero Beach; brother, Lester Jandreau of Bangor, ME; sisters, Albertine Leone of Liberty, NY, Rita Jandreau of Bristol, RI, Florence Ouellette of Caribou, ME; special buddy Ben; numerous nieces and nephews. He was preceded in death by his brother, Millard Jandreau; sister, Nathlie Ouellette. A. FLORIDA DEPARTMENT OF HEALT (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Deceased Emile Jandreau Date Month Day Year of October 14, 2011 Death 2. Place of Death City, Town or Location County Indian River Vero Beach Name of (If neither, give street address) Hosp. or VNA Hospice House Inst. 3. Name of Medical Melissa Dean M.D. Certifier nMedical Examiner nPhysician Address 3745 11th Circle Suite 105 Vero Beach, Florida 32960 Phone Number (772) 567 -1500 4. Name of Funeral Home /Direct Disposal Establishment Strunk Funeral Home and Crematory Address 1623 North Central Avenue Sebastian, Florida 32958 Fla. Lic. No. /Reg. No. F041870 Phone No. (Area Code) (772) 589 -1000 5. Check Appropriate Box a. El The medica certification has been completed and signed. A completed certificate of death accompanies this application. b c.0 6. Funeral Director/ -ireet"BiS ,oler was contacted on loin! ( ( He /she verified that this death from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. was contacted on medical certification of cause of death within 72 hours. ' y , Signa re F.E. No./Reg. No. F042972972 He /she verified that , Medical Examiner, will complete and sign the 10 I-iatj %lc B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-11-470 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. 0No extension of time for filingftheath certificate has been requested. e�+etror Date 10/14/2011 Date 10/19/2011 Subregistrar Signature VI/t} Issued: Due: C. Approval Number: Medical Examiner, AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Date , 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 ` � n - rift Method of Disposition: Place of Disposition e J n C. BURIAL STORAGE DCREMATION El OTHER (Specify) Signature of Sexton or Person -in- Charge Jj 'C�Yv Date of Disposition ) _ 10/ D I I t 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 HOME OF PELICAN IS 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 of purchase. Name(s Address . v /U 1.c 0_12z_o 7L. 3 2_9 6 7 77— 9'- V7a.3 Area Code Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: - /thetc g a-v a,+tid /�-n Dollars ($ 2,000 . ° ° ) on this / 74h day of 0 Ct, , 20 11 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit q , Block 5 , Lot(s) 2-Co 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: ly Corner Markers (set of 4 - $20) Opening & Closing f--" Q / W 0 H Circle One Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Interment Disinterment S gnature of ' ►aser I : \WW- (DATA \Ms - Cemetery \R ECE I PT. doe, TOTAL $ x000.00 TOTAL /'1L ity of Sebastian The following documents were provided as Proof of Residency: and 508£v£ 1.051.00 0 0 0 0 0 0 0 Z o m o, m ° 0 0 0 0 ° O CD(�.1 (�,� CA) CoD W A N ▪ O N CO OWO c0 - (D - (O (O O O O O O O O- 508£4£ 1.051,00 \J O 0 seed 6wAiienp uofoa13 saoueu!PJO to apoa/aal 'soadS Plg/se!doa 0) S S °o °o °o ° 0 0 O O 0 CD A A A A N O W N 00 CO (D - (O (O (O O W N O O O O O O O -+ CD m v 0 0 0 3 C) -v. @ m • g 0 N (D 7 (D C p m n m O O 0 V) y Ei seed 6wA 1!W( 3 0 n 3 m 0 0 t 0 to x -J pied lunowy 0 0 m m O m 7 C m T, to -10> Cn ▪ s m FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY FUNERAL HOME: ADDRESS: PHONE #: HOME OE 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 STRUNK FUNERAL HOME & CREMATORY 1623 Nu. Central Ave. SEBASTIAN, FL 32958 (772)589.1000 (Che One) f - OPEN BURIAL LOT Lot 2L Block 5 Unit 1+ OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit NS E W BURIAL DATE AND SERVICE TIME: I H- 1.AAZS'I 10 12©I 2 D t ► Q.) l0:tX fit-'i FOR DECEASED: Ent\'1 It J ail cli tcuk Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of owne hip) L A C clrea..tx_ dtur o °i ll 136 I Date Name Signature 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. N ME AND SIGNATURE OF LICENSED FUN RAL DIREC .e_iflO 1!__- n iC__> wi 11 ( XI I Name gnature 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: (/ x/..e.‘2t. /°/r, Cem ry Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.