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Home My WebLink About4-05-01UTY OF w�►'�"'i��11�� HOME OF PELICAN ISLANb Certificate No. 2311 �� 4i� �� Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Walter &/or porothy Hock 425 Concha Drive 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 5, Lot 1 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 5th day of December, 2011. CITY OF SEBASTIAN, FLORIDA AI Minner City Manager ATTE ST : Sally A. Maio, MMC City Clerk � � � �' � ,�.PS • � � � yX ia �/� / Name ��1! L� Unit BloCk Lot � ' Date of Mark-out �� Date of Burial /�// /L� Time � � ' Name of Funeral Home � : r�, � n � 1 � Authorized by CITY OF SEBASTIAN 4 3 3 5 CITY CLERK'S OFFICE RECEIPT Name �'` �/� �'� ��.� � I:TC� ❑ Cash Date � .� — � r ��"� / 1 �Check #_� No. Amount Paid 001001208001 001501322900 001501 341920 001501 341910 001501 341930 601010 343800 001501 343805 Sales Tax Garege Sales CopieslBid Specs. LDCICode of Ordinances Election �ualifying Fees � Cemetery Lots � �}�°�--! LoUNiche �—. B��k �� Unit � Cemetery Fees ��— ?1 , .it,�', � � (./ ��s c, � f0�° � p/G • � 5". °; �D� o� �� l � 5 - �- � �{° ,, ,C� /j � ' , a �� Total Paid initia White - Dept. of Origin • Yellow - Finance • Pink - Applicant /S�'�. � WALTER H. HOCK October 3, 1924 - December 2, 2011 Walter H. Hock, 87, of Sebastian, FL, died December 2, 2011 at Sebastian River Medical Center, Sebastian. Born in Glendale, New York, he had been a resident of Sebastian for 7 years coming from Delray Beach, Florida. He served in the United States Navy, during World War II. Survivors include his wife of 25 years, Dorothy A. Hock of Sebastian; 3 sons, William G. Hock of Dix Hilts, New York, Robert C. Hock, M.D. of Estero, Florida, and James J. Hock of Mineola, New York; and 9 grandchildren. � FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNIClPAL CEMETERY una HOME OF PEIKMI KW�D For information contact: 1Gp Kelso - Cemefery Sexfon Sebastian Municipal Cemetery (772) 589-2545 Crty Clerk's Office Cfty Hall, 1225 Main Strest Sebastian, FL 32958 O�ce (772} 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: STRUNK FUNERAL HOME �C CREMA3�RY 3 No.Sentral ��p_ ADDRESS: SEBASTiAN, FL 32958 PHONE #: (Che ne� .� � ,� ��%�EN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE ��AL DATE AND SERVICE TIME: �a � � FOR DECEASED: ` Name Lot _�_ Block ` Unit � Lot Block Unit Niche Block Unit IN� Q� � a �I S( E L. NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Mus# provide proper documentation of ownership} � c�m �- . � ► a 5 _za t ► Name Signature Date I certify that I have determined the ownership of the above described site, that all site fees and adminrstrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED U L CT l ��S �. I�i�.� � 5 �� Name Signature Date Cemetery Sexton Certification: I certify that l have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: / ii Ce ete Sex on Date This form to be provided to Clerk's Office by Sexton for permanent record upon cornpletion. FLORIDA DEPARTMENT OF HEALT A. (TYPE) 1. Name of Deceased 2. Place of Death County 3. 4. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT First Walter City, Town or Location Indian River Sebastian Name of Medical Certifier Edgar R. Blecker M.D. nMedical Examiner �,PI Middle � Last Hock Date of Death Month Day Year December 2, 2011 Name of (If neither, give street address) Hosp. or inst. Sebastian River Medical Center Address Phone Number 229 Sebastian Boulevard Sebastian, Florida 32958 (772� 581-0016 Name of Funeral Home/Direct Disposal Address Fla. Lic. 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 Appropriate Box 6. Funeral Director/ � c. a. • � � The medical certification has been completed and signed. A completed certificate of death accompanies this applicatio �Ll,�,�Q was contacted on +''�L� �J� � � `l�� t�J � He/she verified that this de t as 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. medical certification of was contacted on of death within 72 hours. F.E. No./Reg. No. F042674 BURIAL - TRANSIT PERMIT He/she verified that , Medical Examiner, will complete and sign the �e�� I l Per ission is hereby granted to dispose of this body. Permit No. 1228-11-553 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.€i�ing e ath certificate has been requested. �br �� / � Date Date Certificate Subregistrar Signature � ��/L-/ V Issued: 12/2/2011 Due: 12/7/2011 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. �. CEMETERY OR CREMATO� Method of Disposition: Place of Disposition �J,,�'� � URIAL �STORAGE Date of Disposition �CREMATION Signature of Se�on 1 or Person-in-Charge j �OTHER (Specify) 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 DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar Indian River County, Florida Property Appraiser - Property Data Data For Parcel 31382500001292000024.0 Base Data Parcel: 31382500001292000024.0 Owner: HOCK, WALTER & DOROTHY Site 425 CONCHA DR, SEBASTIAN, FL 32958 Address: Mailing Address Address: City State Zip: 425 CONCHA DR SEBASTIAN, FL 32958 � [ �� tf�p tf�is E>rope�t:y. Property Information Tax Code: 2 Property Use: 0100 - SINGLE FAMILY - IMPROVED Neighborhood: 140018.20 - SEB HLS SEC 13/24/25 AREA Real Appraiser & CW - CHARLES WILLIAMS - Date: 4/7/2006 Legal Description -- c�ick ner� �or �u�� iegai Secondary Owners descriptian No additional owners found. SEBASTIAN HIGHLANDS UNIT 11 BLK 292 LOT 24 PBI 7-56G Photos [�+-] C(ic.k t� er7l�r�c�e. Notes Notes: Click here to view oblique imagery through Bing Maps. Report Discrepancy GIS parce/ shapefi/e /ast updated 12/6/Z011 12:16:10 AM. CAMA database /ast updated 12/6/2011 12:28.�47AM. Page 1 of 1 I http://www.ircpa.org/Data.aspx?ParcelID=31382500001292000024.0 12/6/2011 �� .. ( _ � A� .. Yot✓x� 5.� �.'.ng.�g'S�`nRS.:SLL?�'�, � � $��N :$ "� fi411+tiE £3F PELiCP.E*1 45LAt�ID 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 ho .,rnvirlorl �t timc nf rii �rrhaca Haaress Area Code & Phone Number ] � , Vv Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($ ( ��— . on this �� day of , 20�, for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit �_, Block �, Lot(s) Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. e� Additional Fees paid at time of purchase: �1�� '^'� `�� ` �j, �i Corner Markers (set of 4-$20) Opening & Closing �I�' � W O H ircle One Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser Interment ! `�� Uv� Disinterment .� _I V�!'^1L � ��` � City of Sebastian The following documents were provided as Proof of Residency: I:\1MN-f�ATA�M s-Ceme?eN\R FC F � pT. d oC � and