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Home My WebLink About2-18-08FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso,. Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office - Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a)citvofsebastian.org FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) xxxxx OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE Lot-8—Block 18 Unit DEED 215 Lot—Block—Unit Niche Block Unit N S E W TBA at a later date FOR DECEASED: James R Whitaker Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Rebecca Carol Whitaker Rebecca Carol. Whitaleer June 27, 2017 Name Signature Date 8295 133rd Place, Sebastian, Florida, 32958 1 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 DIRECTOR: Tim Marvin Name Tri Mciou Signature June 27, 2017 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: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. JAMES "JIMMY" R. WHITAKER November 2, 1942 - June 22, 2017 Mr. James "Jimmy" R. Whitaker, 74, died June 22, 2017 at Sebastian River Medical Center in Sebastian, FL. He was born in Asheville, North Carolina and moved to Roseland, Florida in 1965 coming from his birthplace. Jimmy worked 30 years for Piper Aircraft as a Toolmaker and retired from the industry in 1993. Survivors include wife of 54 years, Rebecca Carol Whitaker of Roseland, FL; son Bobby Whitaker of Roseland, FL, granddaughter, Josephine Lynn Whitaker of Roseland, FL. He was preceded in death by son, Joey Whitaker. Memorial contributions may be made to American Heart Association, PO Box 840692, Dallas, TX 75284 or American Diabetes Association, 1101 N Lake Destiny Rd # 415, Maitland, FL 32751 in memory of James "Jimmy" R. Whitaker. At the request of the family services will be private. Born: November 2, 1942 Death: June 22, 2017 State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: June 27, 2017 TRACKING NUMBER: 2017101691 1. DECEDENT INFORMATION Name of Deceased Date of Death JAMES R WHITAKER June 22, 2017 Place of Death - County City, Town or Location Name of facility, or street address If not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral HomelDirect Disposal Establishment Fla. Lie. No./Reg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lie. No./Reg. No. TIMOTHY W, MARVIN F022789 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2017-2-5122 �=— Date Issued: June 23,3, 2017 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: C17-19-06-347 4. CEMETERY OR CREMATORY Place of Disposition: VERO BEACH CREMATORY Method of Disposition: CREMATION Date of Disposition: EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10/12 64V-1.011, Florida Administrative Code CITY OF SEBASTIAN 10728 cADMINNIS/TtRATIVE SERVICES RECEIPT Name�i'�U./11C / t k q-0*Er2_ ❑ Cash Date )i Check # /�7 b*%2 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 001s01 34325- o[c moo. � dirr'A J611< IQ '+- Total Pai Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant N BLOCK 18 (Unit #2) Whitaker, Joseph Patrick (Intered) Unit 2, Block 18, Lot 8 2 yr. old son of James R. Whitaker Block 18 Lot _b,.. Unit 2 Whitaker, James R. Deed #215 for Joseph Patrick Whitaker (age 2) (intered) P.O. Box 186 (Manatee Ave.) Roseland, Fla. Paid by Cox- Gifford - Baldwin Funeral._. Home Check or .00 — 9- —7i Paid by General Receipt No. Dated 9-13 -73 List Price $..75.. GO Discount $ — Na Paid $...75..00 Maximum No. Burial spaces 1 Total area in square feet Monument permitted flat (Data above this line for City Record only) Deed #215 James R. Whitaker Manatee Ave P.O.Box 186 Rosel nd, Fla Low , Blk 18, Unit 2 Deed #215