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Home My WebLink About1-38-03■ ' { � t711' OF iN 9 � ��' �� ,�� iy:.;;r.: - a l�� FlOME OF PELICAN . tStAlHtk Certificate No. 2067 -- _ _ -.- �`�� .�� !��' ��°I�.� Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Dennis C. Brodsky P. O. Box 500214, Malabar, FI 32950 (name) (address) in and for consideration of the sum of $2,250.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plotJniche: Unit 1_ Block 38_ Lot(s)Niche(s) 3& 4_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk 1■ for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 24�' day of February, 2006. CITY OF SEBASTIAN, FLORIDA AT � , p2' � �` �A1 inner Sall aio, MMC City Manager - City Clerk ----. _____._ _ _ -- ------------...__ _. ____._.__ _ _ _.. _._ ___.... ______ _ ______._ _ ____.. _____. _._ __ .�; �. �i� �� , . ,, . . , . . ,., _ , . _ . : .�.: , : , .. . �,15 " �•�,� . .. ki . . ...... . � .. . . . . ' ' : . � � � " . .:. ..... . . .. .. ... . .' ' . . �o �/��l.! g � � . , '�' 1R `.� -� � � `s .�.r� ' , . / � i -�.. ��.; _ I j � ,:; : �� ` ] �c�� . ' / '¢' _';. c ` � ,i . , � ,� ^ , � ; . ' _ ` ' , . / ��,� � '�,.. � ►��` � _ , (G,� . °�` ` � �'^' �� - ^' ` ' �(�Q,\� � � � i ��Y'��!��'�� , � . �� ' - , ,,� :: . . � _ � ... , ,; . ,,... . _ -. .� _: .:. . .. � °� �;�° � ��/f� . r _:.. , ,' :' � lS : °� . �a� �SP�� '3/�� ,� 3 i- � �'Y -1 .� .�$b /`� ,��` � l � � � . ,� -, `.7 /�� _ � �1 , ,r.( C.. G / �� -� • Name �. Unit ~ /� Block � ' Lot .� ; � � ° t ,s r ^' � � Date of Mark-out ,� � "� a '� l � �r.� . c y r, ^ � � r � � � %" ' ,�' /�. � ,� � � � � t �= Time Date of Burial � _ j . `�, .�. �, �� T' f :, Name of Funeral Home � i� G�4 � , � �'. � ` ' Authorized by ; , � � - -- �� FLORIDA DEPARTMENT OF / ` � � HEALT State of Florida, Department of Health, Vital Statistics � [,� APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Frances Elaine Brodsky Death February 16, 2006 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay inst. 6Jilliam Childs Hospice House 3. Name of Medical Address Pho�e Number Certifier John Campbel l, MD 5305 Babcock Street, NE MedicalExaminer x physician Palm Bay FL 32907 (321) 676-9009 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 12822 1001 South Hi ckory Street South Brevard Funeral Home Melbourne FL 32901 FH-937 (321) 724-2222 5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. � Debbi e was con4aded on 02/20/2006 He/she verified that this deatbOHlan fr�amp�e��;sG$Dthat there was no accident nor other extemal cause of death, and that J f1 �� will complete and sign the medical certification of cause of death within 72 hours. �• ❑ was contacted on He/she verified that , Medical Examiner, will complete and sign the edi certification of cau of death within 72 hours. 6. Funeral Directod na � P F.E. No./Reg Date Signed Direct �isposer ' � �`' FE# � ��.,,� 02/20/06 B� � �URIAL - TRA�VSIT PERMIT � Permission is hereby granted to dispose ofthis body. Permit No. FH-93%-5506 � A five (5) day extension of time for filing the death cert�cate (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�fling the death certificate has been requested. Registrar or ��-" � ,_ � `\ `�' \ �' Date Date Cert�cate �` SubregistrarSignature t�;•��..,� �y�'-�`�� Issued: 0/ n 06�ue� 03/09/�nn6 : �_ �� AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date Medical Examine�, , 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. /X waiting period of 48 f�ours after death is required for all cremations. �• CEMETERY OR CREMATORY Sebasti an Ci ty Cemetery Methodof Disposition: Place of Disposition �BURIAL �STORAGE Date of Disposition �CREMATION �OTHER (Specify) Signature of Sexton t or Person-in-Charge � r nis permit must be endorsed by the Sexton or person-in-charge (or by the Funeral DirectodDirect Disposer when there is no Sexton) and retumed within 10 days to the local County Health Department in.the county where disposition occurred. DH 326, 8/97 (Obsoletes all previous ed'Rions) (Stodc Number: 5740-00p-0326-2) Distribution: While: Cemetery or Crematory Yelbw: Fineral Diredor or Dired Disposer PiMc: Local Ropistrar �� , � W_ , �� :'4,.dl� i ��°t ,.Gi:� ��bh� � '��3t, !, ..I� I�4�� ` f. # i ', •. ,�! 1225 Main Stxeet, Sebastian, Fl 32958 Telephone (772) 589-5330 — Fax (772) 589-5570 February 24, 2006 Mr. Dennis C. Brodsky P. O. Box 500214 Malabaz, Fl 32950 Dear Mr. Brodsky: Enclosed is City of Sebastian Certificate 2067 entitling you to full interment rights in Cemetery Lots 3& 4, Block 38, Unit 1. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Si�erely, � Sa11y 'o, MMC City Clerk SAM:ar enclosure � �---�----- �� "Y �r'+ by > ;y� '�'� �°q P, ^ �� •�.Y""'!k.'.;�+ �! ��;� � d �� v_ ,,,� ?irJi�AF OF �Ei.t�APi a5'k.(W!? �6 �' � 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 prov' ed at time of purchase ..a�-�-.� � �' 0,�� s) o� � Address / �ot� -- �,��Z - �y 7 Area Code & Phone umber Residence Address of Intended Occupant if Other Than Purchaser Office Use On/y Receipt is acknowledged in the sum of: �_day of �Z� metery Lot(s) and/or N �/ �� 5'� ~��d � Dollars ($ ,��a _DO � for the purchase of the following �'�u��' f�� Unit �_, Block �, Lot(s) Niche(s) � y�� 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: Opening & Closing ��4►O�' O H Circle One Corner Markers (set of 4 - $20) Vase and Ring for Niches (cost) Signature of Purchaser Ci�v of Sebastian Disinterment TOT, Service fees are to be paid at time of need only I:\1NW-DATA\Ms-Cemetery\RECEI PT.doc �O� �� lililleil South Brevard Funeral Home �%ACHOVIA 42524 _�_ Pa/m Bay Funeral Home wa�no��e ea�k, N.A. �amily East Coast Cremation saae,isa, American Veterans Cremation 2/20/2006 P.O. Box 1346 Melboume, Florida 32902 PAYTOTHE City of Sebastian ** ORDE'R OF $ 2,325.00 Two Thousand Three Hundred Twenty-Five and 00/100*************************************� Do�tlts City of Sebastian ?, \ � \ VOID AFTER 60/.E7AYS \ R f !f � Brodsky, #12822 9 � ��--��-�-- i i�'04 2 5 24��' �:0 6 3 LO 7 5 i 3�: 2000 L88 5 3 9 38 Li�■ �,� THE AMMEN FAMILY City of Sebastian 2/20/2006 130 • Cash Advance Item Brodsky, #12822 Purchase 2 graves, O&C Charge Wachovia - SBFH/P Brodsky, #12822 ��"i � Z W H LL � y Y V � W 0 � � �r C.> � . � a \�' o `� Q � � ,�' � � `� � �` \I` �C � � � � i c � C � g' o ;r � "�` � � � � � J � lL m � � '� �c a�i � m � � aq � � � � � � U' CJ � W U J U ,� o 0 0 � Q ^ � i � � � ' Jy � � C fw.�l .n � t O F � c d � C W C W 0 Y • C 0 e m O 1 � « i t a3 i � 42524 2,325.00 2,325.00