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Home My WebLink About1-38-04■ ' { � 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 � � r. .. . .. .... . .,. .. , � I Name / G Unit � �' � Block � Lot � Date of Mark-out 2. , / / �� /� , _Time �O %��• l��G�l Date of Burial Name of Funeral Home S v 1 � � �. Vv ' Authorized by g g' g g o g $ o � a ° � � � °i � g �° � � � > A t'a N 7 � 0�1• ' � O � <p f0 N � \ '� y � O O � � I 7 +� 0 � I t � O o .z +� '" � � � `� b+ � �o � ,� � � � � $ � � : �.�$� � ` � � e �� W � � � � T � 7 h r �� m � � � e ar � ' O C "Y ❑ - � � A rs u � n M n \, � a a � � � a � d O � � C .�, O � I"� �� s�mm T y � m y T � m= � � U 0 DENNIS C. BRODSKY July 11, 1949 - January 02, 2012 MALABAR Dennis C. Brodsky, 62, an Auctioneer, passed away Monday, January 2, 2012 after a prolonged battle with leukemia. He was predeceased by his wife Elaine, parents George and Josephine Brodsky and infant siblings Frank and Carol. He is survived by his son, Dustin (Angel) Brodsky, brothers Gary, Dale (Cynthia) and William (Pamela), many nieces and nephews and long time friends Pamela Lee and Reverend Raymond and Barbara Purdy. A. 1. Name of Deceased OF Dennis State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT First Middle Last Date of C. Br'odsky �eath Month Day Year January 2, 2012 2. Place of Death City, Town or Location Name of (If neither, give street address) Counry Hosp. or Alachua Gainesville inst. Shands at the University of Florida 3. Name of Medical Address Phone Number certitier Jo►^ge Enri que Lascano, MD 1600 Archer Road, SW Medical Examiner x Physician Gai ►lsvi 11 e FL 32601 ( 352 ) 273-8740 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 18595 1001 South Hi ckory Street South Brevard Funeral Home Melbourne FL 32901 F041850 321 724-222 5. Check a. � The medical certification has been completed and signed. A compieted certificate of death accompanies this Appropriate application. Box 6. Funeral Directod Direct Disposer B. c b� � Amanda dt dOCt01^' S Offl Ce was contacted on n� /n5/�n� � He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that �lor�e Enri nuP I a tca nn, Mfl wiil complete and sign the medical certification of cause of death within 72 hours. � was contacted on f cause of death within 72 hours. �( � � Fo ( BURIAL - TRANSIT PERMIT He/she verified that , Medical Examiner, wili complete and sign the Date Signed O1/05 Permission is hereby granted to dispose of this body. Permit No. FQ4j$5Q-6j2 �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 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 filing the death certificate as been requested. Registrar or Date Date Certificate SubregistrarSignature Issued: O1/05/12 p��: O1/12/2012 Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-�EA 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 CREMATORY Method of Disposition: Place of Disposition $ebdS'C1 d11 C2f112te1^�/ BURIAL �STORAGE Date of Disposition l/�� //;{ • �CREMATION Signature of Sexton or Person-in-Charge �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 ret�rned within 10 days to the local County Health Department in the county where disposition occurred. Distribution: DH 326, 8/97 (Obsotetes all previous editions) (Stock Number: 5740-000-0326-2) White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ' SE� . Mowu o+ PEIKAN ISlANO For informafion contact: Kip Kelso - Cemetery Sexton SeUastian M�,nicipa! Cemetery (772) 589-2545 Cify C1erk's Oflice Cily Hall, 1225 Main Street Sebastian; FL 32958 Of�ice (772J 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: �o�% /� �,c°� ��n f. /� ADDRESS: �o T- S � �� '�' PHONE #: . . . 3�.Q b ! (Check e) PEN BURIAL LOT Lot �_Block �Unit —�- _�PEN CREMAINS LOT Lot Block Unit _APEN COLUMBARIUM NICHE Niclie � Biock Unit . "' W BUR1A� DATE AND SERVICE TIME: / i/ �. /� � 30 c�,e �+►''�. s � A� \ FOR DECEASED: %�t �v�. .S G�_ �,�.'t�.l� S�V • � ivame � �JAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentatiori of ownership) � i� • . Name � Signature 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 NAA�E AND StGNATURE OF LICENSED FUNERAL D1REG7GR. iY�- Nam— e �'�" - �Signature Date ------------------------------------------------------------------------------------------------------------------------------ Cemetery Sexton Certification: I certify that I have checked the ownership inforn��at�on by viewing the owner's deed and confirming with Clerk's office �3nd that all fees have been pa�d ' . • / /'/ / Cem ery ext n Date This foriTi lo be provided to Clerk's Office by Sexton for permanent record upon complet�on.