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Certificate No. 2322
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Genevieve &/or Arthur Hess
253 Dickens Avenue
Sebastian, FL 32958
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 lots:
Unit 4, Block 5, Lots 36 & 37
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 6th day of February, 2012.
CITY OF SEBP�STIAN, FLORIDA ATTEST:
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Sally�aio, MMC
ity Clerk
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Lot
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GENEVIEVE M. HESS
Mrs. Genevieve M. Hess, 88, died June 6, 2012 at Holmes Regional
Medical Center, Melbourne.
She was born February 20, 1924 in Brooklyn, New York and lived in
Sebastian for 18 years coming from Stuart, Florida.
She was a member of St. Sebastian Catholic Church, Sebastian.
Survivors include her daughter, Barbara O'Keefe of Sebastian.
She was preceded in death by her husband, Arthur E. Hess in
February of this year.
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ElARID�DII'ARC6{E�TnF�, ,�' State of Florida, Department of Heaith, Bureau of Vital Statistics
HEAI.�T BURIAL TRANSIT PERMIT
DATE PRINTED: June 7, 2012 TRACKING NUMBER: 2012077069
1. DECEDENT INFORMATION
Name of Deceased Date of Death
GENEVIEVE M HESS June 6, 2012
Place of Death - County City, Town or Lceation Name of facility, or street address if not a facility
BREVARD MELBOURNE HOLMES REGIONAL MEDICAL CENTER
Name and Address of Funeral HomelDirect Disposal Establishment Fla. Lic. No./Reg. No. Phone Number
STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589-1000
1623 N CENTRAL AVE
SEBASTIAN, FLORIDA, 32958
Funerai Director/Direct Disposer Fla. Lic. No.IReg. 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: 2o�2-FOa�s7o-5o�s
. G� ��r • Date Issued: June 7, 20�2
J ,,,�
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
PIaCe Of D'ISpOSitiOn: SEBASTIAN CEMETERY
Method of Disposition: BURIAL Date of Disposition: �// �� •
Sig at e of se ton or person-in-ch ge (or by the funeral director/direct disposer when there is no sexton)
DH 326E, 1/11
64V-1.011, Florida Administrative Code
, ,
FUNERAL DIRECTOR'S RE4UEST TQ CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTtAN MUNICiPAL GEMETERY
ma
HOh1E CF /E11�AN 1ftAAD
For information cflntacK:
Kip Kelso - Cemefery Seacton
Sebastian Munl�Ipel Cemetery
(772) 589-2545
FUNERAL HOME:
ADDRESS
PHONE #:
City C/erk's O�ce
City Hall, 1225 Main Strset
Sebasfran, FL 32958
O�ce (T72) 388-8215 osr 388-8214
Fax: 72) 589-5570
STRUNK FUNERAL NO E�C CaEMA30RY
1623 No. Central Ave.
( he One)
OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND
FOR DECEASED:
Name
:E TIME:
Lot �_ Biock � Unit � c� �I ('�'
Lot Biock Unit
Niche Block Unit
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NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
Mus#� id proper doc entation of ownership)
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Name S' ture 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.
�f A,AAg AND SI N/�TURE,OF LICENSED F�Uf F�tAL DIF� C OR: �
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Name Signature Da e
Cemetery Sexton Certificatian: � ��� �'�N�� ��"'°__�
1 certify that I have checked the ownership information by viewing the owne�s deed and confirming
with Clerk's office and that all fees have been paid:
�e /! / � .
Ceme ry S on Date
This form to be provided to Clerk's Office by Sexton for permanent record upon oornpletion.
CITY OF SEBASTIAN
CITY CLERK�S oFF��E . 4 4 4 2
RECEIPT
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Name �f ��e-V 1 e�i�, (�I e;5� ❑ Cash
Date � � �p — � o(o �Check # l �I �
No. Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 CopiesBid Specs.
001501 341910 LDCICode of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots Z��.K�V . Q�
LoUNiche�,°Ki-,,"�' Block ��, Unit �"'�
001501 343805 Cemetery Fees
� � w Total Paid OG�IJI/ • ��
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
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