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Home My WebLink About4-05-37C�fY OF ,� � r'�-�,.'��''- �� „ � �... _�r� � �� _ �� . HOME OF PELICAN ISLAND Certificate No. 2322 �� 0�� 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 SEB/�STIAN, FLORIDA a inner anager ATTEST: 1aio, MMC Clerk ARTHUR E. HESS Born November 9, 1922 Passed Away February 4, 2012 Mr. Arthur E. Hess, 89, died February 4, 2012 at Indian River Medical Center, Vero Beach. He was born in Brooklyn, New York and lived in Sebastian for 18 years comin� from Stuart, Florida. He served in the US Army during World War 11. He was a member of St. Sebastian Catholic Church, Sebastian. Survivors include his wife of 65 years, Genevieve Hess and daughter, Barbara 0'Keefe both of Sebastian. YLUIC1llAlltYAK!MtNl Vr $tatg O� F�OCIC�� Department of Health, Vital St�tiS#ICS �� APPLICATION FOR BURIAL � TRANSIT PERlNIT A. (TYPE) 1. Name of First Middle Last Date fvlonth Day Year Deceased Arthur E. Hess Death February 4, 2012 2. Place of Dea4h City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Medical Center 3. Name of Medical Address Phone Number Certifier Luis Cisneros M.D. Indian River Medical Center 1000 36th Street Vero Beach, nMedical Examiner v Physician FlOrida 32960 (772) 567-4311 9 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishmert Strunk Funeral Home 1623 North Central Avenue Sebastian, F041870 (772) 589-1000 and Crematory Florida 32958 5. C��eck a. � The medical certification has bsen compl�ted and signed. A completed certificate oi death accompanies this Appropriate application. Sox ' /� b. � � �� (,�� was contacted on 2� � ( �U � � ,��o, ' He,�she verified that this dea�h jw� from natural causes, that there uvas no accident nor other external cause cfi death, and that t�� will complete and sign the medica! certifscation of cause of death within 72 hours. � was contacted on medical certification o'f cause of d�ath within 72 hours. He/she verified that , Medical Examiner, wiil complete and sign the 6. �uneral Director/ ---- 'n� Si nature 1 F.E. No./Reg. No. B�eef�is�oser ^I l} �r }�1�,� �, �� F042674 � B. BURIAL - TRANSlT PEROVIIT Permission is nereby granted to dispose of this body. Permit No. 1228-12-60 _ �'ive (5) day extension of t+me for filing the death certificate (exclusive of v✓eekends) has been requested and granted since the physician has been contacter� by the fiuneral director and vvill not be able to complete the medical certification of cause-of-deatn section of the death certi icate within 72 hours. � No extensi�n of time for ng death certificate has been requested. --�e�is#�er or c -= � � Qate Date Certificate Subregistrar Signature _� �� .� , Issued: 2/4/2012 Due: 2/9/2012 c Approval Numbe�: AUTHORIZATION for CRE9VIATiON, DI�SECiION, or Bl1RIAL-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 a�ter death is required for all cremations. a. Method of Disposition: �URIAL / �"� �CREMATION Signature of Sexton or Person-in-Charge ❑STORAGE ❑OTHER (Specify) � ___4��LL11. • 7 CE9iAETERY OR GFiEMATOR (� �, �� Place of Disposition �) l��,i� C��'� �:..il�.-L� Date of Disposition �tf l�1 � I�� L� �� This permit must be endorsed by the Sexton or person-in-c� rge (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 (Obscletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar r� � e ` + FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING !N SEBASTIAN MUNICIPAL CEMETERY ona HOA� OF PEiKAN IS1MD For information contac� Kip Kelso - Cemefery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Offrce City Hall, 9225 Main Sireet Sebastian, Ft 32958 Office (772} 38&8215 or 388-8294 STRUNK �UI��AC��I��C5��i��; ��Y FUNERAL HOME: 1623 No. Centrat Ave. nre f ADDRESS: �772% 589-1000 PHONE #: ( he k One) � OPEN BURIAL LOT Lot _�_ Block � Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: � Q��, �� V" �� 1'� FOR DECEASED: /�� I,� � t��SS Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Mus# provide proper documentation of owne hip} ��,r��! i�„tl:� l�S� �-� �.,�-�Uc t��.J.� �-� � 2-1 l.� ( 3r��— 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. N ME AND SIGNA URE OF LICENSED FUNERAL DIRECTOR• �--- � '� -� -�Gt�S �� Name Signature �� v Date Cemetery 9exton Certification: .r I certify that I have checked the ownership inforrnation by viewing the owner's deed and confirming with Clerk's office a d that all fees have been paid: � • 6 e e ry exton Date This form to be provided to Clerk's Uffic� by Sexton for permanent record upon cornpletion. Name� U n it _L—_ Block � Lot � � S Date of Mark-out ' � • Date of Burial � / ��s.' Time ` �Bd � 7/J/� Name of Funeral Home �� "' u�/� "" � ,.� ��,�.P.nt Ai.vO Authorized by � �� 7 LZ. d � � � m i � 0 � � � O m 7 ) s f � � � • � � � e 6 � � � d d a � G C O °o 0 w W O � 0 0 0 o z 0 0 0 0 0 o a 0 0 0 ° 0 0 0 ° f ' `'' o A W W � � � N OD p W � N O O O O O O O r C) m r C� G� � m �� 3 � C�i �. � y m � Z � �y � c° � � m -� � � `� fJ m 5: cNi �` T O N O�, � (D N � � _ � y � � \ T � �� y y �Q 3E � 1 _ A � J � z 3 A � ln `� ❑ � U � N � � � � I a � 0 c � u' � � �C a C c7 � � � n mmo � y N W -�iQ� T � Ts �Z m � � � �