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Home My WebLink About1-29-09Total lPakl v F Initials Whits —'D t. of; Dr • ow — Finance • Pink • Applicant �s 5 CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 3222 o Nams 0 Cash Dab No. Amount Pak! 001001208001 Sates Tax 001501322900 Garage Sates 001501341920 Copieald Specs. 001501341910 LDGCode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots *25 LoUNiche Block ,/AA—P, . Unit. _ !(S OlJ 001501343805 Cemetery Fees • Total lPakl v F Initials Whits —'D t. of; Dr • ow — Finance • Pink • Applicant �s 5 06 aryoF SEA HOME OF PELICAN ISLAND 1004 Certificate No. 2000 CIS OF EB STIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: L. B. Brown (name) P. O. Box 510, Roseland, Fl 32957 (address) in and for consideration of the sum of $700.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1_ Block 29_ Lot 9_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 24th day of January, 2005. Y OF SEB T FLORIDA ATT --�_ ,rrencj PAoore Sal A. Maio, MMC City anager City Clerk • O C]Y OF ISE CO 4-c�- HOME OF FEUCAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 January 24, 2005 L. B. Brown P O Box 510 Roseland, F132957 Dear Mr. Brown: Enclosed is City of Sebastian Certificate 2000 for the purchase of Cemetery Lot 9, Block 29, Unit 1. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sing y, Sally A. io, �NIMC City Clerk SAM:ar enclosure st oF" vain MA" City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only is acknowledged in the suu/ -m ofd on this � day o described emetery Lot( Tor I .0 � Dollars ($ d o , d 20 Odor the purchase of the following Unit / , Block ��., Lot(s) Niche(s) r . 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: Comer Markers set of 4 - $20) Opening & Closing[�.7. O D W O H Markers ( set One Vase and Ring for Niches (cost) interment Disinterment Signature of Purchaser Service fees are to be paid at time of need only i :\Ww- DATAWs- CemeWry%RECEIPT.doc mss; c %UUM Cassandra Jane Brown; Sebastlah Cassandra "Cassie" Jane Brown, 20, died Dec. 91 2004, in West Virginia: She was born in West Chester, Pa., and was a lifelong resi- dent of Se- bastian. She was a former stu- dent of Se- bastian River High School. Survivors include her daughters, Brit- taney and Brianna, both of Sebastian; father, L.B. Brown Sr. of Sebastian; mother, Carol Shumate o Canton, Ohio; brother, L tcher Brown II of San ernardino, Calif.; and siste ; Deborah Brown of Palm Bay, Camilla R. Brown of Canton and Pam and Lisa Brown, both of Se- bastian. SERVICES: Visitation will be from 6 to 8 P.m. Dec. 14 at Seawinds'puneral Home, Se- bastian. A graveside service will be conducted at 11 a.m. Dec. 15 in Sebastian Ceme- tery, CRY OF HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FI 32958 - Telephone: 772 -589 -5330 January 7, 2005 Certified Mail Mr. James Young Seawinds Funeral Home 735 Fleming Street Sebastian, Fl 32958 Re: Unit 1, Block 29, Lot 9 Cassandra J. Brown Dear Mr. Young: As of this date the City has not received the $700.00 fee for the purchase of interment rights in Unit 1, Block 29, Lot 9 and also the opening and closing fee in the amount of $75.00. The service and interment of Cassandra J. Brown was held on December 15, 2004. These funds were payable within 48 hours of the need. This matter will be turned over to the city attorney to pursue legal action if these funds are not paid within seven (7) days of receipt of this letter. If you have any questions, please no not hesitate to contact me at 388 -8214. Si re y, Sally A aio, MMC City Clerk SAM/ar Cc: Rich Stringer, City Attorney Shai Francis, Finance Director c(olpy WEST VIRGINIA DEPARTMENT OF HEALTH & HUMAN RESOURCES BUREAU FOR PUBLIC HEALTH - VITAL REGISTRATION PHYSICIANS / MEDICAL EXAMINER'S CERTIFICATE OF DEATH ROOM 165, 350 CAPITOL STREET, CHARLESTON, WV 25301 TVPEi PRINT W PERMANENT , DECEDENT NAME (Fast eamdk, Llafl STATE FILE NUMBER BLACK INK . �'u _ _ V , .�..� 2. SEX 1. . DATE'OF DEATH /Alayh. Day Y1er1 AUTHORITY FOR BURIAL, TRANSPORTATION, REMOVAL THIS SURW--TRANSR PERMIT, WHEN COMPLETELY FILLED IN AND BEARING ABOVE THE SIGNATURES OF THE ATTENDING. PHYSICIAN OR MEDICAL EX ER CONSTI- AMIN TUTES AUTHORITY FOR BURIAL TRANSPORTATION AND REMOVAL OF THE DECEASED NAMED ABOVE. (THIS IS NOT AUTHORITY FOR CREMATION, A SEPARATE APPU- CATION MUST BE MADE.) CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SECTION BELOW THE DECEASED NAMED �� 1. p ❑ IN THE CEMETERY OR CREMATORY NAMED IN ITEM 20b. BURIN- VINS BJ SECTION -� r/aTE�� I HAVE MADE THE APPROPRIATE ENTRY IN THE CEMETERY OR CREMATORY REGISTER l SIGNATURE SEXTON OR OTHER PERSON IN CHARGE THIS BURWL- TRANSIT PERMIT MUST BE SIGNED ABOVE BY THE CEMETERY. OR CRE41ATORY ` RITY. WHERE THERE IS NO Ft1LL Tea PERSON W CHARGE OF THE CEMETERY, THE FUNERAL DIRECTOR MAY SIGN AS SEXTON. THIS PERMIT MUST BE RETURNED WITHIN TEN DAYS TO THE WEST VIRG"A STATE DERARTMENT OF HEALTH VITAL REGISTRATION OFFICE, CHARLESTON. WV 25305 31a CERi1FER f� aw ❑ CEO (p,� cowym came d Shen p**." tae prfalaalpq Uaat1 and carPtaad Nam 231 - - To the beet a my krtaNadpe, death ocW"ed ma to the wu S8) sed u ddad ---d------------- ❑..PpONOUNCNGAND PMY31LUN(pp,�,(aq both prabraW&V ded, end --------- - - - - -- To•the ben a a afore d warn) - - rty klloytedpe, dalttll olxurrW et ita ikra, date; W Wsca. rid due b ft come(p) and rvww r as Stated. -y --- - - - - -- - ------ - - - - -- ---------------------- YT On tr bola Of swmkWion srtl /a MaaStipston, In my opkYOn, death occurred at IM Nora data end Ptace urJ due b the r+uea(el and msnrw u ahNd 31 ' ^Tnu OF CF IiB 31c. DATE SIGNED (Momft Day, rir) V D. 619 Virginia Street, WaCharlestOn. WV 25342 Form VS -002 (Rev. 6/92) a SOCML 5ECURITYWU - 1,f� (-% � 5H. (V -Last Bk111daY ,bb. UNDER 1 YEAR - bc. UNDER t DAY 8 DATE OF BIRTH /Month, )BIRTHPLACE (City ant. Seas a (Yard Months -` DayB Hours Mirsaas Day, Nter) fargn Caveryl 8. WAS DECEDENT EVER IN U S -'� ^- C 7. _1 .t . . ARMED FORCES? 11e. PLACE OF DEATH (Glsck ally ate: see mi'ctoww a1 doter Side/ .. fYes a not HOSPITAL, OTHER " ❑ k1PSltent ❑ ER /Outpatient ❑ OOA any SUM nt Nwauq F1-- ❑ Residee •- •. Olhn (Speclry) 9b FACILITY NAME /If phe nWrl El nc . /10f aWieificn, ' 9c. CRY. TOWN, OR LOCATION OF DEATH . COl1NTV of DEATH IA 10. MARITAL US= Married. 11. SUHV SPOUS ,., /NUJ, !H Sib. 9i'�e mriyen name) C•8. kind d work dale L most d wvrMUrp Nk. �ed / p y 12a. DECEDENT'S USUAL OCCUPATI of 12h KIND OF BUSINESS;INDUSTRY Y Da not Low rsaed.) t" j� +' , ., 13a. RESIDENCE -STATE t3Q COUNTY 13c. CITY. TCAWI OR, OCdT10N ?S 13d. STRE7DN ER - 130. INSIDE CRY 131. ZIP CODE 14. V1M5 �CEDENT OF Ft D ORIGIN? i5. RACE - American kgiw ISpecily No or Yes -a //()1u ,kD, (Yes a1 no) yes. specify Cuban. YVtkte. att. 18 DECEDENT'S ERXICATION ,Y. r--. McXiean, Panto Rican. etc.l O No D yes ) (Spad/y 0* bo ew P" car~) L 8 ii 2 5 � Elementary /Secagay (0.12) Colkpe 11 -a ur 5 .) 1). FA 'S 9 (Fitit, AMiyde. LaTfl t8. MOTHER' E /Fist. . M_. "_ t t9a. INFORMANT'S NAME (T)Fe/Fta1l1 t0b.. MAILING ADDRESS (Sam and Nuritn a awat E RciAe ANinfler Gty a TO., . Slaw, ZP Code) � r 20e: METHOD OF OIS ON 20b. PLACE OF DISPOSITION /NSme d- errteer . . 1 . 1 i '" ' `-` r� Y % o ptecal . a 20c LOCATION -G1y a Town, Stave" oRe-1 ❑ Bwiel ❑ Cnsnation from Stave ❑ D- on SpwIgy) < %. IG \ 21. SIGNATURE OF FUNERAL SERVICE LICENSEE OR '^f• t t..: t. t PERSON ACTING AS SUCH 22. NAME PA Ll l y ► r.: �- °''"µms %:. .�-%'" r�A +:r- � -a �,� t a k' <ti� ,c ,. Ganpbte items 23a -b only 23e. 7o Ilie best d my knmMdgo. dudl ocame0 at the lime. date, and Pteee Hated .(1 G ) ; ' •••- when corWyiM dlysiew is 23b:DokTeSr.NED rot available of time of death IMors0k Day Yw; 180?Mkffo b Cer16Y cause d Oeath. and Title ► BE D BY 25. DATE - 24. itAE OF DEATH �y DEAD (Alorah,. Ovy, tw1 28: tnws REFS O TOME - FR�NOIXiCE 3 DEATH �EyD (�} .EX R /CORONER'' ' c f "' 1J M , �'a \ _ .. ......_ (Yee a n0) AUTHORITY FOR BURIAL, TRANSPORTATION, REMOVAL THIS SURW--TRANSR PERMIT, WHEN COMPLETELY FILLED IN AND BEARING ABOVE THE SIGNATURES OF THE ATTENDING. PHYSICIAN OR MEDICAL EX ER CONSTI- AMIN TUTES AUTHORITY FOR BURIAL TRANSPORTATION AND REMOVAL OF THE DECEASED NAMED ABOVE. (THIS IS NOT AUTHORITY FOR CREMATION, A SEPARATE APPU- CATION MUST BE MADE.) CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SECTION BELOW THE DECEASED NAMED �� 1. p ❑ IN THE CEMETERY OR CREMATORY NAMED IN ITEM 20b. BURIN- VINS BJ SECTION -� r/aTE�� I HAVE MADE THE APPROPRIATE ENTRY IN THE CEMETERY OR CREMATORY REGISTER l SIGNATURE SEXTON OR OTHER PERSON IN CHARGE THIS BURWL- TRANSIT PERMIT MUST BE SIGNED ABOVE BY THE CEMETERY. OR CRE41ATORY ` RITY. WHERE THERE IS NO Ft1LL Tea PERSON W CHARGE OF THE CEMETERY, THE FUNERAL DIRECTOR MAY SIGN AS SEXTON. THIS PERMIT MUST BE RETURNED WITHIN TEN DAYS TO THE WEST VIRG"A STATE DERARTMENT OF HEALTH VITAL REGISTRATION OFFICE, CHARLESTON. WV 25305 31a CERi1FER f� aw ❑ CEO (p,� cowym came d Shen p**." tae prfalaalpq Uaat1 and carPtaad Nam 231 - - To the beet a my krtaNadpe, death ocW"ed ma to the wu S8) sed u ddad ---d------------- ❑..PpONOUNCNGAND PMY31LUN(pp,�,(aq both prabraW&V ded, end --------- - - - - -- To•the ben a a afore d warn) - - rty klloytedpe, dalttll olxurrW et ita ikra, date; W Wsca. rid due b ft come(p) and rvww r as Stated. -y --- - - - - -- - ------ - - - - -- ---------------------- YT On tr bola Of swmkWion srtl /a MaaStipston, In my opkYOn, death occurred at IM Nora data end Ptace urJ due b the r+uea(el and msnrw u ahNd 31 ' ^Tnu OF CF IiB 31c. DATE SIGNED (Momft Day, rir) V D. 619 Virginia Street, WaCharlestOn. WV 25342 Form VS -002 (Rev. 6/92)