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Home My WebLink About1-28-120 ��1 �.: �'� rnr a S�,�AS1't,�,�j -� � _ _ ^ �� .� _: HOME OF PELIGN ISWVD � �'�� / �� J�/�� Certificate # 1885 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Sarah Hughes (name) (name) (name) P. 0. Box 702005, Wabasso, FL 32970 (address) (address) (address) in and for consideration of the sum of �� o o, o o , has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1 , Block 2 8 , Lot(s) 12 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 21 S tday of M a r c h ITY OF �EBASTIAN, FLORIDA ..-- � f'` Terrenc . Moore City Manager 2003 ATTEST: , i% _ -�--�—_ Sally A. M ' , CMC C;ity Cler �� , i ----- - __--__- ------ _ ,� ��f;'��;sn�iis� Unit Block 0 Lot �� Date of Mark-out Date of Burial �/ � U r/��+ � Time �� 7� ` Name of Funeral Home 5 L� ��y� S � . - Authorized by �� Sebastian, Florida _ _ p 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfh.com (772) 589-1933 We hereby certify that these are the remains of NATALIE L. DELLERMAN -- �� - —_ . The remalns were received from SEAWINDS FUNERAL HOME Cremation Permit No, 12-41682-078 _ Issued at HILLSBOROUGH Date of Death APRIL 10, 2012 Date of Cremation �� P .L� / _-- -- �Y J Cremator 0 NATALIE LYNN DELLERMAN Natalie Lynn Dellerman, 30, of Valrico, FL died Tuesday, April 10, 2012 in Tampa, FL. Ms. Dellerman was born May 6, 1981 in Vero Beach, FL and moved to Valrico six years ago from Sebastian, FL. She had been a sales associate with Bealls Department Stores in the Tampa area and had attended Sebastian River High School in Sebastian. Survivors include her father and step-mother Mark Dellerman and Cynthia Cox- Dellerman of Vero Beach; brother Scott Dellerman of Tampa; maternal grandparents Wayne and Sandra Hughes of Valrico; aunt Susan Herr, and her husband Keith, of Valrico; nephew Matthew Herr and niece Kendall Herr both of Valrico. She was preceded in death by her mother Cynthia Hughes Dellerman. CITY OF SEBASTIAN CITY CLERK�S oFF��E - 4 4 61 RECEIPT Name j1,dX lJ�� '�rd /_�e<<er�,c�.� ❑ Cash Date �� 0�! Z �'Checki� .��5 7 No. 001001208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 001501 343805 Amount Paid Sales Tax _ Garage Sales _ Copies/Bid Specs. _ LDCICode of Ordinances _ Eledion Qualifying Fees _ Cemetery Lots _ LoUNiche �? , Block Z�, Unit ___j_ Cemetery Fees v.00 �`�'rn� Total Paid d . �� Inkials White - Dept. of Origin • Yellow - Finance • Pink - Applicant RX Date�'Time 04117l201� 09:37 772 589 1939 Apr 17 12 09:25a Seawinds Funeral Home 772-589-1939 � �� ` ��' � � �� .,�" :;� ��"� �q, J?T}��..�1�� -�. S 6. �.- �.Y �.✓' '' 3' S��inds F��nera Hom� �3� ��emir:g 5:.. i�E�a_�i�n. =�otica � 32�8 Pi�one ( i: 2� �8� 7 S33 � � f t7Z� 583- i°39 5 e2wfi n es fin �',r�^ �L c �m � R2 tc p[ n�'s t�lame - O[gan¢atioS� � � .�,�, , t"L,�x..c'1 l�"n �'2x €�[:.�rnoer - Te{ephane h�urnh�r '� " �e � . Da� - ,�� SubjEC� _ �, � �Y�fY�Gt..(�' Toi�i N`u��r oi °ages: including cover sheez � t,lr9e�� P.eply �SAP � Pl=ase Cotrjment ' rorYour R�corrls ��a_r��t!�. ....�._-- (;� a,�n % V �� '� °�" . �./ % a� � i�-� ��" � �R � �-�-�-' �-i� �� P. aay p.1 �-/� �l � � � RX DatelTime aa�i}��a7� 09;�7 772 589 �93� P,002 Apr 1712 09:25a Seawinds Funeral Home 772-589-1939 p.2 83/12/2612 10:30 772228�079 COS AIR BLDG PAGE 81/01 FUNERAt HOME: ADORESS: PHONE � FUN�RAE. DIRECTOR'S REQU�ST TO CITY OF SEBASTtAN FOR BURiA! OP�NING IN SEBASTIAN MUN�CIPAL CEMETERY � «�a��Krurnur�o For iniormation contacE: Kip kelso - Cemetery Sexton Sebaslian Arlunlcipa/ Cemetery (772) 588-2545 City Cferks �ce City Na/l, '/226 Main Street Sebasfisn, �L 32958 ; 7 i� .� � j(_; ��Gj Offce (772) 38&$,215 a 388-8294 _.. Fax� /7791 �ao_aa�n � (Check pne) OPEN BURIaL LOT Lot Block �� Unit __.,G_.O�'�!V CREMAINS LOT Lot 81ock �i �1nit �"' OPEN COLUMBARIUM N1CHE Niche 81ock Unit BURIAL DATE AND SERVICE� TlME; N S—'-' E � 'r e �'1/ �t" � i 17,�_ L �"��1 - //�, � � �l l �� FOFt D�CEASED: {{ � • I J),,� 1 /\ � �"�� 1 K 1� i�` " I1 / J Name ; �. � � �� zC: ��. NAME AND SlGNATURE OF LOT OWNER OR REPRESENTATII/�; (Must provide proper docurnentation of ownershi � ( ;� j : � ,,� ..i: - i ;�il^t � I �, ,� I:� � l C � Name , —"_ 'Signature ~ , �` ' 'r' / ^ � Da2e � cerrtify that I have detemlined the ownership of the above described site, that a!( site fees and administrative fees have been paid and authorize openi of same. N�AME D SIGNAtURE OF �ICENSED FUN�RAL.;DI E 4TOR: , j � �14 ,.- i� � � � � . , ��`�;.L �. , � :� r L! �,;r- Name �$i �nat '. ' ��' � �2` , , --- — � Date ____�..----_.....,_.�------�-�----._ Cemetery Sexton CertiFcatlon: �'�`-"""" --- i cePtify that I have checked the ownersfilp information by viewing the awner's deed and confirming with Cter 's office and tha# II es have b�en patd: Ce et Se on �'� � Dat This forrn to be provided to Clerk's Office by Sexton for pennanent rec�rd upon comp�efion. . , Name (;� � ir✓�' I � � �,�� i'% i�l /�% � � � Unit ` Block _ �w Lot Date of Mark-out _�� 3 Date of Burial �� /� � Time /�� p� . . n � Name of Funeral Home ��{ �a / 1� �� . ......_�, ._.- Authorized by � � _ _ _ __ __. _ _ _ __. _ _ __ _ �� , � 7o�ZVDS �1 ��a � 3 z�� --� C�--� ��-- ' � � ; %� � v�� -+q� _ � �� /o��--�� '- _ .. . _ SEAININDS �UNERAL �iOME 735 FLEMING STREET SEBASTIAN, FL 32958 TO THE ORDER OF � �� t-0 2231 63-643/670 DAT�/� �D � BRANCH 87979 � ZC��• D� 8 Sacurity Faelur�� = Beckll� en �� ♦ -�1yO� . ACH RT 067006432 � FOR l J�C. t �Y/� iN1Qn/� � 2► S�l � V1Cw�c�2Z I S�� r "r ��■00 2 23 l��• �:06700643 2�: 2000Q0948 � 2��' Name Seawinds Date 4'2'a3 001001 208001 001501 322900 001501 341920 001501 341910 001501 362100 001501 362100 001501 362150 001501 343800 601010 343800 , 001501 369400 001501 369400 680800 220681 ' 680800 220682 680800 220683 CITY OF SEBASTIAN " � � � � CITY CLERK'S OFFICE RECEIPT ❑ Cash k� Check# 2231 ' Amou�Paid , , Sales Tax Garage Sales Copies/Bid Specs. LDC/Code of Ordinances Communily Cenier Rent Yacht Club Rent . Non Taxable Rent Cemetery Lots Cemetery Lots LoUNiche , Block , Unit _ U4 B14 L20 Fernandez Interment Fee u1 B28 L12 Dellerman Weekend Service Yacht Club Security Deposii Community Center Security Deposit Riverview Park Securily Deposit i �' 75.00 , 125.00 r FLORIDA DEPARTMEfJT OF I�E1�LT A. (TYPE) 1. Name of Deceased First CYrTi'HIA State of Florida, Department of Heaith, Vital Statistics • � APPLICATION FOR BURIAL - TRANSIT PERMIT Middle LYNN Last DELLERMAN 2. Piace of Death City, Town or Location Name of County Hosp. or INDIAN RIVER ROSELAND Inst. Date of Death (If neither, give street address) Month Day Year MARCH 21, 2003 SEBASTIAN RIVER MIDICAL CENTER 3. Name of Medical Address Phone Number Certifier SYED MAHMOOD, M.D. 7754 BAY STREET, �7 Medical Examiner Physician SEBASTIAN, FLORIDA 32958 772/589-3000 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLII�IING STREET SEAWII�IDS F[TN�� HOME SEBA.STIAN, FLORIDA 32958 2617 772/589-1933 5. Check a. �$ The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate appiication. Box 6. Funeral Director/ Direct Disposer b. � was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. c. � was contacted on He/she verified that , Medical Examiner, will compiete and sign the certification of cause of death within 72 hours. Sig� ture F.E. No./Reg. No. ii � 2294 Dat 3/�2%03 s. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 03-2617-039 ❑ 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 abie to complete the medical certification of cause-of-death section of the death certificate within 72 hours. �No extension of time for filing t death certificate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 3/22/03 Due: 2�26 c Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-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 after death is required for all cremations. �. CEMETERY OR CREMATORY , Method of Disposition: Place of Disposition �'" � � �BURIAL �STORAGE Date of Disposition �`.�'S� � , �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 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 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Numbec 5740-000-0326-2) Pink Local Registrar Receipt_i From: �'�� as�� 5��, �1�� in fihe sum of: � � ��Q�/� �� i��/l�D , „ � �� 7�Za�� Xn l� r t �GC�U-�'V�J v � �L! / " d'� Dollars ($ ��' ) on this 2�� day of ��GJZG� , 20 D 3 for the purchase of the following descxibed Cemetery Lot(s)/Niche(s) upon the tesms and condiiions a.s sta.ted herein: Descrzption of �'roperty: Cemetery Lot(s)/Niche(s} � Z' Blocic Z� Unit � � ^ d ✓' �= Purchase �'rice: � �J Dollars ($ �7� � } Texms and Condition of Sale: G� Z�-�� ""`C�� .��, �� . , � �-�-� ��..� This contract shall be binding upon both parties, the seller and the purchasex, when approved by the owner of the property above described: I, or we, agree to purcha.se the above described property on the terms and conditions stated in the foregoing instrument: �urchaser signature _.. _ Purchaser signature The City of Sebastian agrees to sell the above mentioned property to the above narned purchaser(s) on the texms and conditions stated in the above insti-ument. � ---- ` ' . City of z.stian % itness i � 1 � � � F� l �-- )�.. ;1 � - ?`I��'�. �'��i� � ; � , � � _ �.. �� p �� r�� {� i�— � ��D � ��'(� ! L�R� � �L'�� / `��1 � C� �/� � �� ,� �� \ ✓,��'.��. � � � � �, �, \� f� �;� CITY OF SEBASTIAN CITY CLERK'S OFFICE `"` "' ""' ,�„ f°w RECEIPT `'y � *� �` . ' ad - ° �, r Name t .�_:�'�.� E , , e �t .;Ar! .,y� }.'' �r � ; ..:� .J Date -�-•J 001001 208001 001501 322900 001501 341920 001501 341910 001501 362100 001501 362100 001501 362150 001501 343800 601010 343800 001501 369400 001501 369400 680800 220681 680800 220682 680800 220683 ,.5�,. <�„ Cash � Checkl� Amou�Paid �! Sales Tax Garage Sales Copies/Bid Specs. LDC/Code of Ordinances Community Center Renl Yacht Club Rent Non Taxable Rent } J, Cemetery Lots � � Cemetery Lots LoUNiche , Block , Unit _ Interment Fee Weekend Service Yacht Club Security Deposit Community Center Security Deposit Riveroiew Park Security Deposit r , i � / /"... ,}: , ,, � , a� t � .� � , . ; � ; . _:S' - �„',-, ,,' ..w_ � � f�. 3 . , -.....�..o..,.s...,...._ f"� �� :�,',. , f.' .S '� f' F " t. ,' ." . Tofal Pald IniHals �- Whita — Dspt. of Oripin • Y�Ilow — Fin�nu • Piek - Applicant