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Home My WebLink About4-05-40Name Fi Z, .) e? D G /e0 -r A/1 Ate) Unit Block Lot //r, > 4;Z 4' ,?—/t Lt.) F,& Date of Mark -out Date of Burial !f/ JA/ /6 Name of Fune Authorized by Time 'lD •� X �� 151 Name —_4 A1114 13 IA f /C UnitT Block Lot Y y Date of Mark -out Date of Burial 3 Zlg_l 1,41 Time 1 D° _ Name of Funeral Home Authorized by Certificate No. 2340 CITY OF SEEB-ASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Edward & /or Anne Welch 134 Easy Street Sebastian, FL 32958 In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 5, Lot 40 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 6t" day of August, 2012. CITY OF SEBASTIAN, FLORIDA 'Al Minner City Manager ATTEST: .. n,,- Sally A aio, MMC City Clerk 08/15/2018 14:18 FUN RAL DIRECTOR'S REQUEST TO FOR 9URIAL OPENING IN SEBASTIAN I FUNERALI ADDRESS: PHONE* _ Check One XXXX OPEN BURIAL OPEN CREMAI OPEN BURIAL DATE AND FOR DECEASED: NAME AND SIGNAT (Must provide proper Name I certify that I have detenr fees have been paid and; NAME AND SIGNATURE Gary Name Cemetery Sexton Cart I certify that I have chE office and that all fees For information contact: Kip Kelso .Cemetery Sexf Sebastian Municipal COME (772) 589.2545 City Clerk's ONice City Hall, 9225 Main Stre Sebastian, FL 32958 Office (772) 388-8215 or 38f Fax: (772) 589.5570 Funeral Home and Crematory vj kv l �- LOT UM NICHE TI C. LOT OWNER OR REPRESENT station of ownership) #5872 P.001/001 OF VjPI Ch - GliAi1ESIDE W/TENT & CHAIRS Signature the ownership of the above describe ite that all Drize opening of same. LICENSED FUNERAL DIRECTOR: Signature the ownership information by viewing I been paid: 9 h r, deed This form to be provided t� Clerk's Office by Sexton for permanent rflord upon 9/15/2016 Date and administrative 9/15/2016 Date confirming with Clerk's Vero Beach Crematory, LLC 1830 Wilbur Avenue Vero Beach, Florida 32960 We hereby certify that these are the cremated human remains of: Edward C. Welch September 14, 2016 September, 19 2016 (Date of Death) (Date of Cremation) Strunk Funeral Home and Crematory (Funeral Home in Charge) 4720 (Cremation ID Number) Sebastian, Florida (City and State) By; rema Signature) FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso _Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 rC 1 _1�" 1 ^ f (Check One) WIvjl1— r) L "mCh XXXX OPEN BURIAL LOT I Lot-40—Block 5 Unit 4 OPEN CREMAINS LOT Lot—Block—Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 10:00, Wednesday, September 21, 2016 - GRAVESIDE W/TENT & CHAIRS FOR DECEASED: Edward C. Welch Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Karen S. Welch cj(nhen S'. qUd h 9/15/2016 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. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Gary D. Evans Name Gary 0. Evans 9/15/2016 Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN 10380 ADMINISTRATIVE SERVICES RECEIPT Name �4ur lYi I WEE - ❑Cash Date �b Check # f 7 S6g ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees oc)IE 1 343805 UN.r 4 619 s Lon 4 y� Total Paid iti s Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant FLCn;LOnFrr�rat>±+r nF , State of Florida, Department of Health, Bureau of Vital Statistics HEALT BURIAL TRANSIT PERMIT DATE PRINTED: March 19, 2014 TRACKING NUMBER: 2014041799 1. DECEDENT INFORMATION Name of Deceased Date of Death ANNE B WELCH March 19, 2014 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral Home /Direct 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 Funeral Director /Direct Disposer Fla. Lic. No. /Reg. 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: 2014- FO41870 -5046 a G4 Date Issued: March 19, 2014 J Meade Grigg, State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY Method of Disposition: BURIAL Date of Disposition: -?6 4- EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10/12 64V- 1.011, Florida Administrative Code CITY OF SEBASTIAN CITY CLERK'S OFFICE 4860 RECEIPT Name n �e -+ ` ❑ Cash Date _ ' I LI LYCheck# (P35 No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies /Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche ! 0 , Block Unit 4 001501 343805 Cemetery Fees C/ )kL' CtAA' V4' Total Paid 120010 0 Initials White - Dept. of Origin • Yellow - Finance • Pink . Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso .Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax: (772) 589 -5570 FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE #: 772- 589 -1000 (Check One) X OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: Anne B. Welch 7"n- Lot 40 Block 5 Unit 4 Lot Block Unit Niche Block Unit N S E W Saturday, March 22, 2014 - 10:00 AM GRAVESIDE SERVICE NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Edward C. Welch Name �� c-f AL2L03/19/2014 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. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Timothy W. Marvin 03/19/2014 Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees v een paid: Cem tery exton Date This form to be provided to Cler s Office by Sexton for permanent record upon completion. My Of HOME OF PELICAN ISLAND jy 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, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. 3 x K".1.WFlim Ch Name(s) ` 1,3�s Sfir� �t Se bps f� a 2� Address (_-7Z Area Code & Phone Num er Name & Residence Address E: • �du•le�.rci �- � �n e .intended Occupant if 01 OFFICE USE ONLY rchaser Receipt is acknowledged in the sum of: (Qlnp LI,V�G� /6-0 Dollars ($ l000, 00 ) on this. _ L day of US f 20 /,_2 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit _ ( ' Block _ , Lot(s) 1"0 Niche(s) 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: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Interment Temporary Marker Preparation & Installation Signature of Purchaser I : \Ww- DATA \Ms - Cemetery \REC E I PT. d oc /W O H Circle One Disinterment TOTAL$ (000.0° J��U� L/ of Sebastian The following documents were provided as Proof of Residency: FI°L (I and 19C tAf"' T y CITY OF SEBASTIAN 4484 CITY CLERK'S OFFICE RECEIPT Name MG r /- m rs. ❑ Cash Date 6 CD t Z Check #:533 No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501 341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees () OQ 601010 343800 Cemetery Lots Lot(Niche oalock Unit.- 001501 343805 Cemetery Fees board. oL �iA aG_k_:cL„ ,�� • Total Paid l� Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant