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HomeMy WebLinkAbout4-05-13Name Unit ` Block Lot y Date of Mark -out Date of Burial 6 44 Time `ado a Name of Funeral Home r Authorized by CITY OF ��� . � � ,. �.;m, �.• ,.� � �-�; ,:--�m .,-- � HQME OF PELICAN ISLAND Certificate No. 2346 ��� ��� �� � ������ Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Genevieve E. Imbimbo 356 Columbus Street 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 13, 14 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 25th day of September, 2012. CITY OF SEBASTIAN, FLORIDA � �I Minner City Manager ATTEST: ��� , �. Sally A. aio, MMC City Clerk State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT HF4LTH DATE PRINTED: June 27, 2016 TRACKING NUMBER: 2016099790 1. DECEDENT INFORMATION Name of Deceased Date of Death GENEVIEVE IMBIMBO June 24, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. NodReg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32956 Funeral DirectorlDirect Disposer Fla. Lic. No./Reg. No. DAVID W. WALLACE F046853 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. zone -24 5149 �— Date Issued: June 24,, 2016 2016 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 Place of Disposition: SEBASTIAN CEMETERY Method of Disposition: BURIAL Date of Disposition: 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, Fonda Administrative Code 03/12/2012 10:30 7722287079 COS AIR BLDG PAGE 01/01 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5�W Z3 S�tQ �1rf.D�7` �av�twwi�uxo For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589.2545 FUNERAL HOME: City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-9214 Fax: (772) 589.5570 EAl�/i,vlls f �/— ii/dri2A � /IG�E" ADDRESS: Zrl5 S /cLE,sr/�✓d v`T c5E6,asri,>anr FL. .F PHONE* 77Z -s89 -X933 (Chec One) /3 OPEN BURIAL LOT. Lot Block �_ Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N_S E W / BURIAL DATE AND SERVICE TIME: 63�/� %/✓l/�sL1oSi // .Il• /11� FOR DECEASED:y��✓Ei�/EV6 Z�JB/iJlBO Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signature ate 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 —Z>,v sel0 w Lywww eE Name D e 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 10099 ADMINISTRATIVE SERVICES RECEIPT Name h TTCIQ / •M PCO ❑ Cash �q Date (o aZ7/1b *heck#J a,� � 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 She Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees ©OIS'DI ,k IS'b.00 UMIT4 ague, s Lar �3 dap- �� Total PaidTt L-�' OD l ials Security Dep Held -Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant 41�3��