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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:
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Sally A, aio, MMC
City Clerk
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Authorized by
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DOMINICK SAMUEL IMBIMBO
Dominick Samuel Imbimbo, 93, died Sept. 22, 2012, at VNA Hospice
House in Vero Beach. He was born in Berkeley Heights, N.J., and
lived in Sebastian for three years, coming from New Jersey.
Survivors include his wife of 67 years, Genevieve Imbimbo of
Sebastian; daughter, Kathy Ditton of Sebastian; and son, Donald
Imbimbo of Mansfield, Pa.
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ELO�RID�iDII'ARCbtE�T9F�. ;' State of Florida, Department of Health, Bureau of Vital Statistics
����T BURIAL TRANSIT PERMIT
DATE PRINTED: September 25, 2012 TRACKING NUMBER: 2012129808
1. DECEDENT INFORMATION
Name of Deceased Date of Death
DOMINICK SAMUEL IMBIMBO September 22, 2012
Piace of Death - County City, Town or Locatlon Name of facillty, or street address if not a facility
INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE
Name and Address of Funeral HomelDirect Disposai Estabtishment Fia. Llc. No.lReg. No. Phone Number
SEAWINDS FUNERAL HOME 8� CREMATORY F041682 F041682 (772) 589-1933
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
Funeral Director/Direct Disposer Fia. Lic. No./Reg. No.
ANTHONY GABBARD F044749
2. BURIAL - TRANSIT PERMIT
The Florida Department of Heaith, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
/� Permit Numbef: 2012-F041682-5091
• aG / �/� • Date Issued: September 22, 2012
C(, arl j t
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Meade Grigg, 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: BURiA� Date of Disposition: � g �� '
Signatu of e�ct n or person= -charge (or by the funeral director/direct disposer when there is no sexton)
DH 326E, 1/11
64V-1.011, Florida Administrative Code
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SE�T�N
. ����� .
nOM) Oi PEtKAM ISIAND
For informafion contact:
Kip Kelso - Cemetery Sextvn
Sebastian Municipa! Cemetery
(772) 589-2545
City Clerk's Ot(ice
City Hall, 1225 Main Sireet
Sebast;an, FL 32958
OfRce (772J 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME: �� (' U�i � a1 L`�t S I'
ADDRESS: � 3
PHONE #: ''j �j � r j q ,3 3 � `� - -
�(Che One) i �
PEN BURIAL LOT Lot �� - Block � Unit �_
_�PEN CREMAINS LOT Lot Biock Unit
_�JPEN COLUMBARIUM NICHE Niche Biock Unit
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BURfAL DATE AND SERVICE TIME: � �� <� �'� Z7 l�—
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FOR D�CEASED: i��„�; ��� k�-i��1���,�L�Y�
i�ame
IJAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE'
(Must provide proper docume�tatior� of ownership) �
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Name ` Signature� I D te
I certify that I have determined the ownership of the above described sile that all site iees and
administrative fees have been paid and authorize opening ot same
NAA4E AND SIGNATURE �F LICENSED FUNERAL DIREC7Gf�.
` �� � �� ��- �
ame �Signat�tre Date
--------------•-------------------------------------------------------------------------------------------------------• -------
Cemetery Sexton Certification:
I certify thal I have checked the ownership iniorrr�at�on by viewing the owner's deed and confirming
with Clerk's office �3nd that aIl fees have been pa�d
� - � ��'
Cem te Sexton Date
This fonTi to be provided to Clerk's Office by Sexton for permanent record upon co►nplet�on.