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HomeMy WebLinkAbout4-08-05aName J-6 WO/ Unit Block Lot Date of Mark-outI IF h Date of Burial L/I /'5-- Time DOA G Name of Funeral Home Authorized by e r-- Il MYOF HOME OF PELICAN ISLAND Certificate No. 2350 , CITY OF SE13STIR Certificate of Interment Rights I� I' IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: I I ,john &/or Shirlay Buffa 1412 Tradewinds Drive 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 lots: Unit 4, Block 8, Lots 5a & 5b i of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with thel conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 6t" day of November, 2012. CITY OF SEBASTIAN, FLORIDA ATTEST: 4/A Minner Sall A. aio MMC Y �i City Manager Cy Clerk � f I it l from SEAWINDS CREMATORY Sebastian, Florida 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfh.com (772) 589-1933 We hereby certify that these are the remains of JOHN BUFFA L;5- / The remains were received SEAWINDS FUNERAL HOME & CREMATORY Cremation Permit N J5-3380-5053 _Issued at INDIAN RIVER COUNTY Date of Death FEBRUARY 28, 2015 Date of Cremation MARCH 3, 2015 By Cremator State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: March 7, 2015 TRACKING NUMBER: 2015034794 1. DECEDENT INFORMATION Name of Deceased Date of Death JOHN BUFFA February 28, 2015 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. Lit. No./Reg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lit. NoJReg. 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: 2015-FO73380-5053 Date Issued: March 2, 2015 (/ State Registrar -� 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: C15-19-03-045 4. CEMETERY OR CREMATORY Place of Disposition: SEAWINDS CREMATORY Method of Disposition: CREMATION Date of Disposition: /a 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-1.01 1, Flonda Administrative Code CITY OF SEBASTIAN CITY CLERK'S POFFICE PT 4998 Name 5 h r G--8 Gl ❑ Cash Date 3 ' `Y — 1 [kCheck # 533-7 No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Coples/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election QuarVng Fees 601010 343800 Cemetery Lots LotMiche 5 a . Block Unit _ 001501343805 Cemetery Fees L Total Paid 50 0 Initials White - Dept. of Origin 9 Yellow - finance • Pink • Applicant CM of MIN., ROME of PELICAN ISLAND 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. h0 Q,nd/6v Sh i r1Qy 8 Lk -4 0, Name(s) )L412- -'rQdt w inds Wa. e bou+i ar\ FL. 32_q59 Address (_77a) 5E V - q 0 53 Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: �` no am Cam D o I I a rs ($ / 00 , © 0 ) . on this- 60 �A day of /V o ye N ber , 20 42 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit -, Block , Lot(s) Q -4- 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) Temporary Marker Preparation & Installation Signat re of urchaser I1WW-DATA\Ms-CemeterylRECEI PT. dor- Interment /W O H Circle One Disinterment TOTAL $ 1066, 00 Oy of Sebastian The following documents were provided as Proof of Residency: and CITY OF SEBASTIAN CITY CLERK'S OFFICE 4755 RECEIPT Name Mrd- M r5 6 u f 0. ❑ Cash Date Inkials Total Paid 10610.60 White - Dept. of Origin • Yellow - Finance • Pink - Applicant [XCheck # No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery LotsC11 0 U . Da Lot/Niche 0-'t b , Bl (y Unit_ 001501 343805 Cemetery Fees Inkials Total Paid 10610.60 White - Dept. of Origin • Yellow - Finance • Pink - Applicant 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 gB&FT"� � a vctrtnN rsu+rso For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) $89-2545 City Clerkps Office City Haff, 1225 Mein Street Sebastian, FL 32958 Office (772) 3884215 or 388-8214 Fax: (772) 589-5570 (FUNERAL HOME: ADDRESS: ,JS" .5" PHONE * % �2 • �g 9—/q,? (Check One) OPEN BURIAL LOT � Lot Block ______ Unit _ Wj .PEN CURMAINS LOT L A Block -� Unit OPEN COLUMBARIUM NICHE Ni Block �� BURIAL DATE AND SERVICE TIME: S, s -�S l of o FOR DECEASED: V45 ^/ &eono-000W Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation Of ownership) Name signature Date I Icertify 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 FUN .SAY/d tai W.w/.1c�'� Name Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirmin with Clerk's office and tha all es have been paid: 9 w Cemeteryextod D e This form to be provided to Clerk's Office by Sexton for permanent record upon completion.