The URL can be used to link to this page

Home My WebLink About4-05-16Certificate No. 2363 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Anthony Walton 878 Wentworth 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 16 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 5t" day of February, 2013. CITY OF SEBASTIAN, FLORIDA I AI Minner City Manager ATTEST: y� "i Sa A. Maio, MMC City Clerk Name /xL�� ll . �; if/es Unit / Block Lot Date of Mark -out Date of Burial d /y / /3 - Time 10.'00,4 ' f 4?,e,4 S 1L Name of Funeral Home 5 1;—, ,, r 5 Authorized by ELIZABETH KATE WALTON July 1, 1975 - February 2, 2013 Mrs. Elizabeth Kate Walton, 37, died February 2, 2013 at Jackson Memorial Hospital in Miami. She was born in Lansing, Michigan and lived in Sebastian, FL since 2007. She was a graduate of Coral Shores High School, Tavernier, FL, received her Bachelor's Degree from the University of West Florida, Pensacola, FL and was a member of the Riverside Church Assembly of God, Sebastian, FL. She was survived by her husband Anthony Walton of Sebastian, parents, Richard and Judy Gillmor of Sebastian and sister, Susan Curlee of Wilton, CT. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY �o HOY& OF ftuc N 1sw4v 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 STKU: k'K FUNERAL HOME & V ya: ".: °�j Y FUNERAL HOME: 1623 too. Central Ave. ADDRESS: PHONE #: /�k One) OPEN BURIAL LOT OPEN CREMAINS LOT ((• ` n OPEN COLUMBARIUM NICHE URIAL DATE AND SERVICE TIME: FOR DECEASED: l tZQb� Name Lot_ Blocks Lot Block _ Niche Block Unit _ Unit Unit IE_ ., W . NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) -AK UPI CLAbyX Name 1i 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. ."�E AND SIGNATURE OF LICENSEEU- MAERAL DIRECTOR: I Mary Iv") LAM Ill s 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 th t all fees have been paid: 2-6 A, Cem tery xt n Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. FLORIDA1 DIIARCmEii or'. ,' State of Florida, Department of Health, Bureau of Vital Statistics HEALT BURIAL TRANSIT PERMIT DATE PRINTED: February 6, 2013 TRACKING NUMBER: 2013019355 1. DECEDENT INFORMATION Name of Deceased Date of Death ELIZABETH KATE WALTON February 2, 2013 Place of Death - County City, Town or Location Name of facility, or street address if not a facility MIAMI -DADE MIAMI JACKSON HEALTH SYSTEMS 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: 2013- FO41870 -5021 • a G t Date Issued: February 5, 2013 Lt J 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: BURIAL Date of Disposition: Ate =3 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 Q RECEIPT U Name 5 ati k / i Ja l -� V n ❑ Cash Z01-3 Date -I -o2V °/ O(Check# No. Amount Paid 001001 208001 Sales Tax _ 001501 322900 Garage Sales _ 001501 341920 Copies /Bid Specs. _ 001501 341910 LDC /Code of Ordinances _ 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots _ LoUNiche I � , Block Unit _ 001501 343805 Cemetery Fees _ a% 150. v� Total Paid Initials White - Dept. of Origin • fellow - Finance • Pink - Applicant 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. Names) 7 8 I�e��f � or k Sfr� e F� 3Z 58 Address ��7,1_ jq Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: � �l�Q_g i � Dollars ($ / DUCE. U G ) on this. day of ) 20 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit , Block , Lot(s) 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 gnature of Purchaser I: \W W- DATA \Ms - Cemetery\RECEI PT.doc Interment /W O H Circle One Disinterment TOTAL $/ D 0 0. U Q Oty of Sebastian The following documents were provided as Proof of Residency: and CITY OF SEBASTIAN CITY CLERK'S OFFICE /, p RECEIPT 4 U Name n 4-h o n Woj Date No. 001001208001 001501322900 001501341920 001501 341910 001501 341930 601010 343800 001501343805 Sales Tax Garage Sales Copies/Bid Specs. LDC /Code of Ordinances Election Qualifying Fees Cemetery Lots ❑ Cash Aheck # Amount Paid Lot/Niche I Iv , Block _�, Unit Cemetery Fees _ Zq Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant