HomeMy WebLinkAbout4-05-11 Name //A4 i A4 . j Y � ie. J . Ix e. #45
Unit 1(
Block (5—
Lot it
Date of Mark-out f//S /'/ 3 .
Date of Burial -!/A 3 / 13 Time I. ' W/O- G /0Zi
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Name of Funeral Home 5 A,/ LJ , /DS
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`41 Authorized by
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4 J°]7
RECEIPT i
Name '<U r-4 /efrs ❑ Cash
Date q -2.3 -13 tit Check# f/3 I
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 / 4600-00
Lot/Niche f I '�'/1 Block 5 Unit 4
001501 343805 Cemetery Fees
0/C 15 p oo
zd,- �' ,� '14 Total Paid L/(5 t,'.l�f�
Initials
White—Dept.of Origin• Yellow—Finance •Pink•Applicant
CRY OF
seBA:.siniAN
HOME OF PELICAN ISLAND
Certificate No. 2369
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:
Kurt Evers
1202 Chipewa Drive
Barefoot Bay, FL 32976
it
In and for consideration of the sum of $4,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots: f.
Unit 4, Block 5, Lots 11 & 12
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 ;!
1 regulations prescribed therefore by the City of Sebastian.
Y P
CONVEYED THIS 22nd day of April, 2013.
,
lj CITY OF SEBASTIAN, FLORIDA ATTEST:
A I Minner Sally . . Maio, MMC
City Manager City Clerk
4B» Saturday,April 20,2013 )) SCRIPPS TREASURE COAST
Obituaries
Barbara Evers
Barefoot Bay
Barbara A. Evers, 73,
died April 15,2013,at Se-
bastian River Medical.
Center,Sebastian.
She was born in New
York City and lived in
Barefoot Bay for the past
12 years,
coming from
Stuart.
Before re-
-01 tirement,she
worked as an
interior dec-
orator.
After re-
tirement,she volunteered
at the Sebastian Inlet State
Park Treasure Museum.
She attended St. Luke
Catholic Church.
She was a member of
the Red Hat Society of
Barefoot Bay and a life
member of the Women's
Auxiliary Sebastian.
Survivors include her
husband of 54 years,
Kurt Evers,Barefoot Bay;
daughters, Donna Steen-
kamp of South Africa and
Cheryl Wheless of Winter
Garden; and four grand-
daughters.
Memorial contribu-
tions may be made to
Veterans of Foreign Wars
Post 10210, at 815 Louisi- I
ana Ave., Sebastian, FL
32958-4111.
Services:Visitation will I
be from 10 a.m. to noon I
April 23 with a service i
at noon at Seawinds Fu-
neral Home Chapel with t
burial to follow in Sebas- J
tian Cemetery. A guest i
book is available at www. c
seawindsfh.com.
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
HOME OF PELICAN ISLAND
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
FUNERAL HOME: Se,4>�� lrt D S Fvv e✓,---( Ht,v'i--C
ADDRESS: 7 3 Sr 5 ./f i I) —St 9' `'' � Fie 3 a 9-CS
PHONE#: —2 ? )- C?) ? -- / ” 3
( k One)
C A OPEN BURIAL LOT Lot / 1 Block 5 Unit Li
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: /1�f Sc�41 ri L 2 3/ a-G/ 3
FOR DECEASED: )31/1-( , ✓a L iJ z✓- S
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Cvv' /e ✓"
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:
194`-I Ytl r,-4-6,64.--d 11-23-/3
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 nd that all fees have been paid:
, 7/3//3 ,
e ete Sexton 21 Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
FLrJRiDADFPARC t r°F'', ;•' State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED:April 17,2013 TRACKING NUMBER: 2013058083
1. DECEDENT INFORMATION
Name of Deceased Date of Death
BARBARA A EVERS
April 15,2013
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
SEAWINDS CREMATORY F073383 F073383 (772)589-1933
735 SOUTH FLEMING STREET
SEBASTIAN,FLORIDA,32958
Funeral Director/Direct Disposer Fla.Uc.No./Reg.No.
ANTHONY GABBARD
F044749
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.
�I Permit Number: 2013-F0733835021
Act.G4 , - Date Issued: April 18,2013
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: 9-2 3- ( 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