HomeMy WebLinkAbout4-06-37Certificate No. 2370
(CITY OF SSEB STI 1
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Allen E. Schultz &
Paula Schultz Bright &
Diane Schultz Helms
9574 Parker Drive
Micco, FL 32976
In and for consideration of the sum of $8,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 6, Lots 35, 36, 37 & 38
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 23rd day of April, 2013.
CITY OF SEBASTIAN, FLORIDA
'k Al Minner
City Manager
ATTEST:
Sally . Maio, MMC
City Clerk
ALLEN A. SCHULTZ
Mr. Allen A. Schultz, 83, died April 20, 2013 at his residence in Micco.
He was born August 30, 1929 in Newington, Connecticut and lived in
Micco, FL coming from Pompano Beach, FL in 1982.
He was a veteran of the National Guard having served during Peace
Time. He was the Owner /Operator of Allen Appliance Repair from
1950 - 1982. He was a member of the Loyal Order of Moose, #1767,
Sebastian, FL.
He was survived by his beloved wife of 62 years, Jean Schultz of
Micco; son, Allen E. Schultz of Micco; daughters, Paula Schultz Bright
of Vero Beach and Diane Schultz Helms of Micco; 10 grandchildren;
22 great grandchildren.
Name ft 5 G%ZGC �� 3 &9S
Unit
BI
Lot -3 ,`
Date of Mark -out
Date of Burial Time 004 c- ItIQ��
Name of Funeral Home S / C✓ o �✓ �r S�S
Authorized by
CITY OF SEBASTIAN
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
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4
CrrY CLERK'S OFFICE
4371
RECEIPT
RECEIPT
ame S� S c h LL Z- ❑ Cash
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Name !�j' 4 lei: 5QALLi f Z-
❑ Cash
ate Z,3 - ® W Check #
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W ®� 6
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-13
Check #
Date +
❑
fife -act card
o.
Amount Paid
No.
Amount Paid
)1001 208001 Sales Tax
001001 208001
Sales Tax
)1501 322900 Garage Sales
001501 322900
Garage Sales
)1501341920 Copies/Bid Specs.
001501341920
Copies/Bid Specs.
)1501 341910 LDC /Code of Ordinances
001501341910
LDC /Code of Ordinances
)1501 341930 Election Qualifying Fees
001501341930
Election Qualifying Fees
)1010 343800 Cemetery Lots
601010 343800
Cemetery Lots
�7 f
Lot/Niche � /_, Block Cf� Unit L4
Sf/
7, 3 U �(
Unit
Lot(Niche3 , Block
)1501343805 Cemetery Fees
001501343805
Cemet4 ee� 3L
Total Paid 1,5Q•u !�l
'C' Total Paid
Initials ® ® ®.
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant White - Dept of Origin • Yellow - Finance • Pink - Applicant
rL0RMADEPAKra�+r or'. State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: April 22, 2013 TRACKING NUMBER: 2013061096
1. DECEDENT INFORMATION
Name of Deceased Date of Death
ALLEN A SCHULTZ April 20, 2013
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
BREVARD MICCO 9852 RIVERVIEW DRIVE
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 -5070
• aG4. /_ [, __ Date Issued: April 22, 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 CREMATOR Y
Place of Disposition: SEBASTIAN CEMETERY -- rti � ' 1 2C� n 2
Method of Disposition: BURIAL Date of Disposition: T 20/,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
04/24/2013 16:07
FOR
FUNERAL HOME:
ADDRESS:
PHONE #:.
h One)
OPEN BURIAL
OPEN CREMA
OPEN COLD
BURIAL DATE AND S
FOR DECEASED: I
Ne
NAME AND SIGNATL
(Must provide proper c
Name
92136 P.001/001
DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
-OPENING IN SEBASTIAN MUNICIPAL CEMETERY
of �uuur awo
For information contact:
Kip Kelso - Cemetery Saxton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Mall, 1225 Main Street
Sebastian, FL 32958
OA►oe (772) 388.8215 or 388 -8214
Fax. (772) 589 -5570
& CRIEMAI+DRY
(772)
Lot 3� Block _� Unit
Lot Block Unit
VICHE Niche Block Unit
N S E W __
TIME: )5 113 LW an
OF LOT OWNER OR REPRESENTATIVE:
mentation of ownership)
Fz L4 z4)1_:�
Signature Date
I certify that I have det ined the ownership of the above described site, that all site fees and
administrative fees have been paid and authorize opening of same.
N
ANQ SIGNATURE, 4IGNATURE, OF LICENSED FUNERAL DIRECTOR:
Name Signature ate
Cemetery Sexton Certifi tion:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office and t t all fees have been paid:
CeM*e16ryAaxt6ri I Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.