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HOME OF PELICAN ISLAND
Certificate No. 2390
CITY OF - EBASTI N1
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Thankamma Pally
357 Vine 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 6, Lot 21
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 16th day of September, 2013.
i
CITY OF SEBASTIAN, FLORIDA ATTEST:
Al Minner Sally A aio, MMC
City Manager City Clerk
L- --ill
Name
Unit
Block_
Lot
D t e of Mark -out
9
a
5l, ]Yi✓ '
Date of Burial Time �aO
Name of Funeral Home 5 -,el pt—:,
Authorized by - . tt( " J
ABRAHAM PALLY
Abraham Pally, 78 of Sebastian, Fl. passed away September 13, 2013 at the VNA
Hospice House in Vero Beach, Fl. Mr. Pally was born August 26, 1935 in Kerala,
India.
He lived in Sebastian for the past 28 years having come from Des Moine, IA.
Prior to his retirement, he worked as a Social Worker in the Health Care field. Mr.
Pally was a member of St. Sebastian Catholic Church, Sebastian, A and The
Knights of Columbus Sebastian, FL.
He is survived by his loving wife of 42 years, Thankamma Pally, daughters,
Cecilia Boyer and Sheena Jones, both of Sebastian, Fl., sister, Mary Korah ,
India, and grandchild Logan Bowyer,
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4816 p
RECEIPT U
Name OjJ0 Ran M Q At--` ` y ❑ Cash
Date I '° �✓� " l VCheck# �3 r
No.
001001208001
001501322900
001501341920
001501 341910
001501 341930
601010 343800
001501343805
Amount Paid
Sales Tax
Garage Sales
Copies /Bid Specs,
LDCICode of Ordinances
Election Qualifying Fees
Cemetery Lots ` U� d
Lot/Niche Block Unit
Cemetery Fees
& & c -50 .Ua
Cu, (N+ ' "W Total Paid 1156.0C
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
.-1
JTATEMENT
I DATE
TERMS
TO
ADDRESS
IN ACCOUNT WITH
Ae
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1D
ZZr
& ed� DC5812
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEA
IIoMf 'D; Pfltc AN ISLAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian M«nicipal 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
FUNERAL HOME:
ADDRESS:
PHONE #:
(Check ,One)
OPEN BURIAL LOT Lot Block Unit _
OPEN CREMAINS LOT Lot __Block Unit
---OPEN COLUMBARIUM NICHE Niche Block Unit
W
BURIAL DATE AND SERVICE TIME
=– Z "00101 –
FOR DECEASED:
IVarTle
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
N Signature ale
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
NAIAE AND SIGNATURE OF LICENSED FUNERAL DIREC10R.
Name Signature Date
-
------ --------------------------------------------------------------- ----------- ---------------- ------------- --- - - - - -- - - - - - --
Cemetery Sexton Certification:
I certify that I have checked the ownership inforir!ation by viewing the owner's deed and confirming
with Clerk's office ,ind that all fees have been paid
I e�2 4 �)X 6 X,
Ce7etF gexton 7- Da e
This form to be provided to Clerk's Office by Sexton, for permanent record upon completion
Sep.18.2013 08:40 AM SEAWINDS FUNERAL HOME 7725891939 PAGE. 2/ 2
!�DII'hHfht�+T qF, , /State of Florida, Department of Health, Bureau of Vital Statistics
HE ALT BURIAL TRANSIT PERMIT
DATE PRINTED: September 18, 2013 TRACKING NUMBER: 2013131494
DECEDENT INFORMATION
Name of Oece89ed Date of Death
ABRAHAM PALLY September 13, 2013
Place of Death - County City, Town or Location Name of facility, orstroet address If not s facility
INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE
Name and Address of Funeral HomaIDlrect Disposal Establishment Fla, Lie. No,/Reg. No, Phone Number
SEAWINDS FUNERAL. HOME F073380 F073380 (772) 689 -1833
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
Funeral DirectorlDlreet Dlspoear Fla. Lle. NoJReO. No,
ANTHONY GA89ARD FD44740
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.
�///(�J permit Number: 2013- F073380 -5088
Date Issued: $eptember 14.2013
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:
EDRS maintains all statutorily required informatlon 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 thoir filo they may do so.
DH 326E, 10/12
64V•1,011, Florida Administrative Code