HomeMy WebLinkAbout4-06-09Name
Unit
Block
Lot
Date of Mark-out— 1> Z, 1 3 •
Date of Burial �.0 !r, / ZJ Time oa
Name of Funeral Home S �11t c c� i At
Authorized
Certificate No. 2397
CITY Off' DEB A -TIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Marion K. Puya
898 Grandin Avenue
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 6, Lots 9 & 10
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 6t" day of December, 2013.
CITY OF SEBASTIAN, FLORIDA ATTEST:
/1VAl Minner
City Manager
1
Sally A' Maio, MMC
"City Clerk
DOMENICK RICHARD PUYA
June 21, 1931
December 6, 2013
Mr. Domenick Richard, Puya, Sr., age 82 of Sebastian, FL died
December 6, 2013. He was born in Bristol, Rhode Island to Anthony
and Mary Puya. He served in the US Air Force and had several
business ventures ie. Automotive Repairs and Diagnostic Shops, Home
and Business Security Services, Jewelry Sales and Repair. Preceded in
death by daughter Marie Louise (Puya) Chucchi. Survived by his wife
of almost 40 years, Marion (Cassie) Henderson (Cribb) Puya; children,
Domenick Richard Puya Jr., Ernest James (Kim) Puya, Patricia (Jim)
Cribb Parham, Robbie (Paula) Dale Cribb, Roger Duane Cribb. Fourteen
grandchildren; Stuart, Josh and Justin Turner; Amanda, Alyssa and
Marissa Chiucchi; Maria, Alyna Russo; Julian Puya; Jessica (Josh) Cribb
Pawlik, Kathryn and Robbie Jr. Cribb; Jesse and Zachary Parham,
Three Great grandchildren India and Gage Turner; Jackson Pawlik,
Brother Anthony and Sister Lucy Grillo. Nieces and nephews and host
of other relatives and friends.
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
TAN
HOME OF FEIICAN IfIAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Mein Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589.5570
FUNERAL HOME: S'� O S
ADDRESS: 7 3
ev'J Hr. r7Ae—
se.b.
3z.
PHONE #: 3
(Check One)
_,OPEN BURIAL LOT Lot —Cl Block Unit_
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit `
BURIAL DATE AND SERVICE TIME: _ b s, N S E W
FOR DECEASED: c1b -e 't irK �,-
Na-me
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership
Name
Sl ature 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:
1��i dJ CTICa ar� 4 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 atd that all fees have been paid:
Cerne /
ry Weo D at
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
FLORIDADIFARrbtENr OF'- State of Florida, Department of Health, Bureau of Vital Statistics
HEART BURIAL TRANSIT PERMIT
DATE PRINTED: December 10, 2013 TRACKING NUMBER: 2013172556
1. DECEDENT INFORMATION
Name of Deceased Date of Death
DOMENICK RICHARD PUYA December 6, 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 FUNERAL HOME F073380 F073380 (772) 589 -1933
735 SOUTH FLEMING STREET
SEBASTIAN, FLORIDA, 32958
Funeral Director /Direct Disposer Fla. Lic. 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.
Permit Number: 2013- FO73380 -5159
ap /� J j Date Issued: December 6, 2013
�c. �
Meade Grigg, State Registrar
I 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 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
CM of
Fi{JME Of PELICAN tSl.6,ND
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.
S) ,
Address
3- �Ycn��� �6S- -dos` �7�' 'P)
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
VC te,.rc, v7
t U40A.$. 0FFICE USE ONLY
Receipt is acknowledged in the sum of:
Dollars ($
on this. 62 4�h day of b4FCCM6-e K , 20 /.3 for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit q , Block (�o , Lot(s)
9 4, /10 Niches)
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)
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
!: \WVV- DATA \Ms - Cemetery \RECE I PT. d oc
Opening & Closing
Interment
/56, U o
/W O H
Circle One
Disinterment
TOTAL $ oZ % j U, U o
Vv
ty of Sebastian
The following documents were provided as Proof of
Residency:
and