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Home My WebLink About4-06-23Name u 10,4x,14 `. e2tfdJ,1-e'ext5 3 I'le5 Unit Block & Lot Date of Mark-out Date of BurialT�yTime Name of Fune Authorized by 03/30/2017 12:04 Rug 24 2011 1 NVIr : T InrVK IeIV Alltel InA Slip : Nome & Oolo LeV31 Descilpl t a. squaro . Appfbved CAICRod Am Eronlpta : 0;33RM MP LF SERJET FAX C!f y CO/ 5ello,r i rn 1rh p W u f �r dMlrry Pr.►It 1711 AN" 25 I•r% A W?:: 111 • QV ? Ilr fl Inr IP (nf OIi 1lNAil p fQow� frgaAmin[ AlunaaMall 1 Srha 1l llln l'1' W.1 Ic 11 fur5lnrle.1 1Wvr.tinder 2 il.R nw., m(mer)11.1, t .uun•d fuoud.❑ ), •A IV COY of SetWrlbn' . bm Ilan Cenwitr% l 11 %nrih rrnlril Mc. I` I'f Nrlp) Uwan Llh-T �2�SS M Fes. V2. HIS : xea : C �" i rl lion L T __ n11 : of : By ; if 7y ; #6643 P.001/001 F Pod" s yir�/'7 i'�truudali.m I„arnl sr We 7r /-7— .Innr n..ralLJ lit 11a1I• Z, 444A�F-Pl- QOL <J-Ky✓7 F CRY OF SE HOME Of PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax October 10, 2016 Charles Cable 966 Crown Street Sebastian, FL 32958 RE: Interment Rights to Unit 4, Block 6, Lot 23 Sebastian Municipal Cemetery Dear Mr Cable, Enclosed is City of Sebastian Certificate 2521 entitling you to full interment rights in Unit 4, Block 6, Lot 23, in the name of Charles Cable. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Te to Records Clerk Enclosure FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 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 FUNERAL HOME: Strunk Funeral Home and Crematory- SEBASTIAN ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) xxxxx OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIM FOR DECEASED: Gloria Iris Cable Name Lot-23—Block 6 Unit 4 Lot—Block—Unit Niche Block Unit N S E W Tuesday, October 4, 2016 Chapel Service NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Charles Cable i' 101tom Cable 9/30/2016 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: Gary D. Evans Name Gary 0. Evans Signature 9/30/2016 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 that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. 09/30/2016 13:53 FUNI RAL DIRECTOR'S REQUEST TO FOR BURIAL OPENING IN SEBASTIAN I FUNERALI ADDRESS: PHONE* _' (Check One) xxxxx OPEN BURIAL OPEN CREMAI OPEN COLUMI BURIAL DATE AND FOR DECEASED: For information contact: Kip Kelso . Cemetery Sam Sebastian Municipal Came (772) 589.2545 City Clerk's Office City Hall, 1225 Main Stre Sebastian, FL 32958 Office (772) 388-8215 or 388 Fax. (772) 589-5570 Funeral Home and Crematory LOT NICHE Cable OF Tuesday, October 4, 201§ Chapel NAME AND SIGNATURE JOF LOT OWNER OR REPRESENT (Must provide proper doc mentation of ownership) #6018 P.001/001 Charles Cable "baJasAN,, 9/3012016 Name Signature Date 1 certify that I have determined the ownership of the above describec t ite that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Gary D. Evans GarYQ'Evans 9!30/2016 Name Signature _ Date Cemetery Sexton Certifl tion: I certify that I have checked the ownership information by viewing thi Fwnersdeedtnconfirming with Clerk's office and that all feeslla been paid: This form to be provided to Clerk's Office by Sexton for permanent rijord upon State of Florida, Department of Health, Bureau of Vital Statistics --'— BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: September 30, 2016 TRACKING NUMBER: 2016150992 1. DECEDENT INFORMATION Name of Deceased Date of Death GLORIA IRIS CABLE September 28, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER VERO BEACH VNA HOSPICE HOUSE 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. NodReg. No. GARY D. EVANS F065074 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: September ber 28,-5165 �— Date Issued: September 28, 2016 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 �tQSI b � E 201 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, Flonda Administrative Code MYOF S HOME OF PELICAN ISLAND Certificate No. 2521 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: Charles Cable 966 Crown 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 23 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 28th day of September, 2016. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager Janette willipmrrs,`MMC City Clerk - - CITY OF SEBASTIAN 10387 ADMINISTRATIVE SERVICES RECEIPT ❑ Cash Name U.n.f )L ' ab te- Date 9136106 (Check #`7SZR Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees -Le, rkir 4 BrK b L37- ;L3 )LZ Total Pal Ste. I ials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant mr OF SFw�9M fix-= a sa 1 H06M OF PELICAN ISLAND 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. Name(s) r n) Address Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser Receipt is acknowledged in the sum of: on this at D day of Std' Cemetery Lot(s) and/or Niche(s). OFFICE USE ONLY 00I/06 — Dollars ($ 11 000. 00 20 11/, for the purchase of the following described Unit 4- , Block G , Lot(s) a 3 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 S�gnit&e d-Purdiaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc Interment /W O H Circle One Disinterment TOTALS City The following documents were provided as Proof of Residency: CITY OF SEBASTIAN 10525 ADMINISTRATIVE SERVICES RECEIPT Name &bLp ❑Cash Dated heck #A D Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees X010 I o -�q-3 V7W t4f)T- 4A1t 6 Lor.Z3 &�OA10 — Total Pal �� d0 Im�t121s Security Dep Held!!-- Amount $ Check # White- Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant