Loading...
HomeMy WebLinkAbout1-28-10 Name AIP I A • / Unit •0 Block 0" Lot /0 Date of Mark-out 1- Date of Burial 0 Time el! C Name of Funeral Home ALAI) 6 Authorized by O - O CRY OF SEBASTIAN HOME OF PELICAN ISLAND Certificate No. 2042 CITY OF SEB ,t'�ST1 N Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Allen Green 1404 Tradewinds Way,Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $700.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 1 -- Block 28___-Lot/Niche 10 of the S ebastian 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 2nd day of September, 2005. CIT OF SE ASTIAN,FLORIDA ATTEST: ir 'Jr (1)Altb--611nUb Minner Jeanette Williams, CMC City Manager Deputy City Clerk /O J — p . , -A.6Imo' w_:.r..� ��'. ':... ... .modZ-. RATING. .. _ ....._. . y47.-- -•� /•• ----"I•... •_,1 •- CREDIT ixtfIT ry ww�A '_ -I. , d V4 s • / 27/171r4 . • 9 fil...a / AM.CS •P j46� N v I tire 4`7‘ Xi • c\ic-. , c`;, 1/1A "44`2f� • C. sc, a5.D tr i.. i Gar.:• ,r •i-"."""WWI ....., /I rip 7 / -Will (r,if —� ;0.1 • A - fi - 4 r. �„ l',.._, •' jori..1 . .. ,r., < - C.the' �. /���� � LYE ..'�©�i/,� �flw'^, � `'i'.. . ... . . i priye. .. it"i . ''i977 Y Ai so . s, ja . ” _f 0, 205;QNg . , ar+ � Nl b "0: / \ . ..11 o} 1, ! er 0. n s n V, ' • r_,q " ' ` t-,r au 2 ' t ip"'' _ -.., i t r w t .k . r " : i . ''z r fir+ .'0 F . ,,L , :: • 12 3 416( STATEMENT ) Date y/1./0 5-7 TO gi !✓aewe.e/1' TERMS /- /0 IN ACCOUNT WITH /./ A/O ,e% 1 -vx /0 Lo '/ , 7co (c ; ry x4;, g._ lA 4.7'f 4VL 01/--radet(if 'eb 054- 0 zto r= Stock Form 25812 /y // fill I $ 0 8 8 0 o g o ° r cn S Er 3 co co o g o 0 1 0 ii ,' •'• R Z N g A -2-sp. tG w Er =m O m �i oyi �� 7 N Er o c4 • so T =�� m-fin i CO IT co 1 _l 0> • o t m 0 ar -1 C Q • O ,\ = n N. C ar er so ID n Oa W o a d 0) a (EY Of SLDASTIAN °2 HOME OF vPELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City i of Sebastian to determine the correct rate, and in a ccordance with cemetery rate regu tions, residence of purchaser or person for whom lot is intended for interment must be provi d t time of purchase Name(s Address 77L_' - L5-? -G ,? Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt ' acknowledged in the sum of: Dollars ($ a. o d ) on this .,, '__ day of, ; �� , 205 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit / , Block , Lot(s) /c 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 /--77.,5-7 /u W G:5> H Circle One Vase and Ring for Niches(cost) Interment ,dm,, Disinterment OrTA-L) e,?5", c) Signature of Purchaser ' ity of Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECE I PT.d oc A / : FLORIDA DEPARTMENT OF /`` r V HEALT State of Florida, Department of Health,Vital Statistic P APPLICATION FOR BURIAL-TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month D Year Deceased BRITTANY JOY LEWIS of 8/31/05 Death 2. Place of Death City,Town or Location Name of (If neither,give street address) County Hosp.or BREVARD MICCO Inst. HIGHWAY 3. Name of Medical ROBERT E. WHITMORE Address Phone Number Certifier 1750 CEDAR STREET ]Medical Examiner ]Physician ROCKLEDGE,FLORIDA 321-633-1981 4. Name of Funeral Home/Direct Disposal Address Fla.Lic.No./Reg.No. Phone No.(Area Code) Establishment 735 FLEMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 2617 (772) 589-1933 5. Check a. El The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. 0 was contacted on He/she verified that this death was from natural causes,that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. c. El was contacted on He/she verified that ,Medical Examiner,will complete and sign the medical certification of cau f death ithin 72 hours. 6. Funeral Director/ C • nature F.E.No./Reg.No. Date Signed Direct Disposer �—' 3114 9/1/05 I B. BURIAL - •NSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 05-2617— 150 ©A five(5)day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. 0No extension of time for filing the deat cert' to been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 9/1/05 Dye: 9/8/05 c. AUTHORIZATION for CREMATION, DISSECTION,or BURIAL-AT-SEA Approval Number: Date Medical Examiner, ,gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY r Method of Disposition: Place of Disposition 5 E,4.4 S 77,$ 4/ IV7,t/Te !{. RIAL 9STORAGE Date of Disposition 9/3 3/ / 9 CREMATION ['OTHER(Specify) Signature of Sexton i t� „ {� e)rG or Person-in-Charge f /�y0 Q // 7j This permit must be endorsed by the Sexton or person-in-charge(or by the Funeral Director/Direct Disposer when there is no Sexton)and returned within 10 days to the local County Health Department in.the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326,8/97(Obsoletes at previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 5740-000-0326-2) Pink: Local Registrar r Fu` Pm,