HomeMy WebLinkAbout1-31-10 , .
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Date of Mark-out /
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011AE OF PELICAN ISLAND,
Certificate No. 2081
4 r Oi a` SEB A.5 1 IAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Deborah M. Dillahay 1101 Turtle Run Dr., #107,Sebastian,F132958
(name) (address)
in and for consideration of the sum of $450.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following plot/niche:
Unit_1_Block 31_Lot(s)Niche(s)_8, 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 1st day of May 2006.
CITY rr F SE:A IAN, FLORIDA ATT '
• inner Sall/Maio, MMC
City Manager City Clerk
*Replacement Deed
for Deed #1077
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FLORIDA DEPARTMENT OF �/
Stall Florida,Department of Health, Vital Slitics
HEALT APPLICATION FOR BURIAL-TRANSIT PERMIT C .
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Carl W. Learned Death Oct. 23 2000
2. Place of Death City,Town or Location Name of (If neither,give street address)
County Hosp.or
Indian River Vero Beach Inst. VNA Hospice House
3. Name of Medical Address 1 3060 U.S. #1 Phone Number
Certifier Noor Merchant, M. D. Sebastian, FL 561-589-0879
nMedical Examiner Physician
4. Name of Funeral Home/Direct-Di3peael Address Fla.Lic. No./Reg. No. Phone No.(Area Code)
Establishment 1623 N. Central Avenue
Strunk Funeral Home Sebastian, FL 1228 561-589-1000
5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ® Wendy was contacted on 10/23/00
1 He/she verified that this death was from natural causes,that there was no accident nor other external cause of death,
and that Dr. Merchant will complete and sign the medical
certification of cause of death within 72 hours.
c. ❑ was contacted on He/she verified that
,Medical Examiner,will complete and sign the
medica icati n of ca a of ath within 72 hours.
6. Funeral Director/ .n re F.E. o./Reg.No. Date Signed
Direud Di pu,ei ' 1862 10/23/00
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-00-01193
❑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.
ONo extension of time for filing the death certificate has been requested.
'Reldblicit ul • ^. Date Date Certificate
Subregistrar Signature (\l1/4. Issued: /0/3 3/e o Due: /0/12,/,‘,
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
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL OSTORAGE Date of Disposition 0674 fi,L) ,, 7/ ?v r]
El CREMATION OTHER(Specify)
Signature of Sexton 1 '
or Person-in-Charge J} ,`'(� lijie,,
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 all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar