HomeMy WebLinkAbout4-02-01Name
Unit_
Block_
Lot
Date of Mark -out
Date of Burial d. Time
Name of Funeral Home .5 2 L; , gg'.
Authorized by
' ^AA 55
f tax F,>J4��P�
Certificate No. 2406
CITV1 OF SEB S T IA
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Fidelmar & Gloria Boyzo
112 South Oak Street
Felismere, FL 32948
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 lot:
Unit 4, Block 2, Lot 1
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 4t" day of February, 2014.
CITY OF SEBASTIAN, FLORIDA
�f.
Joseph F. Griffin
Interim City Manager
ATTEST:
Sally �Aaio, MMC
City Clerk
FLORIDADII°,ti - EIL W ,•I State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: February 4, 2014 TRACKING NUMBER: 2014017286
1. DECEDENT INFORMATION
Name of Deceased Date of Death
LEOPOLDO BOYZO February 2, 2014
Place of Death - County City, Town or Location Name of facility, or street address if not a facility
BREVARD PALM BAY ON BABCOCK STREET, 1/4 MILE SOUTH OF MICCO ROAD
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. No. /Reg. No.
TIMOTHY W. MARVIN F022789
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: 2014- FO41870 -5016
Q G4� T Date Issued: February 3, 2014
J •„
Meade Grigg, State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District 18 Approval Number:
4. CEMETERY OR CREMATORY ^� 1 I 1
Place of Disposition: SEBASTIAN CEMETERY t 01)j '2-11120 I , 1
Method of Disposition: BURIAL Date of Disposition:
J TI
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
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
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE #: 772- 589 -1000
(Check One)
X OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
FOR DECEASED: Leopoldo Boyzo
Name
Lot 1 Block 2 Unit 4
Lot Block Unit
Niche Block Unit
N S E W
Friday, February 7, 11:00 AM Our Lady of Guadalupe
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
T--1 �-d jla��Ljo W 2q 4
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:
Tim Marvin
Name ignature 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 be n paid:
Cemete exto Date
This form to be provided to Clerk's ffice by Sexton for permanent record upon completion.
02/04/2014
2,150.00
City of Sebastian UNIT 4, BLOCK 2, LOT 1
1228 -14054 O/C fee and purchase cemetery
property
LMP98 M/P CHECK
3a�ZD
1 t2_ cau�'h
6330
. 32g4R
(i
.:
0
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4837
RECEIPT
Name J - / l: /� b u ?'G 11 Cash 2
Date q- I / q )( Check # 633C
C
No.
Amount Paid
001001
208001
Sales Tax
001501
322900
Garage Sales
001501341920
Copies /Bid Specs.
001501
341910
LDCICode of Ordinances
001501
341930
Election Qualifying Fees
601010
343800
Cemetery Lots
;Lo, 0
LoMiche i Block
2 Unit "t
,
001501
343805
Cemetery Fees
0 /(- 150.610
jW �L'af/v' Total Paid '5 6 . QU
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant