HomeMy WebLinkAbout4-02-02Unit
Block�.L
Lot
Date of Mark -out
Date of Burial Za. Time
Name of Funeral Home
Authorized by
Certificate No. 2407
ITY OF SEBAS-MAN!
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Veronica Hernandez
119 South Bay Street
Fellsmere, FL 32946
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 2
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 4th day of February, 2014.
CITY OF SEBASTIAN, FLORIDA
Joseph F. Griffin
Interim City Manager
ATTEST:
--
~�'
Sally/A. Maio, MMC
- City Clerk
FLOMADErAirmiEir w • ,. State of Florida, Department of Health, Bureau of Vital Statistics
HEALT BURIAL TRANSIT PERMIT
DATE PRINTED: February 4, 2014 TRACKING NUMBER: 2014017300
1. DECEDENT INFORMATION
Name of Deceased Date of Death
JOSE A HERNANDEZ 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- F041870 -5017
Date Issued: February 3, 2014
cc. J 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 CREMATOR
Place of Disposition: SEBASTIAN CEMETERY 112A � I� 12-01
Method of Disposition: BURIAL Date of Disposition: _/ IL
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: ,lose A. Hernandez
Name
Lot 2- Block 2 Unit 4
Lot Block Unit
Niche Block Unit
N S E W
Friday, February 7, 2014 11:00 AM Our Lady of Guadalupe
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
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 hav be n paid:
Cemetery xto Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
02/04/2014
2,150.00
City of Sebastian UNIT 4, BLOCK 2, LOT 2
1228 -14055 O/C fee & Cemetery Property
Hernandez
LMP98 M/P CHECK
•
6331
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE /, p
RECEIPT 4 U 7 n
Name��r`.i %�l�/ f-1 �.i��l�')��z ❑ Cash 6-331
Date ) Iq
/ y Check#
No.
Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501 341920
Copies /Bid Specs.
001501341910
LDC /Code of Ordinances
001501 341930
Election Qualifying Fees
601010 343800
Cemetery Lots
lac—ol CIC
2—
Z
Lot/Niche , Block
Unit
001501 343805
Cemetery Fees
(50-00,
Total Paid -2156. o ��
Initials
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
oTYLf
SET�N
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, FL 32958
(772)589-5330 Phone
(772) 589-5570 Fax
May 11, 2017
Theresa Marrero
115 Ogden Avenue
Sebastian, FL 32958
RE: Interment Rights to Unit 4, Block 2, Lots 15 & 16, Sebastian Municipal Cemetery
Dear Ms. Marrero,
Enclosed is City of Sebastian Certificate 2537 entitling you to full interment rights in
Unit 4, Block 31, Lots 15 & 16, in the name of Theresa Marrero.
If you have any questions, please contact our office at 388-8209.
Sincerely,
Cathy sta
Records Clerk
Enclosure