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HomeMy WebLinkAbout4-02-06Name Unit_ Block Lot _ Date of Mark-out-- Date ark-out Date of Burial 1 �/� / /� ' Time ' Oa Name of Funeral Home d •� ��w DS Authorized by GLADYS LENOFF May 28th, 1923 -January 22nd, 2015 Certificate No. 2446 CITYOFSEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Kenneth Lenoff & Marsha Lenoff 501 Glencove 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 2, Lot 6 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 23rd day of January, 2015. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: Sally A.io, MMC City Clerk State of Florida, Department of Health, Bureau of Vital Statistics ---- BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: January 28, 2015 TRACKING NUMBER: 2015012570 1. DECEDENT INFORMATION Name of Deceased Date of Death GLADYS LENOFF January 22, 2015 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral Home/Direct Disposal Establishment F!a. Lic. No./Reg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No. DAVID W. WALLACE F046853 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: 2015-FO73380.5020 Date Issued: January 23, 2015 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 CITY CEMETERY Method of Disposition: BURIAL Date of Disposition: B 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 CRY OF SEBASTIAN CITY CLERK'S OFFICE 4981 RECEIPT Name Mr. tr• L -eh U 1 � ❑ Cash Date i' ZOO' $ ACheckp��QQ ''%%� No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots ��t1 LoUNiche(IBlock 'L Unit 001501 343805 Cemetery Fees 0-VitA .e Total Paid 150•U0 InKials White - Dept. of Origin • Yellow - Finance . Pink - Applicant Jan 23 1511:52a Seawinds Funeral Home 772-589-1939 p.1 Jun 02 2012 S:46RM HP LASERJET FAX p.2 FUNERAL DIRECTOR'S. REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY f1�4 p �ItMdtM MJJiD For Information cantaC): Kip Kelso - Carrratery Saxton Sebastian Municipel Cemdfery (772) 689-Z545 C/ty Clerk'* Ofto City Hall, 1223 Maln Street Sabastian, FL 32058 Orlice (772) 388-8215 or 388-827 a Fax; (772) 589.5570 FUNERAL HOME: E�J��ry1>S I6 A-'E/Z.I/ ADDRESS: 173-5-S S T+ S~G`^,Q.osT/w,�r/ •.• PHONE #: -79Z— S��!• / 7,5-3 II 11 I ( ,heSk One) PEN BURIAL LOT Lot Block Z Unit S PEN CREMAINS LOT Lot IocK Unit . PEN COLUMBARIUM NICHE Niche Stock —Unit BURIAL DATE AND SERVICE TIME;�I� ��� 7 �A•/� C9RRV�SiAL FOR DECEASED: C7 1i�iT..� I rvarrme NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documenta)ior, of owner7�0,17 -P-" Y, Name sIgnatore Da� I certify that I have deternvined the ownership of the above described $Ite that all site tees and administrat)ve fees have been paid and authorize opening of some NAME AND SIGNATURE OF LICENSED FUNFRA ECT _�' T2s ,j Name tgne Cate ......... • ..........--------------------- ---------­ ,,......-...... .............................. Cemetery 5exior7 Certification: Certify that I have checked the ownership Information by viewing the owner's deed and confirming witft Clerk's office and ha I1 fees have been pa!d eme ry to Date This fOrtTt to be provided to Clerk's Office by Sexton for permanent record upon completion. r,eY 10111 �i CRY OF SEBASTIAN CRY CLERK'S OFFICE 4978 / RECEIPT Name mr. LP_v1444 D Cash Date ' Z-3 ^ �5 ❑ Check# No. t. l2a4 Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010343800 Cemetery Lots X000.00 LotMiche�Block Z unk,4 001501343805 Cemetery Fees Total Paid (00.0 00©0 vnitials White- Dept. of Origin •Yellow - Finance • Pink - Applicant arr a �J�r 1 f� HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Area Code & Phone Number MarSht, L­eno-r Ia- n �-L Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY tReceipt is acknowledged (in� the sum of: Dollars ($ 1666, LOO on this day of 20_ for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit _4-) , Block 1. , Lot(s) 61 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 Interment /W O H Circle One Disinterment TOTAL $ 1 0 0 0. Q Q C,J,-&k,a- _yr Pity of Sebastian The following documents were provided as Proof of Residency: I:\WW-DATA\Ms-Cemetery\RECEIPT.doc and