The URL can be used to link to this page

Home My WebLink About4-02-3103/12!2012 10:30 7722287079 COS AIR BLDG PAGE 01/01 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY H,F HOWOFi MM/ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 FUNERAL HOME: ADDRESS: City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589.5570 EALIJ/N•T>.S /�l�iV.E.�CA,C /claillE i S FLEirgii✓G STj?EET PHONE Che One ( OPEN BURIAL LOT. Lot 3/ BlockiTZ Unit- $1-40,_ OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: FOR DECEASED: Name zrz,p vo ee i EaESGyi NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) FG. S hGwnh &6,f ter,. 0049 of i7 6 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 FUN DI CTOR- -.o✓%d l�7• Ul v/iAc�E �c w i 6 Name ignatur 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 been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. State of Florida, Department of Health, Bureau of Vital Statistics 371ra BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: October 17, 2016 TRACKING NUMBER: 2016159931 1. DECEDENT INFORMATION Name of Deceased Date of Death ELYNORE TEDESCHI October 14, 2016 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 HomelDirect Disposal Establishment Fla. Lit. No.IReg. No. Phone Number SEAWINDS FUNERAL HOME F073360 F073380 (772) 589.1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral DlrectorlDirect Disposer Fla. Lic. NoJReg. 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: October 17, 0-5232 16 �— Date Issued: October 77, 2016 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 CEMETERY Method of Disposition: BURIAL Date of Disposition: 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, Flodda Administrative Code CITY OF SEBASTIAN 10388 ADMINISTRATIVE SERVICES RECEIPT Name f tDCSCi-i-1 —0 Cash Date � d 1) 2116 'yCheck # ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 00(5-o! - 343los ISO,00 7 Total Paid nitials Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant is Lot 111 Date of Mark -out //_' Date of Burial /D�/"i / ��' Time, rojex✓L-- Name of Funeral Authorized by Certificate No. 2418 CITYOF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Shawnn Ward & Eleanor Tedeschi 135 Capri Avenue Sebastian, FL 32958 In and for consideration of the sum of $2000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 2, Lots 31 & 32 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 6th day of May, 2014. CITY OF SEBASTIAN, FLORIDA Joseph F. riffin City Manager ATTEST: Sally A. io, MMC City Clerk CROF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax May 6, 2014 Shawnn Ward 135 Capri Avenue Sebastian, FL 32958 RE. Interment Rights to Unit 4, Block 2, Lots 31 & 32 Sebastian Municipal Cemetery Dear Ms. Ward: Enclosed is City of Sebastian Certificate 2418 entitling you to full interment rights in Unit 4, Block 2, Lots 31 & 32, in the name of Shawnn Ward and Eleanor Tedeschi. If you have any questions, please contact our office at 388-8215. Sincerely, Sally A. M io, MMC City Clerk Enclosure • r �},r °• 4' ,�' :� e'er. ,ti \111 r r��/,�.. w � y r� '�" City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) 135 - Address s o z. 4109r46) 241 -tet Area Code & Phone Number' ('7-72,)51 i- D Z V 7 Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: YA�0 Ge t � Dollars ($ �00 0.4 on this J day of , 20 IV- for the purchase of the following described Cemetery Lot(s) and/or Niche( ). Unit �4 , Block Z , Lot(s) 3Z 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 Signature of Purchaser Interment /W O H Circle One Disinterment TOTAL $_ /D 0.(-) DO w City of S stian The following documents were provided as Proof of Residency: I:1WW-DATAIMs-CemeterylRECEIPT.doc I and City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Address Area Code & Phone Nu 32966 �7zs ) U-'W-0zC17 Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is act nowledged in the sum of: :� o3 Dollars ($%f 0U °° ) on this 7%g, day of , 20 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit , Block �— , Lot(s) <-S / 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: Comer Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Interment /W O H Circle One Disinterment Temporary Marker Preparation & Installation .RA 6�2- `6 33 TOTAL $ /000 Signature of Purchaser City of Seb stian The following documents were provided as Proof of Residency: 1:IVM-DATA1Ms-Cemetery\RECEIPT.doc I and tuaspddv - Auld . esueuli — moil aA . u161J010 1de0 111Mslel3!ul Pled 1e301 r saed /Gelewa0 908£ti£ 1.05600 liu fy '' � X18' � ayoil�lo� Co slot 1Jalew80 009EVE 060609 _----- seed 6ulkilenp uo4wl3 OMM 609600 smueu)PJO 10 epo0/00l 066M 609600 •soWS Plepido0 OUM 605600 sales eSweO 006ZZE 609600 _ xe1 sales 60080Z 600600 'ON Pled 1unowy a3EC 4 ugv3 o OWN r� 103311 c 9 V - 301d10 SM11310 AM N1fiiSV83S 30 AM Name No. 001001 208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 001501 343805 CITY OF SEBASTIAN " CITY CLERK'S OFFICE p S RECEIPT 8 0 Cash 144 eck4 /our Amount Paid Sales Tax Garage Sales Coples/Bld Specs. LDC/Code of Ordinances Election Qualffying Fees Cemetery Lots /0060- Lot/Nlche ,��, Block—z- ,unit `T Cemetery Fees Tota! Paid lC`504 Initials White — Dept. of Origin • Yellow — Finance • Pink - Applicant