The URL can be used to link to this page

Home My WebLink About4-02-37Name i A L1 J+X'\ /' Z NZ Q 7 wi --K '7 9 IV 73 fari2 S Unit Block Lot Date of Mark -out Date of Burial olio Time X00 G Name of Funeral Home §IJC 14 '%•� �� itC�i�� &J, Authorized by M OF SE�TAN Q HOME OF PELICAN ISLAND Certificate No. 2439 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Gilda & William Zaleznick 1772 Sunrise Lane Sebastian, FL 32958 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 lots: Unit 4, Block 2, Lots 36 & 37 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 27th day of October, 2014. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: 41ao, MMC City Clerk WILLIAM L. ZALEZNICK May 13th, 1953 - October 27th, 2014 State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT S-hOfl�u HEALTH DATE PRINTED: October 29, 2014 TRACKING NUMBER: 2014155550 1. DECEDENT INFORMATION Name of Deceased Date of Death WILLIAM L ZALEZNICK October 27, 2014 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 Fla. 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. NodReg. 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: 2014-F973380-5270 /Lac/,�,jDte Issued: October 29, 2014 J Meade Grigg, 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 �N Place of Disposition: IJCITY CEMETERY BURhe Method of Disposition: IAL\J 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, Florida Administrative Code 10/30/2014 08:18 7722287079 vulZd 14u4msp 5aawindarunerelHome COS AIR BLDG PAGE 01/01 772-589-1939 p.t ROR BURIAL OPENING IN SEBASTIAN MUNICIPAL CI=fJIETERY �WGfNKAM174'fP ' For'lntormelion canlact: Kip KeIs4-Cematerp sexton SaimstlanMlrnkipaf CAmefery (772) 088.2845 CRY clemla ORtce CityHnn, 1225 Main Street Sebastian, FL 32958 pine (772) 3148,8210 or 30-82T4 FeA: 1772) 589-5570 FUNERAL HOME: �.9wr vat �,fv��G hrcrn�� AODRESS- -4-JQ �cr..�r ��.F .-, • • - PHONB #: �7Z • 3� ` /S33 {G Om)— PEN BURIAL LOT Lot ,�,.,,. Unit .4z� _PSN CREMAINS LOT LC31-- . retook �Unit _,•,,,, op`~TtCOLUMBARIUM NICHE Niche block 'Unit W BURIAL• DATE AND SERVICE PME:C/GTd Q�rY^ FOR DECEASED: l//•r�+r L. �92�Y�� rvame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: lmVAPPVrdeproperdoco mantetlon of ownership) A a gnalure Omte I y that I have deltelmIned ins ownership of the above described Vile tp4;1 all site rens and 8dfdyl(3tmilve fees heave been paid and authorize openlltp of srame NAME AND SIGNATURE OF LICENSED FUNS' ECTQR. Gin r„8/�q//Rl.C" �^"^�' t3t pfne rgnature cemetery Semorr Cenificalion: I Certi4y that I have eheCked the ownership information by vtewing the owner's deed and c0nrrrmin9 with Cjerk'suffkfslno t tall fees have been paid yi3v �y Cem ery n Da to This form to be, provided to Clerk's office by sexton for permanent record upon compf4tion. ilY Of f vY HOME Or 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. G djo -- UJ(-( Darn Za(eZnI ck Name(s) l-7 Address - -7Sv Se13c,5f-)c.n FZ- 32 CP ll Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: ($ ZOGo.00 on this�� day of (i cto b 2 r 20� for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit Li , Block Z Lot(s) 3 % --1- 3 7 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 - $20) Opening & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation 00-a A"� Signature of Purchaser I:%W W-DATAVAs-CemeteryVRECEIPT.doc Interment /W O H Circle One Disinterment TOTAL$ ZOOp, OO CAy of Sebastian The following documents were provided as Proof of Residency: PrV f2 /-app Ceb,5drand Total Paid 5 6.OQ Initials White- Dept. of Origin • Yellow- Finance • Pink Applicant CITY OF SEBASTIAN MY CLERK'S OFFICE RECEIPT /, Cl /. 4 7 4 /vi rS 244 e Z h Icp— N,. , D Cash Date 10 - 29 - N kCheck# ` / 4 0p No. Amount Palo 001001208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots , / LolMiche�Block Z Unit 001501343805 Cemetery Fees X50.00 0/ C, Total Paid 5 6.OQ Initials White- Dept. of Origin • Yellow- Finance • Pink Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE 4943RECEIPT Name Mr. r.y ! i n/ - Lo n a c Cash Date 10 - 2 7- I `Y' ❑ Check # No. Amount Paid 001001208001 Sales Tex 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots 2 ()0U 00 Lof lche 310,3 7Bbck Unit 001501 343805 Cemetery Fees AJQ - /J ) Total Paid 7()60 00 Inkials White—Dept. of Origin• Yellow — Finance • Pink - Applicant Jul 16 15 02:43p Eaglemonuments 17724657949 p.2 Troll � ' t Ids Q e--+-C-Q--- 3kkaZ, City of Sebastian 1 = '4`4.2_- ,h(b�F 5.5-kf be.. Cemetery 1Cemetery AA.N I072)5rt4.2S0 T""� � �ji S —F at A 117121 228-4427 Nem : Vests for IYeforneetiawl purpose%rnxuytdin2 Moo umeats at'Sebastian I'Patti re) . Nolo: Thh 8 lar Sia8ir Markers entire 2 fl,&over 2 ft.(one 2 fa IF peered(aaadatlon) mow muss to Chi of Sebastian Dry Mix Sebastian l'cnUtrrr IQIt Nonb emirs,Awl. F4)urtdatlatt PH.UVU 32958 • 7/ /` ��,� Atftatlem t•treeslery Sexton data' a,' 4i •instilled I u ter 3-0/6/ /.6.471 : (� tit r� X QT' 1Ou K �1- }.f. S n� >t>M ,Sefh5- Nam O 8 0aif. : HIS:IBJ I U`OA() HER: G-•• L'1 i c J1 Na1 12+ r,C3S9Z D.Q.B. D.O.D. .a l- map. Legal Descripition : . y I1rtil 13ut. . 2 Lot3 7 Sgnar*Ft. Approved 5y : Chocked By : »art: t By : E:ramph : NOTE : ANY MARKER OVER 2 FT.LONG REQUIRES A POURED CONCRETE FOUNDATION THIS INCLUDES A BASE ANY MARKER SMALLER THAN 2 FT.LONG REQUIRES A DRY MTX THIS INCLUDES A FLAT GRASS MARKER. Jul 16151)2.4f p Eaalemonuments 17724657949 n.1 FAX Company Name: EAGLE MONUMENTS Phone: (772) 464-5547 FAX: (772) 465-7949 Address: 805 Barrel Avenue, Fort Pierce, FL 34982 TO: Kip Kelso (City of Sebastian) FROM: Andrea Dunk Sebastian Cemetery FAX #: 772-228-9927 FAX #: 772-465-7949 DATE: 07/16/2015 PAGE(S): 3 ❑ Urgent 0 For Review 0 Please Comment ❑ Please Reply Good afternoon Kip, Please see following an installation form for William L. ZALEZNICK's slant marker along with a copy of proof. Dimensions of Slant Marker 3'-0' x 0'-10" x 1`-4" Name & Dates on stone: William L. Zaleznick DOB May 13, 1953 - DOD October 27, 2014 Mrs. Zaleznick has not provided grave location details. Please advise convenient date for installation. Should you have any questions or need clarification regarding this installation, please do not hesitate to get in touch with me. Thank you! Best regards, Andrea Dunk adunkOstonemor.com --'1111111.111111.1.- Jul 1615 02:47p Eaglemonuments 17724657949 p•3 Jul 06 15 12:13p Eaglemonuments 17724657949 p.2 g :;,' --„---- 1 ......_.__________, MO/ it) 7 Ik. 'I C. • , 1 ,� 11 III) , ((Th.__ fr . - , .,.r„. , . r., ,. ,____4, , 9, it.:0, ..,. L 1 \ • 4),. . J. di. ., i • 4 .....v t—=3 I v y !� \ ” . = SI ` ii) 1 Ir rl il� I ` ' 1 ) / \ ' - �' C~a f 1 n `-- :� )1e. I -C---'=1. • 1 \`FtI t? 1 'f' = � rg Da E' : X •-.-J41 *_1/4::::--- -_ ,... .. ...i --,- //. d f —7 oiL -\--3 w( 401) / / L \ ., :_1_,-. I /I � � /0 �o ,, r Pc o i F.....s.l I p .. –kcal 4. La 1 1 e0 -) /cps 1 5 . --� k ) c..% . a ' r 1 con I— ! Z___.3N H i , • ;:' \*\11i. iii , e k . l 1 •