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Home My WebLink About4-05-21r C1 I Y Gr HOME OF PELICAN ISLAND Certificate No. 2504 CITE 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: Nancy Holmes & Robert Gouveia 202 Degan Place Sebastian, FL 32958 In and for consideration of the sum of $1000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 5, Lot 21 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 3rd day of May, 2016. CITY OF SEBASTIAN, FLORIDA t4 � Joseph F. Griffi City Manager ATTEST: J nette Williams, MMC City Clerk MOF SEBASTIAN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax May 16, 2016 Nancy Holmes 202 Degan Place Sebastian, FL 32958 RE: Interment Rights to Unit 4, Block 5, Lot 21 Sebastian Municipal Cemetery Dear Ms. Holmes, Enclosed is City of Sebastian Certificate 2504 entitling you to full interment rights in Unit 4, Block 5, Lot 21, in the name of Nancy Holmes & Robert Gouveia. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Enclosure 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) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: Lot-21—Block 5Unit 4 Lot—Block—Unit Niche Block Unit N S E W SATRUDAY 5/7/2016, 11:00 AM - Chapel Service FOR DECEASED: Robert Nigel Gouveia Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Nancy Holmes Navu> H04* ek 05/03/2016 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 CJ[Mtkq CW- c/ "1X 05/03/2016 Signature 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 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 FIOil dia BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: May 3, 2016 TRACKING NUMBER: 2016071046 1. DECEDENT INFORMATION Name of Deceased Date of Death ROBERT NIGEL GOUVEIA April 30, 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 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 DlrectorlDirect 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: 1670-5073 May 2, 20 Date Issued: May 2, 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 I —1 �I Method of Disposition: BURIAL Date of Disposition: h 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, 10112 64V-1.011. Florida Administrative Code )I /�L--C _ t J 42 f �' Namer Unit Block :I Lot 11 D to M Mark out /6 . CL w W, 41P Date of Burial !C171 / C. Time Name of- Funeral Home S 1jec.9- Authorized by CITY OF SEBASTIAN 10085 ADMINISTRATIVE SERVICES RECEIPT Name N0'1JK Vl+'�l ❑ Cash Date l Check # -7-TZ U Credit Amount Paid 001001 208001 Sates Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 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 �o tic ► 343 205 a(l, ' Total Paid ni 'als Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant mof SFOTKN 26v� 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. II Pc36ozj-G6LAVEIq j�p-r�lcy F�LNLk-s + Name(s) ava ��,g �L� e �sT,�l FL 3aa-'s8 ress Area Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY. Receipt is acknowledged in the sum of: rs ($ )1000 , 80 on this �P-I) day of --M" I" , 20 iso for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 4— , Block 45 , Lot(s) c? ( 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 & Instal !_ _.�: Sidpature .� PurHaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc Interment /W O H Circle One Disinterment TOTAL City of Sebastian The following documents were provided as Proof of Residency: and ROBERT NIGEL GOUVEIA June 1, 1956 - April 30, 2016 Mr. Robert Nigel Gouveia, 59, died April 30, 2016 He was born in Trinidad and Tobago and has lived in Florida since 2002 coming from West Hempstead, NY. Robert was employed by CVS Health. He was a true lover of life, love, the beach, God and all of His creation. He attended St. Sebastian Catholic Church, Sebastian, Florida Survivors include his wife, Nancy Holmes of Sebastian; first wife, Linda Gouveia of Pahn Bay; son, Sean Gouveia of Palm Bay; daughter, Christina Marie Saltzman (Punks) and her husband, Ryan of Palm Bay; grandsons, Cameron James & Samuel Joseph Saltzman of Palm Bay; mother, Janet Gouveia of Trinidad and Tobago; sisters, June Liddell and her husband, Jim of Canada and Samantha Labarrie and her husband, Nick of Colorado and brother, Gregory Gouveia and his wife, Sandra of Trinidad and Tobago. Memorial contributions may be made to American Cancer Society, 3375 20th Street, Vero Beach, FL 32960 in memory of Robert Nigel Gouveia. Visitation will be 10:00 AM to 11:00 AM Saturday May 7, 2016 at Strunk Funeral Home, Sebastian with a Prayer Service at 11:00 AM at the funeral home chapel. Interment will be 12:00 PM on Saturday May 7, 2016 at Sebastian Cemetery. Born: June 1, 1956 Death: April 30, 2016 CITY OF SEBASTIAN 10083 ADMINISTRATIVE SERVICES RECEIPT NameD Cash Date 3 9,OCheck # a Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 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 - -3qL,32,cn IPOD.� 'jg�> e�w Total Paid L0.44 cwch, ao Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant