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Home My WebLink About4-18-05CT Of HiOME OF PELICAN OSLAVID Certificate No. 2077 V 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: Herbert & Jeanette Mary Thomas 701 Baird Avenue, Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit 4_ Block _18_ Lot(s)Niche(s)_5_ 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 7th day of April 2006. OF ASTIAN, FLORIDA ATTEST: = c Crk 1 Minner Sally Maio, MMC Ci Manager City Clerk j..^L3_'l.Yl / /.'� « /_sue ✓�: ��+ Unit Block Lot Date of Mark -out y/ lO G /i��/ Date of Burial � Time Name of Funeral Home (,ice t.iC��L��► / uW Authorized by 7 L1. SL N S m v e m • f 1 m m • v n m. m g 0 _u c °o o_ W A CO O CT rn g 0 °o O o o z v d o m o 0 0 0 m m 0 0 O � � N CO 8 O W O N O , 0. O O O O O C, r 'D m r C) G7 d n �. @ fD m -� D cod m T y O Cn y CD `D °a T � CO 3C c 7 T G �c c t cr N y � S D 3 _ C c ,9 d m a C'7 n < mmo mom .o to o0 I� n T � T S A Z m 4— 0 cr October 01, 1939 - June 22, 2010 Jeanette Mary Thomas, 70, of Vero Beach, FL died Tuesday, June 22, 2010 at the Indian River Medical Center in Vero Beach. Ms. Thomas was born October 1, 1939 in Milwaukee, WI and moved to the area 21 years ago from her place of birth. She was an elementary school teacher in Milwaukee prior to retirement. Survivors include her sister Patricia Schaefer of Milwaukee, WI. Services: Burial will take place 2:30 PM, Tuesday, June 29, 2010 at Sebastian Cemetery in Sebastian, FL. FLORIDA DEPARTMENT OF HEALT LT State of Florida, Department of Health, Vital Statistics Lily 1 APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of JEANETTE MARY THOMAS 06 22 2010 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County INDIAN RIVER VERO BEACH Hosp. or INDIAN RIVER MEDICAL CENTER Inst. 3. Name of Medical Address Phone Number Certifier TALIB HUSSAIN, MD 7768 BAY ST, SUITE 12 Medical Examiner X Physician SEBASTIAN, FL 32958 772- 589 -7177 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 S. FLEMING ST. SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 41682 772- 589 -1933 5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box NO M* DR. HUSSAIN was contacted on 06/23/10 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that HE will complete and sign the medical certification of cause of death within 72 hours. was contacted on He /she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director / ° Ig 1at _ F.E. No./Reg. No. Date Signed Direct Disposer r A-0 %7f'i —,;?3,_f 0 B. BURIAL - TRANSIT PERMIT C. Permission is hereby granted to dispose of this body. Permit No. 10- 41682 -114 ® A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. FINo extension of time for fili g th death certifi to has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 06/23/10 Dt1e: 07/05/10 AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date Medical Examiner, , gave authorization by telephone to Funeral Director /Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. Method of Disposition: BURIAL ®CREMATION Signature of Sexton or Person -in- Charge ❑STORAGE 1 DOTHER (Specify) CEMETERY OR CREMATORY Place of Disposition SEBASTIAN CEMETERY Date of Disposition /_ XI Ae, -his permit must be endorsed by the Sexton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sexton) and returned vithin 10 days to the local County Health Department in the county where disposition occurred. ,H 326, 8197 Obsoletes all Distribution: White: Cemetery or Crematory ( previous editions) Yellow: Funeral Director or Direct Disposer Rock Number: 5740- 000 -0326 -2) Pink: Local Registrar Req�led %4.Tt Papn Sep 04 2009 2:13PM COS CEMETERY 7722289927 p•2 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR IBURIAL OPENING IN SEBASTIAN MUNICIPAL, CEMETERY . S MOrN W /fIKAM KWiO For information contact: Klp Ke1SO - Cemetery Sexton Sebastian Municipal Cemetery (772) 669.2645 Crty Clarks O ica City Hell, 1225 Matn SIM@( SebaStlan, FL 32958 0117ce (772) 388-8215 or 388.8214 Fax. (772) 589 -5570 FUNERAL. HOME: SEAW I Ob.S F U 0E-120 Lr OM ADDRESS: `135- 6. FLEM10k ST' PHONE #: ri 7 - 5-9q — 19 3 3 (Check One) k 1 g Unit ,.QPEN BURIAL LOT Lot r Bloc ,,OPEN CREMAI NS LOT Lot ,!_Block ----Unit PEN COLUMBARIUM NICHE Niche Block ----Unit BURIAL DATE AND SERVICE TIME: FOR OF-CEASED: :1EAME TTE MIARY I HON ivame 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 &Ite that all site fees and administrative fees have been paid and authorize opening of same NAME AND SIGNATURE.OF LICENSED FUNERAL DIREC/70R. 6/23110. Name iSneture ._ .. _.__....------------- Date ..................................... -- ------ ------------------- --- _- ___....._.._... --- ..... Cemetery Sexton C®rtification: I certify that t have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid 1,�A �;, ��g 6 /g /v Ce ter ex on pate This form to be provided to Clerk's Office by Sexton for permanent record upon completion. C/C. - 'tY OF �T 401E OF PELICAN 95LAND, 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 April 10, 2006 Herbert Thomas & Jeanette Mary Thomas 701 Baird Avenue Sebastian, Fl 32958 Dear Mr. Thomas: Enclosed is City of Sebastian Certificate 2077 entitling you to full interment rights in Cemetery Lot 5, Block 18, Unit 4. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, Carte, Sally aio, MMC City Clerk SAM:ar enclosure CT (u ;ell 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, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase ame(s) Address ' Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt 's acknowledged in the sum of: Dollars ($,--7e I - o o ) on this day of , 20� for the purchase of the following described Cemetery Lot(s) a d /or Niche(s). Unit / , Block _, Lots) .5— 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) Signature of Purchaser W O H Circle One Interment Disinterment r" TOTAL City of Sebastian Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEIPT.doc 63-515/670 24 Name Y-f i-belri- -Zh eyt-a c Date c .C4 Name No Pay to the cc, Order of g�a� 110-1ce �// = ---Dollars First National BANK AND TRUST COMPANY THE SUPERCOMMUNITY BANK' SEBASTIAN, FLORIDA 32968 -Z Awi 240 2 S13 L, 16110 1:06700SL�al: , , m U 0 1 P LA- U, LA. 4c 0 co U) a- Lu Se ui ca 02 0 LL. LU W C) _j VV C =3 0 IE Z, CL cr) x 2- ca 0 2 -1- 4) M 4) A2?.-(-)�§EX,E 0) -j co co C9 0 —1 M 0 —j Q GUARDIAN8 SAFETY BLUE WBL CL CL O 21 C) C> C> C, u') C) CD. m C14 Cl) C) -0 C> 00 00 C> CIA C-4 cn C14 C�-W ! C> C> C> CD C> O 1 t p V t2 V Z3 O C) CD C> C> CD. (D C) C�l C> C> C� co C� C> GUARDIAN8 SAFETY BLUE WBL CL CL O 21 City of Sebastian Sebastian Cemetery Ph. # 1(772) 589 - 2545 Fax # 1(772) Note This Is for informational purposes reguarding Monuments at Sebastian Cemetery . Note Please return to D.O.B. Dry Mix Sebastian Cemetery D.O.D. 2010 Legal Description 1921 North Central Ave. Foundation poured 32458 by ; herman Attention Cemetery Sexton date ; 9/9/10 Blk.: 18 stone installed Lot: 5 by ; herman 1 - 0 x 2 - 0 x 0 - 4 standard grey granite flat grass marker date : 9/9/10 Size : ' K.K. G. Checked By Names & Dates: His: LJ— . ieanette thomas Date : Example 4 " deep ! \ \ 12" D.O.B. D.O.B. 1939 D.O.D. D.O.D. 2010 Legal Description 4 Unit: Blk.: 18 Lot: 5 Approved By: K. G. K. K.K. G. Checked By Date : 9/9/10 By: eagle Example 4 " deep ! \ \ 12"