HomeMy WebLinkAbout4-10-01Certificate No. 2141
~~~
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Lottie H. Morgan
and/or Barbara M. Schwin 5780-1 Pelican Pointe Dr., Sebastian, Fi 32958
(name) (address)
In and for consideration of the sum of $1.900.00 is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following
Lot(s)/Niche(s)
Unit_4_Block_10_Lot(s)_i & 2_
of the Sebastian Municipal .Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 11th day of July, 2007.
1'111 II ICI
Manager
FLORIDA
ATTEST: ~, g
ICJ ,
Jeanette Williams, CMC
Deputy City Clerk .~-
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July 11, 2007
Mrs. Lottie H. Morgan
andJor Barbara M. Schwin
5780-1 Pelican Pointe Drive
Sebastian, FI 32958
RE.' Interment Rights to Unit 4, B/ock 10, Lots 1 & 2 Sebastian Cemetery
Dear Mrs. Morgan:
Enclosed is City of Sebastian Certificate 2141 entitling you to full interment rights in
Unit 4, Block 10, Lots 1 & 2.
Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal
Cemetery.
If you have any questions, please contact our office.
Sincerely,
J anette Williams, CMC
City Clerk
JW:ar
enclosures
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City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
~o~r,~ ~~0~6,~~
Name(s)
Address
.7'72 - ~8 - 9/~~
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
~~ this ~.,~,,,~,r~_day of , 20d 7
described Cemetery Lots nd/ Niche(s).
Dollars ($~ 00, d' )
for the purchase of the following
Unit _~, Block ~, Lot(s) / 9` e2 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 - $20) Opening & Closing
Vase and Ring for Niches (cost) Interment
Signature of Purchaser
W O H
Circle One
Disinterment
~~T'OTAL/~$ / rJ0. OD
of Sebastian
Service fees are to be paid at time of need only
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EARLS. MORGAN, SR
LOTTIE H. AiIORGAN ,,,, / ~ ~ ss-Iws~s~
5780-1 PELICAN POINTE DR. T12~88-9187 Date--/-~-I
SEBASTIAN FL 32958
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CASH ADVANCE ACCOUNT-SEBASTIAN
916 17TH ST.
VERO BEACH, FL 32960 y ~ / ~'7 ~ /``r 63-1205/670
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FLORIDA DEPARTMENT OF
HEALT
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date th Day Year
Deceased Earl S. Morgan, Sr. °f July 11, 2007
Death
2. Place of Death City, Town or Location
County
1 ndian River Sebastian, Florida - -
Name of (If neither, give street address)
Hosp. or
Inst. Sebastian River Medical Center
3. Name of Medical Address Phone Number
Certifier Dirk Parvus, MD 13695 US Highway 1
Medical Examiner Physician Seba stian, Florida 32958 772-589-3186
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 North Central Avenue
Strunk Funeral Home Sebastian, Florida 32958 1228 772-589-1000
5. Check
Appropriate
Box
a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b. ~`] Dirk Parvus, MD was contacted on July 11, 2007
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 medial
certification of cause of death within 72 hours. I'
c.
was contacted on
cause of death within 72 hours.
He/she verified that
,Medical Examiner, will complete and sign the
6. Funeral Director/ Si F.E. No./Reg. No. Date Signed
Direct Disposer ~i~ ~ ____
B.
BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-0294
A five (5) day extension of time for filing the death certificate (exGusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not bt: able to complete the medical cert~cation of cause-of~leath section of the death certficate within
72 hours.
~No extension of time for filing the death certificate has been requested.
q~. Date Date Certificate
SubregistrarSignature ~,. ~~,~C1 Issued: July 12, 2007 Due: July 18, 2007
c. 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 Examiners approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is
required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
~URIAL STORAGE Date of Disposition July 14, 2007
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge
This 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
within 10 days to the local County Health Department tn.the county where disposition occurred.
DH 326, 8197 (Obsotetes all previous edkions) DisVibution: White: Cemetery or Crematory
{Stock Number 5740-0000326-2) Ysllow: Furrorat Director or Direct Disposer ~~ I~ ~
PiMc: Local Registrar i~