HomeMy WebLinkAbout4-14-40C ~ - - - -- - ----------------- °~
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Certificate # 1868
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Certificate of Interment Rights
Helen Turner
(name)
(name)
(name)
rnv a
~,~~AS~
~...
~~~
HOME OF PEUUN ISLAND
1306 Dewitt Lane, Sebastian, FL 32958
(address)
(address)
(address)
in and for consideration of the sum of ~ 1, 400 . oo ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 14 ,Lot(s) 39 & 40
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 22nd day of November 2002
C3TY CF SEBAST~N, FLORIDA
~~ e ..
Terrence R~-li%Ioore
City Manager
ATTEST:
n ~ ~~-`
Sally A. M,~aio, CMC
City Clerk
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CITY OF SEBASTIAN ~ ~ 4,,,
CITY CLERK'S OFFICE ~ ?~ ,
RECEIPT
Name • ~•~` ^ Cash
~~
Date -"° r~'..1. C7 Check# ~~E:z
AmourdPai
001001 208001 Sales Tax
001501.322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501 362100 Community Center Rent
001501 362100 Yacht Club Rent
001501 362150 Non Taxable Rent
001501 343800 Cemetery Lots
601010 343800 Cemetery Lots
'1 i
Lot/Niche "'' ~ "'Block ~' ,Unit
001501 369400 Interment Fee
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800 220683 Riverview Park Security Deposit
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Total Pald
Initials
White - Dapt. of Origin • fellow - Finance • Pink • Applicant
Name
Unit
Block
Lot
Date of Mark-out_ ~~~ ~ ~/~,~ ~..
t~~, ~'~.
Date of Burial_ ~ '~. ~
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Name of Funeral Home - ,.~
Authorized by ,~~ J ~ ,.~,~.
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FLORN\ PARTMEtJT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
~~~ I~4~
1. Name of First Middle Last Date Month Day Year
Deceased of
Ralph Carl Turner, Sr. Death Nov. 17 2002
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Tandem Helath Care of Vero Beach
3. Name of Medical Address Phone Number
Certifier S ed Zaidi, M.D. 13090 U.S. #1
Medical Examiner Physician Sebastian, FL 772-589-3755
4. Name of Funeral Home/~iceet-BispO~'al Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N . Central Avenue
Strunk Funeral Home Sebastian FL 1228 772-589-1000
5. Check a. LJ I he medlcal certltlcatlon has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~ ViCki' was contacted on 11 /18/02
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Zaidi will complete and sign the medical
certification of cause of death within 72 hours.
c. ~ was contacted on He/she verified that
Medical Examiner, will complete and sign the
di I c Ific I of cause of death within 72 hours.
6. Funeral Director/ Si at a F.E. No./Reg. No. Date Signed
Direct Disposer ~- J 1862 11 / 17 /02
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No.1228-02-463
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.
~No extension of time for filing the death certificate has been requested.
~Registreter~+ ~ Date Date Certificate
Subregistrar Signature ~'~,, C~ Issued: 11 /17/02 Due: 11 /22/02
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 Examiner's 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
Method of Disposition:
~/ BURIAL
CREMATION
Signature of Sexton 1
or Person-in-Charge J}
STORAGE
OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition ~~ ~,;Z~`p .~
This permit must be endorsed by the Sexton orperson-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 in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
DH 326, 8/97 (Dbsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
(Stock Number: 5740-000-0326-2) Pink: Local Registrar