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Home My WebLink About4-10-18CITY Of HOME OF PELICAN ISLAND Certificate No. 2183 CIS 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: LaVerne Raines 36 Treasure Circle, Sebastian, FL 32958 (name) (address) 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 10 Lots 17 & 18 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 10th day of June, 2008. CITY )DF S,T )BASTIAN, FLORIDA ATTE Al Minner ty Manager Sally A.'laio, MMC Citv Clerk Name Unit Block /0 Lot /8 Date of Mark -out Date of Burial-� / f ''� A, q Time Name of Funeral Home cam) q _- a Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE 4176 i RECEIPT I Name itm cs koj o es ACash Date q-3-09 ❑ Check # No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bld Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots ' QQ /1 iche Block V Unit Lo �, , l y UU 001501343805 Cemetery Fees • Total Paid / 0. D 0 Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant Obituaries I Death Notices I Newspaper Obituaries I Online Obituaries I Newspaper D... Page 1 of 1 Donate Now JAMES RAINES James E. Raines, 71, died June 4, 2008, at his home. He was born in Rector, Ariz., and lived in Sebastian since 1986, coming from St. Louis. He retired as manager of the Wabasso KOA Campground. He was a member of St. Sebastian Catholic Church and the Eagle Aeries Lodge 4067. Survivors include his wife of 50 years, LaVern Raines; sons, Marc Raines of St. Louis and Timothy Raines of Clearwater; daughters, Vickie Elbrecht and Deborah Kauffman, both of St. Louis, and Brenda Kahn of Sebastian; brother, Bill Raines of West Plains, Mo.; sister, Norma Volner of West Plains; and 10 grandchildren. Memorial contributions may be made be made the American Heart Association, 1101 Northchase Parkway Suite 1, Marietta, GA 30067. SERVICES: Visitation will be from 3 to 7 p.m. June 9 at Seawinds Funeral Home, Sebastian, with a wake service being at 6:30 p.m. A funeral Mass will be at 10 a.m. June 10 at St. Sebastian Catholic Church. Burial will follow in Sebastian Cemetery with military honors conducted by Sebastian River Area Veterans Honor Guard. A guest book may be signed at Seawindsfh.com /obit.php. Published in the TC Palm on 6/8/2008. Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact Legacy.com • Terms of use Powered by Legac." r.GC►111 obituaries nationwide Back http:// www .legacy.com/tcpalm/Obituaries. asp? Page= LifeStoryPrint &PersonID= 11116... 6/10/2008 F[ARIDA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased JAMES EDDIE RANINES of 6/4/08 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County or. INDIAN RIVER SEBASTIAN Instp 36 TREASURE CIRCLE 3. Name of Medical Address Phone Number Certifier EDGAR R. BLECKER, MD 229 SEBASTIAN BLVD F-jMedical Examiner Physician SEBASTIAN, FL 32958 772 - 581 -0016 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 735 FLEMING ST SEAWINDS FUNERAL HOME SEBASTIAN , FL 32958 2617 772- 589 -1933 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box was contacted on He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that 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 mediq certification of cause of death within 72 hours. 6. Funeral Director/ Si na F.E. No. /Reg. No. Date Signed Direct Disposer , FO 44126 6/5/08 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 08- 2617 -107 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 certifi ha n requested. Registrar or Date 6/5/08 Date Certificate6/10/08 Subregistrar Signature Issued: Due: 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition aw OURIAL STORAGE Date of Disposition �p g} Zo 8 / OCREMATION 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 in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8M7 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer ` (Stock Number: 5740.000 -0326 -2) Pink: Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY MIX SE .,� HOME OF PELICAN ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 FUNERAL HOME: City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax: (772) 589 -5570 A Wi rJA-S ADDRESS: -7-4-S � cffi! N PHONE #: S781-14133 s.-/7&i (Check One) QQ OPEN BURIAL LOT Lot V Block 0 Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: CIF /pt OQ [�(.�LLA0Z FOR DECEASED:f�ry►�,� Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) 40 Von .�, -V6.7 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 ECTOR: Name Signature Date Cemetery Sexton Certification: I certify that I Rave checked the ownership information by viewing the owner's deed and confirming with Clerk's office and Z II fees have been paid: 6 08 . Ce —metky Z Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.