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Home My WebLink About4-17-01rT OF 70ME OF PELICAN ISLAND Certificate No. 2084 A i'i 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: Joyce Streeter 351 Biscayne Lane, Sebastian, FI 32958 (name) (address) in and for consideration of the sum of $1,400.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit 4_ Block _,17_ Lots/Niches-1 & 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 17d' day of May 2006. OF SE ASTIAN, FLORIDA ATTEST: Minner S Maio, MMC City Manager City Clerk Name /r/ S .C� �J' �/ 721 1Y �. ✓r'' G�Unit Block Lot / Date of Mark -out r Date of Burial 'rb 6 Time /"/ ' �' ' �' 6}1C�� Name of Funeral Hme i,� w Authorized by Cj u r FLORIDA DEPARTMENT OF HEALTH State of Florida, Department of Health, Vital Statistics 7 APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased CHESTER JAMES STREETER of MAY 13, 2006 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County MELBOURNE Hosp. or HOLMES REGIONAL MEDICAL CENTER BREVARD Inst. 3. Name of Medical Address Phone Number Certifier CRAIG DELIGDISH, MD 95 BULLDOG BOULEVARD Medical Examiner Physician MELBOURNE, FLORIDA 32901 321-727-3495 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING STREET SEAWINDS FUNERAL HOME SEBASTIAN, FLORIDA 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 b• [:] 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. IVE 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/ Si net a F.E. No./Reg. No. Date Signed Direct Disposer 2294 MAY 15, 2006 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 06-2617-099 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 rtif eh b en requested. Registrar or - Date Date Certificate Subregistrar Signature Issued: MAY 15, 2006 Dye: MAY 19, 2006 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition URIAL STORAGE Date of Disposition CREMATION MOTHER (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, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar a-7" `� 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 Name(s) Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: G� Dollars ($/, L on this i" day of , 20=16 for the purchase of the following described Cemetery Lot(s) and/dr Niche(s). Unit Block , Lot(s) / J;(,�. 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 750 O W O H Circle One Vase and Ring for Niches (cost) Interment Signature of Purchaser of Sebastian Disinterment AL $/ Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEIPT.doc MY Y ('�i�•. VPELICAN KOME 4F 15+:M.P+ID City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Name(s) Address Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: G� Dollars ($/, L on this i" day of , 20=16 for the purchase of the following described Cemetery Lot(s) and/dr Niche(s). Unit Block , Lot(s) / J;(,�. 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 750 O W O H Circle One Vase and Ring for Niches (cost) Interment Signature of Purchaser of Sebastian Disinterment AL $/ Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEIPT.doc a1Y OF SE-.low HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FI 32958 ...Telephone 772-589-5330 ... Fax 772-589-5570 August 18, 2005 Esther Marie Craig -Rea 472 Rolling Hills Drive Sebastian, Fl 32958 Dear Ms. Craig -Rea: According to our records, you requested we hold the following cemetery lot(s) and/or niche(s) for you: Unit 4, Block 17, Lots 1 & 2 The city does not accept credit cards or installment payments, therefore, as a courtesy it does agree to hold lots/niches for thirty (30) days to allow family members time to exercise their financial options or think of their future needs. If we do not hear from you before September 8, 2005 we will assume you are no longer interested in the purchase of the lots/niches. If you have any questions regarding this matter, please contact Cemetery Sexton Kip Kelso at 589-2545. Thanks for your attention to this matter. Sin , Sally A. o, MMC City Clerk SAM/ar a MY of rj r1 � �1` ��` ,.+� � { � r •tit HOME OF DELI N PSI AND 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 — Fax (772) 589-5570 May 17, 2006 Mrs. Joyce Streeter 351 Biscayne Lane Sebastian, Fl 32958 Dear Mrs. Streeter: Enclosed is City of Sebastian Certificate 2084 entitling you to full interment rights in Unit 4, Block 17, Lots 1 & 2. 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, Sally Maio, MMC City Clerk SAM:ar enclosure