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Home My WebLink About4-17-05My OF SFOIDAST AN HOME OF PELICAN ISLAND Certificate No. 2007 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Velda Clark (name) 517 Fleming Street, Sebastian, Fl 32958 (address) in and for consideration of the sum of $1,400.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit—4— Block 17 Lot—5 & 6 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 1 st day of March, 2005. CITY OF SEBASTIAN, FLORIDA James A. -Davis - Interim City Manager ATTEST7 Sally A. Maio, MMC City Clerk Name v _ ! , h� /✓ f — Unit Lot Date of Mark -out Date of Burial �p 5 Time IF Name of Fune Authorized by 0 (� Opo tD (O tG p f.T O O O O G �C) NJ CA) JFFLORIiRTMENT OF �-ILT V (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT f-- / 7 -6-5- Name as Name of First Middle Last Date Month Day Year Deceased of VIVIAN BEATRICE SHIPLEY Death FEB 24, 2005 Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or ST. LUCIE FT PIERCE Inst. LAWNWOOD REGIONAL MEDICAL CENE R Name of Medical Address Phone Number Certifier RICHARD PENA—ARIET 2100 NEBRASKA AVE 772-461-0915 Medical Examiner X Physician FT. PIERCE, FL 34950 Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING ST 2617 772-589-1933 SEAWINDS FUNERAL HOME SEBASTIAN, FL 32958 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. C. was contacted on He/she verified that , Medical Examiner, will complete and sign the mediQal certification of cause of death within 72 hours. Funeral Director/ Signator F.E. No./Reg. No. Date Signed Direct Disposer 4 2294 2/25/05 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 05-2617-046 ® 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 rti at has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued: 2/25/05 Dye: 3/10/05 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. �. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition URIAL ❑STORAGE Date of Disposition ❑CREMATION ❑OTHER (Specify) Signature of Sexton i or Person -in -Charge Jj '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. Distribution. Yellow e lowFuneral ite Diirecto Dior rectorDirect Disposc, 3t ck Number. r. 5740-0 all previous editions) Pink: Local Registrar hock Number: 5740-000.0326-2) 9 u—kd 5 rym SEBASU&N HOME OF PEUGN MMD 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) C'k9 A-511 Address ` 117-- Sig -�2o 9 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: cpc.-� on this day of ��_ , 20 �s'for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit �_, Block % , Lot(s) 5-* is 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: o0 Corner Markers (set of 4 - $20) Opening & Closing W O 1 H Cir ne Vase and Ring for Niches (cost) Interment Disinterment TOTA $ GC --9 Signature of Purchaser City of Service fees are to be paid at time of need only I:1W W-DATANs-Cemetery\RECEIPT.doc my of 'SIE w HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, F132958 Telephone (772) 589-5330 — Fax (772) 589-5570 March 2, 2005 Ms. Velda Clark 517 Fleming Street Sebastian, F132978 Dear Ms. Clark: Enclosed is City of Sebastian Certificate 2007 for the purchase of Cemetery Lots 5 & 6, Block 17, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. SinWely, Sally A.aio, MMC / City Clerk SAM:ar enclosure a iY OF HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589-5330 — Fax (772) 589-5570 March 2, 2005 Ms. Velda Clart 517 Fleming Street Sebastian, F132978 Dear Ms. Claik: Enclosed is City of Sebastian Certificatc2007 for the purchase of Cemetery Lot: 5 & 6, Block 17, Unit 4. Also enclosed is a copy of dour receipt and the Rules and Regulati(ns governing the Sebastian Municipal Cemetery. If you have any questions, please contact)ur office. Sincerely, Sally A. Maio, MMC City Clerk SAlk:ar enclosure