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Home My WebLink About4-17-29MY OF SF*BAS,TIAN HOME OF PELICAN ISLAND Certificate No. 2031 CIT Y 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: Clarence & Loretta Epsilands 481 Kendall Avenue, Sebastian, Fl 32958 (name) (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 Lots _29 & 30_ 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 8th day of August, 2005. G1 SalmitvClerk o, O I We- MIA Q • Unit Block Lot Al n Date of Mark-out- Date of Burial ! /D Time ll ot7 Name of Funeral Home Authorized by CITY OF SEBASTIAN 4420 CITY CLERK'S OFFICE 4 RECEIPT Name, ) I f ar) k L /C S_ 1 !_ar) f►S ❑ Cash ' — �`t C G 555 Date YCheck# 1 No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche , Block Unit ^� 001501 343805 Cemetery Fees " —C,f<. r�-- Total Paid Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant rhue- FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY G1Y(i NOME OE ►Eucm mAm For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8294 Fax: (772) 589 -5570 STRUNK FUNERAL HOME & CREMATORY FUNERAL HOME: AA,-% ADDRESS: SEBASTIAN, FL 32958 PHONE #: (OPEN BURIAL LOT Lot 2-61 Block Unit_ end 2p31 OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: 1 ��' �N�►� -Q l - EI 50 FOR DECEASED: C Ce- t 0-01 aIs I ( Qrdi s Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Nvfme agnature at 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 Name iI g 201( Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Z�� J, ..'a ��Z - — ///? xj Ceofiete Se'xion Da e This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CLARENCE NICHOLAS "CLEP" EPSILANTIS Born March 2, 1928 - Baltimore, MD Died November 8, 2011 - Vero Beach, FL Mr. Clarence Nicholas "Clep" Epsilantis, 83, died November 8, 2011 at VNA Hospice House, Vero Beach. He was born in Baltimore, Maryland and lived in Fellsmere for 22 years coming from Annapolis, Maryland. He worked as a Conductor for B >:t 0 Railroad in Maryland for over 42 years having retired at the age of 60. He served in the US Marine Corps during World War II. He was a member of the Lion's Club in Fellsmere. Survivors include his sons, Nicholas and Clarence A. Epsilantis both of Fellsmere; daughter, Cynthia Fischer of Sebastian; stepdaughter, Annette Casas; 10 grandchildren; 13 great - grandchildren. He was preceded in death by his wife of 56 years, Loretta; stepson, Joseph Quinn. FLORIDA DEPARTMENT OF HEALTIT' 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 Clarence Nicholas Epsilantis of November 8, 2011 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Indian River Vero Beach Hosp. or VNA Hospice House Inst. 3. Name of Medical Melissa Dean M.D. Address Phone Number Certifier 3745 11th Circle Suite 105 Vero Beach, Florida 32960 (772) 567 -1500 Medical Examiner hysician 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral Home 1623 North Central Avenue Sebastian, and Crematory Florida 32958 F041870 (772) 589 -1000 b. t;neck a. IJ Appropriate Box c. EJ I he medical certification has been completed and signed. A completed certificate of death accompanies this application. Sf c D i , was contacted on < < 12S I (�D I I He /she verified that thiia deeat�h, was from natural causes, that there was no accident nor other external cause of death, and that 15 IJL� will complete and sign the medical certification of cause of death within 72 hours. was contacted on medical certification of cause of death within 72 hours. He /she verified that Medical Examiner, will complete and sign the 6. Funeral Director / 1 n ,S�ignatu F.E. No. /Reg. No. t S' d D4act- 04poser -C.y 1� — f ,� k 1 F042972 (' -- B. BURIAL - TRANSIT PERMIT Per fission is hereby granted to dispose of this body. Permit No. 1228 -11 -516 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. E]No extension of time for fili g the ath cei*fieate F►as been requested. Registrar or ` t , , p Date Date Certificate Subregistrar Signature V� V y v ---, Issued: 11/8/2011 Due: 11/13/2011 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 BURIAL STORAGE Date of Disposition - l�AC> 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 in the county where disposition occurred. DH 326, 8197 (Obsoletes all previous editions) (Stock Number: 5740- 000 - 0326 -2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar CITY OF SEBASTIAN CITY CLERK'S OFFICE 3 3 2 9 RECEIPT Name h. cS % 1(,c /1 -1-i S ❑ Cash Date O ' �� Check No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopleslBki Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche A Block / 7 Unit `r 001501343805 Cemetery Fees Total Paid Noo. 00 Initials White - Dept. o Origin • Yellow - Finance • Pink • Applicant arf or SEISAST%N HOME OF PELICAN ISLAND 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 C yI l- f -` j Q FIS C—h e v 4 r IN � Mrs, C(ay-ence. Lis I (ao tis Name s) s e bast l Q ri , F 3 L Z 95S �- 1 Ke�►d� 11 fl �� . Address -7 -7J) 5Nq- 8�0 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: / -jittmud Dollars ($ 6(),(00 ) on this � day of CLSf , 20 Q5 for the purchase of the following described Cemetery Lot(s) and /o Niche(s). Unit_, Block % 1 , Lot(s 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) Signature of Purchaser Interment Disinterment W O H Circle One TOTAL $ 71ty of Sebastian Service fees are to be paid at time of need only I: \W W- DATA \Ms - Cemetery\RECEI PT.doc 1225 Main Street, Sebastian, F132958 Telephone (772) 589 -5330 — Fax (772) 589 -5570 August 8, 2005 Ms. Cynthia Fischer & Mr. & Mrs. Clarence Espilantis 481 Kendall Avenue Sebastian, Fl 32958 Dear Mr. & Mrs. Espilantis: Enclosed is City of Sebastian Certificate 2031 for the purchase of Cemetery Lots 29 & 30, 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. Si e ly, Sally A. o, MMC City Clerk SAM: ar enclosure