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Home My WebLink About4-11-35Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Annegret A. Falldorf 415 Loquat Drive, Barefoot Bay, FL 32976 (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 lot: Unit 4, Block 11, Lot 35 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 21St day of December, 2009. CITY OF SEBASTIAN, FLORIDA ATTEST: /HI I V III II ICI ity Manager {ar Sally A. Maio, MMC City Clerk Mr F�cldorf fiv�ed hLs w( es rid-me orn Vie. deed. MOF HOME OF PELICAN ISLAND Certificate No. 2241 MYU SEBASTIAN Certificate of Inte DaetZt Rights IN ACCORDANCE with provisions of the de of rdinances of the City of Sebastian, it is hereby certified that: Chdstel Falldo 415 Loquat Drive, Barefoot Bay, FL 32976 (name) (address) In and for considers n of t su of $2,000.00 is entitled to full interment rights in the 5ebastia Municipa emetery for the following lots: Uni 4 Block 11 Lots_ ofd bastian Municipal Cemetery,, as maintained o 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 21st day of December, 2009. rY SEBASTIAN, FLORIDA Al I , I& �- Minner City Manager ATTEST: Sal A. Maio, MMC City Clerk Certificate No. 2241 CITY 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: Christel Falldorf 415 Loquat Drive, Barefoot Bay, FL 32976 (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 11 Lots 35 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 21st day of December, 2009. SEBASTIAN, FLORIDA AI Minner City Manager ATTEST: !A Sal y`A. Maio, MMC City Clerk Name " Unit Block ref 1'a lIOcRF Lot Date of Mark -out moo q Date of Burial /P Gj � }ime " Name of Funeral Home ,f Authorized by Annegret A. Falldorf AnnegretA. Falldorf, 72, died Dec. 21, 2009, at Holmes Regional Medical Center, Melbourne. She was born in Dortmund, Germany, and lived in Barefoot Bay for 10 years, coming from Long Island, N.Y. Before retirement, she worked for a caterer in a bakery. She was a former member of the German - American Club, Vero Beach. Survivors include her husband of 50 years, Christel Falldorf of Barefoot Bay; son, Peter Falldorf of Colorado Springs, Colo; and two grandchildren. SERVICES: At the request of the family, services will be private. Burial will be at Sebastian Cemetery. A guest book may be signed at strunkfuneralhome.com. Arrangements are by Strunk Funeral Home and Crematory, Sebastian. Published in the TC Palm on December 23, 2009 FLORIDA DEPARTMENT OF �y ^ L 1 State of Florida, Department of Health, Vital Statistics r APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Annegret A. Falldorf Death 12/21/2009 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Melbourne Inst. Holmes Regional Medical Center 3. Name of Medical Address Phone Number Certifier Srinivas Dontineni 675 S. Babcock Street Medical Examiner Physician Melbourne, FL 32901 321/952-3163 4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral 1623 N. Central Avenue Homes 6 Crematory Sebastian, FL 32958 F041870 772/589 -1000 5. Check a. [--j The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. gg Dr. Dontineni_ M. D. was contacted on 12/21/2009 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that SriniyaS Dontineni. M.D. will complete and sign the medical certification of cause of death within 72 hours. c F-1 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/ Signature F.E. No. /Reg. No. Date Signed F044048 12/21/2009 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -09 -0623 Rg(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. F] No extension of time for filing the death certificate has been requested. - QA@*4wx.or Date Date Certificate Subregistrar Signature Issued: 12/21/2009 Dqe: 12/25/2009 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 Sebastian Cemetery FICURIAL STORAGE Date of Disposition CREMATION OTHER (Specify) Signature of Sexton 1 or Person -in- Charge 1 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 IQ—, nl, �...�....� 11— nnn —1. 11 Dino- 1 —.1 P— ict... • OWP i i� CITY OF SEBASTIAN CITY CLERK'S OFFICE 1 Rrr'CIDT Name Cash ❑ Check # No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche _3_- Block Unit 001501343805 Cemetery Fees jame O/� Total Paid J(J� I White - Dept. of Origin • Yellow - Finance • Pink - Applicant Q�- / 6o 2 11(�DG 72v �zo TO r sTA n�Enrr 094528 Date �Zi ." Ff C,) ` llz f� F f�, 0� f) / / y TERMS IN ACCOUNT WITH .��` ,� �< � , ..,� .� � C ` ,� �✓ji�' ,ifs �� Stock Form 25812 04/13/2010 10:08 7725892583 0313012010 14:98 Star �P. U (Bak 159 F1Fe.ec�t, l,�A lud:1S T 1 brl!!•141714i q! N* 291.71)13 :gold To. SEEIAS -iW4 C -APEL DAVID HINCEMAN 1823 NORTH CEN -RAL AVE 5EBAS 'iAN, FL 32959 Phr,ne 772.589.10001 Fax 7 ":•589.2583 Sh p Via PDO; RUCK Eshn•ateu Ship Date 0447/10 -arms �iET 30 DAYS Freigrit P REPAY STRUNK FUNERAL HOME PAGE 04 (FAX) F.00I tool Order Acknowledgement Acknowledgeirent No 731.0 Sales Order Date. 0309110 Page 1 snip To 5. RUNK FL -NERAL HOME JUANITA 916 17TH S-. VEPO BEACH, Ft_ 32960 Phone 772.466 -1955 pax: Cistomer !D 4199 Saes Quote No P.O Number P O Date 03/•: 9;10 Saier0arson TERRI REEL Quantity Item No. Color L?escllption 1 SLANTI-0 STAR BLUF 3.6 X 1.0 X 1 -6 PSF Sawn Back BRP Rock Pitched Serp Top CARVE d, LETTER, PCP ATI ACHED, SLACK. LITHO R:F, r"A, LDOkF SEND DRAWING F GR APPROVAL. 1 BASE u- y STAR BLUE 4.6 X 1.6 x a6 PFT BRP I fe D '/I0 Ae y� t>o74