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Home My WebLink About4-04-40CITY OF HOME OF PELICAN ISLAND Certificate No. 2284 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: Keith Mclsaac 1662 N. Central Avenue, Sebastian, FL 32958 (name) (address) In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 4, Lot 40 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 4 day of February, 2011. CITY OF SEBASTIAN, FLORIDA Al Minner City Manager ATTEST: Sally Maio, MMC City Clerk Name )a de N e )4/1 V yX /tom fide$ Unit Block 4 Lot Date of Mark -out /d Date of Burial 5 711 Time X00 (6/1/1 Name of Funeral Home 5 (eu/i (1 `iAl ke r YI/L Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4279 CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4280 Name r' t t rS eckrnC Cash lame 5 n Ic/tY\c IS act-C Cash Date 2-4 1 R Check 3513 )ate 2 a l 1 XCheck 5 C 2-03 No. Amount Paid Jo. Amount Paid 001001 208001 Sales Tax 101001 208001 Sales Tax 001501 322900 Garage Sales )01501 322900 Garage Sales 001501 341920 Copies/Bid Specs. )01501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances )01501 341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees )01501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots JJ D OC C 601010 343800 Cemetery Lots II Li Lot/Niche 0 Block T� U `r Lot/Niche `'t 0 Block `"C Unit 001501 343805 Cemetery Fees 001501 343805 Cemetery Fees 0156' 0 0 Initials White Dept. of Origin Yellow Finance Pink Applicant Total Paid 1. 000 ;liLairri4 Total Paid ;250. 00 Initials White Dept. of Origin Yellow Finance Pink Applicant DARLA SUE McISAAC (July 28, 1958 January 30, 2011) Mrs. Darla Sue Mclsaac, 52, died January 30, 2011 at her residence in Zephyrhills. She was born in Tuscola, Illinois and lived in Zephyrhills since 2004 having moved from Sebastian where she resided for 20 years. She was the Office Manager for Mclsaac Services. Survivors include her husband of 32 years, Keith Mclsaac of Zephyrhills; sons, Keith (Christina) Mclsaac, Jr. of Vero Beach, Kevin Mclsaac of Sebastian, Kirk (Barbara) Mclsaac of Zephyrhills; mother, Loretta Henderson of Vero Beach; brother, George Henderson of Zephyrhills; sisters, Sheila (Rick) Walker of Vero Beach, Cindy (Lee) Hall of Vero Beach; grandchildren, Gavin, Anna Rose and Owen. She was preceded in death by her father, George Henderson and grandparents, Alice and George Henderson and Louise and Martin Beccue. 1. Name of First Middle Last Deceased DARLA SUE MCISAAC Date Month Day Year Death 01/30/2011 2. Place of Death City, Town or Location County PASCO ZEPHYRHILLS Name of (If neither, give street address) Hosp. or Inst. 33740 MANDRAKE ROAD, ZEPHYRHILLS, 3. Name of Medical Certifier NOEL A. PALMA nMedical Examiner 1 Physician Address 10900 ULMERTON ROAD LARGO, FLORIDA 33778 Phone Number 727/582 -6800 4. Name of Funeral Home /Direct Disposal Establishment R FUNERA HOMES CREMATORY Address 623 N N. CENTRAL AVENUE SEBASTIAN, FL 32958 Fla. Lic. No. /Reg. No. FO 41870 Phone No. (Area Code) 772/589 -1000 A. 5. Check Appropriate Box 6. Funeral Director/ r B. C. Approval Number: Medical Examiner, (TYPE) a. b. c. DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740 -000- 0326 -2) The medical certification has been completed and signed. A completed certificate of death accompanies this application. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL TRANSIT PERMIT 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. medical certification of cause of death within 72 hours. Sign t re i vt_ti was contacted on F.E. No. /Reg. No. Date Signed F044048 02/01/2011 Medical Examiner, will complete and sign the BURIAL TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -11 -0054 pg 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. D No extension of time for filin the death certificate has been requested. flogietooP or A 1 Date Date Certificate Subregistrar Signature INULN Issued: 01/30/2011 Due: 02/03/2011 AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Date 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 5 t<ALA/ (:1-..-, 7 BURIAL STORAGE Date of Disposition DCREMATION OTHER (Specify) Signature of Sexton or Person-in-Charge He /she verified that 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 Yellow: Funeral Director or Direct Disposer Pink: Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBASTLAN FUNERAL HOME: ADDRESS: PHONE (77'2 Name Cem tery'e HOME a ►EtK&n tsw+o 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 -8214 Fax: (772) 589 -5570 (Ch ck One) OPEN BURIAL LOT Lot '5Jo Block "r Unit _OPEN CREMAINS LOT Lot Block Unit -OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: /3 a ,5/1 1 7 :oo FOR DECEASED: Ja r I N\ c-I aC3zc_ name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR. 2 Date W Mc--1-5ctot cheefitie4,1, %,I.A,:i2W1034/-t 1 KeAAN 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 Signature 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 This form to be provided to Clerk's Office by Sexton for permanent record upon completion. f< 611 114 sa L) Y), Corner Markers (set of 4 $20) Vase and Ring for Niches (cost) Temporary Marker Preparation Installation Signature o Purchaser I:\WW- DATA \Ms Cemetery\RECEI PT.doc 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, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) (06,1 N. Confral !e, Sebastian 3zg58 Address 9 Area Code Phone Number Name Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: (94c02 J1)t&t( Q, Q //t Dollars /,000_ on this 4 day of Feb ra 20 11 for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 4 Block q Lot(s) L0 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: Opening Closing W 0 H Circle One Interment ity of Sebastian Disinterment TOTAL ®®a vv The following documents were provided as Proof of Residency: and Kecy rvt,o ad 4- 6) 0- fro c c ct mc� 5Lf DO r Sf \rdo gec FL 3 29(0 7 C z 5 �f ret*( U► 14QC14_11v\c,rk IS ke:*(n's 5 5 f-eK Indian River County, Florida Property Appraiser Property Data Data For Parcel 30382100001999900012.0 Base Data Parcel: 30382100001999900012.0 Owner: KEITH DARLA MCISAAC Site Address: 1662 N CENTRAL AV, SEBASTIAN, FL 32958 Mailing Address Property Information Address: PO BOX 780576 Tax Code: 2A City State Zip: SEBASTIAN, FL 32978 TOWN OF WAUREGAN Photos [4-] Click to enlarge. Notes Report Discrepancy i Map this property. Property Use: Neighborhood: Legal Description Click here for full legal Secondary Owners description No additional owners found. Notes: Click here to view oblique imagery through Microsoft Live Maps. 0100 SINGLE FAMILY IMPROVED 010001.00 ROSELAND EAST RR TO US #1 Real Appraiser CH CHARLIE HEATH Date: 1/26/2006 GIS parcel shapefile last updated 2/1/2011 12:16 :42 AM. G4MA database last updated 2/1 /2011 12:32 :22 AM. Page 1 of 1 http://www.ircpa.org/Data.aspx?ParcelID=30382100001999900012.0 2/1/2011