The URL can be used to link to this page

Home My WebLink About4-04-28Certificate No. 2300 CITY OF SE S -TIAN1 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Deborah L. White 111 Capri Avenue Sebastian, FL 32958 In and for consideration of the sum of $3,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 4, Lots 26, 27, & 28 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 31St day of May, 2011. CITY OF SEBASTIAN, FLORIDA ATTEST: I t Minner Manager Sally A. Maio, MMC City Clerk T State of Florida, Department of Health, Vital Statistics H LT APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased of Helen L. Britt Death 05/29/2011 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Medical Center 3. Name of Medical Address Phone Number Certifier Richard A. Penly 1265 36th Street Medical Examiner hysician Vero Beach, FL 32960 772/567 -6340 4. Name of Funeral Home /Direct Disposal Abl N. Central Avenue Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment Strunk Funeral bl Homes & Crematory Sebastian, Florida 32958 F041870 772/589 -1000 5. Check a. F-1 The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. : Sharon was contacted on May 30, 2011 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Richard A. Penly_ M.D. will complete and sign the medical certification of cause of death within 72 hours. c. 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/ gn ture F.E. No. /Reg. No. Date Signed �* —Qia r l 11 �j "(,r'1�Q �yj F044048 05/30/2011 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-11 -0264 F] 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. Rivo extension of time for filing th ath certificate -has been requested. Rej+s"&r-or Date Date Certificate SubregistrarSignatur� Issued: 05/29/2011 Due: 06/03/2011 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 CREMATO��,, j� Method of Disposition: Place of Disposition rj� u BURIAL STORAGE Date of Disposition dam IJ 1 3 1 20 i t CREMATION nOTHER (Specify) Signature of Sexton / or Person -in- Charge %S .ice 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 Sep 26 2008 2:45PM HP LRSERJET 3200 FUNERAL DIRECT FOR BURIAL OPEN[ FJNERAL HOfME. ADDRESS: PHONE #: Se otb'c STRUNK FUNERAL 1623 No R'S REQUEST TO CITY OF SEBASTIAN 3 IN SEBASTIAN MUNICIPAL CEMETERY "000 V PELICAN ISLAND �o. iriformatior contact: Kelso - Cemetery Sexton astian Municipst Cemetery (772) 589 -2545 City Clerk's Offte ty Nall, 1225 Main 8freet Sebastian, FL 32958 (772) 388 -8215 or 388 -8214 9099 VIORMATORY Central Ave. 589 -1000 ( One) / /,, OPEIN BURIAL LOT L) l �Slock �' Unit i OPEN CREMAINS LOT L�t._____Block Unit —.OPEN COL'UMBARIUM NICHE N'che Block Unit BURIAL DATE AND SERVICE TIME: O JAM— 3(W' F OR DECEASED: ivarme :JAME AND SIGNATURE OF LOT OWN ER OR REPRESENTATIVE: (^ust rovide Pr rnentaton of c wnersr g +--� L�� 1 2�� A%U Signature Dante I I certify that I have determined the ovvne� ship of the above described site Ihal all site fees and aarninistrative fees have been paid and authorize opening of same vA11E AND SIGNATJRE OF LICENSES F ERAL DIRECT R. _ _ D - h�reWnj ouvid �� Name i 'Signature W Date ------------------------------------------------ i............. _------------------------------------ - - - - -- - -._.. _. Cemelery Sexton Certification: I certify that i have checked the ownersr�ip irmforr.ation by viewing the owner's deed and confirming with Clerk's office and that all fees have teen paid Ceaielerf Sexton, pate This form to be provided to Clerk's Off.c� by Sexton for permanert record upon cornpie ► ton. p.1 Name -/- ��X ��ieiI Unit Block Lot Date of Mark -out Date of Burial Name of Funeral Home , Authorized by �, CM of AC 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. be-bora.h L. Wkife Name(s) H/ f Caaori Ave, Se_bas -han FL 32—g5& Address , �7z)17'- Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser #a(o �2onq(cl b-ftiJe. ft Z.9 Nelern arI'f/ - (tcL5o_r jcinq in Arlin9�n lVa +l Cemcf-ery� #97 Debovah Wh i �� OFFICE USE ONLY J Receipt is acknowledged in the sum of: �t�'l P�I.Q(�XLO(_. Q.�� B-Q ��J Dollars ($ 3000)o )o ) . S 7" on this day of , 20 (( for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit. L4 , Block , 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 150,00 / w O H Circle One Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation 71)cbgt_c� Signature of Purchaser !: \WVV- DATA \Ms- Cemeterv\REC E I PT. d oc Interment Disinterment TOTAL $ 3150. U o ty of Sebastian The following documents were provided as Proof of Residency: and HELEN LOUISE BRITT January 26,1938 -May 29, 2011 Mrs. Helen Louise Britt, 73, died May 29, 2011 at Indian River Medical Center, Vero Beach. She was born in Washington, DC and lived in Sebastian for 30 years coming from Fort Bragg, NC. She was employed by the Army Times Newspaper and the Bureau of National Affairs as a Secretary for the Federal Government. She was a member of St. Sebastian Catholic Church where she was an active member of the St. Sebastian Women's Guild. Survivors include her husband of 50 years, Edgar C. Britt of Sebastian; son, John M. Goheen of Vero Beach; daughters, Deborah L. White of Sebastian and Karen Ann Blair of Middleboro, MA; 7 grandchildren and 2 great grandchildren. 4�j W Total Paid 3150.00 Initials White — Dept. of Origin • Yellow — Finance • Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4305 De by re 1 JliEIe [I Cash Name -3 i V7-0 ( Check # p ' Date No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees UUQ 00 601010 343800 Cemetery Lots Lot/Niche T? , Block Unit 7 001501 343805 Cemetery Fees 4�j W Total Paid 3150.00 Initials White — Dept. of Origin • Yellow — Finance • Pink • Applicant N r 11"Ell L -d 7.GL /PR7.901 C. t w � nn � lJ Q 9 Z � \,it >"4 J o° �v ,q C" ci hid � N F v v � �l P_81 t w � nn � lJ Q 9 Z � \,it >"4 J o° �v ,q ci hid � N co v I sales luewnuoW fgilenr) CP d7.4:r.0 L L An Inf