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Home My WebLink About4-05-10I Certificate No. 2321 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: Delores & /or Stephen Lino 3970 Old Dixie Highway Malabar., FL .32950 In and for consideration of the sum of $4,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 5, lots 9 & 10 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 2"d day of February, 2012. CITY OF EBASTIAN, FLORIDA ATTEST: AI Minner Sally A. Oio, MMC City Manager Ci . Clerk Name—&-&,1 b Ie,-r7 • /I ,E?/ L Unit Block Lot "1 C Date of Mark-out- Date of Burial � ! / Time :L"Q�Q. '02�� Name of Funeral Home x Authorized by DELORES LINO Mrs. Delores "Dee" Lino, 71, died May 9, 2013 at Vitas Hospice in Merritt Island. She was born June 25, 1941 in Washington DC and lived in Sebastian and Malabar for 34 years coming from Bucks County, Pennsylvania. She was the Owner /operator of the Dee's All Breed Pet Resort that she and her late husband, Steve, designed, built and operated from 1999 to 2013. She was a member of the United Schutzhund Club of America. Survivors include son, Mike Lino of Fort Myers. She was preceded in death by her husband, Stephen in 2012. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY �Tlq� HOME OF PELICAN ISLAND 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 FUNERAL HOME: STFiUNK FUNERAL HOME & CREMATORY ADDRESS: o. en SEBASTIAN FL 32958 PHONE #: (772) 589.4000 (Check Ones OPEN BURIAL LOT Lot 10 Block �_ Unit OPEN CREMAINS LOT Lot Block Unit n �� OPEN COLUMBARIUM NICHE Niche Block Unit l� � E Wj�� BURIAL DATE AND SERVICE TIME: S <, vV FOR DECEASED: �L l U I—A_n U Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide pro documentation of ownership) Na-2 Sign 4t 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. NAME AND SIGNATURE OF LICENSED FUN L DIRECTOR: Name ignature 6 Date Cemetery Sexton Certification: 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: ,� � 0 4, �Y-) � � � - S io Ce ete Sexton D16te This form to be provided to Clerk's Office by Sexton for permanent record upon completion, FL7RILs.DiIAACGiEwTOE' ,.' State of Florida, Department of Health, Bureau of Vital Statistics H LT EA BURIAL TRANSIT PERMIT DATE PRINTED: May 9, 2013 TRACKING NUMBER: 2013069572 1. DECEDENT INFORMATION Name of Deceased Date of Death DELORES JONES LINO May 9, 2013 Place of Death - County City, Town or Location Name of facility, or street address if not a facility BREVARD MERRITT ISLAND VITAS HOSPICE OF COURTENAY SPRINGS Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No. /Reg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589 -1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director /Direct Disposer Fla. Lic. No. /Reg. No. TIMOTHY W. MARVIN F022789 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2013- F041870 -5078 t Date Issued: May 9, 2013 !� J Meade Grigg, State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY ) A ' Method of Disposition: BURIAL Date of Disposition: EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10/12 64V- 1.011, Florida Administrative Code CITY OF SEBASTIAN CITY CLERK'S OFFICE 4377 RECEIPT Name �fr U n tom/ f/ _ ! i� (r) ❑ Cash Date 5— 15 — I S YCheck #�! 06 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 601010 343800 Cemetery Lots Lot/Niche , Block , Unit_ 001501 343805 Cemetery Fees Q'& /_56'00 Total Paid J Initials White -Dept. of Origin • Yellow - Finance •Pink - Applicant Total Paid Zk-w. Initials White - Dept. of Origin • Yellow - Finance a Pink - Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name / '' t r y Lin o ❑ Cash Z-2-1Z Check # Date No Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees QUO 00 601010 343800 Cemetery Lots //',1 LotlNiche --00, v , Block_, Unit 41 001501 343805 Cemetery Fees Total Paid Zk-w. Initials White - Dept. of Origin • Yellow - Finance a Pink - Applicant My Of VERAST t 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. e rye -s o-oa /o r s %ego H n L � �, Name(s) 3870 Old D(ule (Awy, Modabar. i:�'c- 3250 Address I 729-- x473 Area Code & Phone umber Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: JJLG� Dollars ($ )nQ U on this. Z, r'd day of Fib , 20 1 Z for the purchase of the following described Cemetery Lot(s) and /or Niche(s). Unit 4 Block , Lot(s) / G 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) Temporary Marker Preparation & Installation Signature of Purchaser !:\VHIN- DATA \Ms - Cemetery \RECEIPT. doc Interment /W O H Circle One Disinterment TOTAL $ z0 LCD . O O 1j6&VQt& �jj&alr� C # of Sebastian The following documents were provided as Proof of Residency: and •r