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Home My WebLink About4-28-17Name Unit Block Lot -W 17 Date of Mark -out Date of Burial I - r (i - Ok..) Time k k 0 0 Name of Funeral Home-, Authorized by I Name Unit Block Lot Date of Mark -out Date of Burial _ -7 :S _Time Name of Funeral Home Authorized by Citu of orbatiliau r ti` L 1 4 4 g D L[ .l+ NO. THIS INDENTURE MADE This ......... 25th ...... day of ..............January ..................... A. D., ]DC2000 betsceen Ibe City of Sebastian, a municipal Corporation existing under the laws of the Stale of Florida, as Grantor and Loran Tomberg ................................................2:D': .Box'89................................................................... Wabasso, 32970 ................................................................FL..................................................................... of the County of Indian. River ......... ........ ................................ an'i slate of .....FJ.or7. ..................... as Grantee, WITNESSETHr That the Grantor for and N consideration of the sum of S 750.00 ................. to it la hand paid, the receipt whereof Is herewith ao- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee her...., built, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: AB of Lot(s) 17..... Black, .28 ..... UNIT ...4 ........ , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being in Indian Rival County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of mid cemetery. The conditions, restrictions and requirements contained in this instrument shall be covenants running with the land. In the event of the failure of the owner of any properly situated within rid cemetery to ob- serve and comply with inch rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner in and to said property shall terminate and the mine shall roved to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has mused this instrument to be executed in its name and on its behalf by its Mayor and attested by Its City Clerk and its corporate seal to be hereto affixed, the day and year fust above written. CITY OF SEBASTIAN, /FLORIDA ............ Aliestr Mel e City Clerk Signe) 1115is d seed Delivered In it. Pre nee ofe '�// �.. / // ........ ............... (OIitg deal) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ......... 25th ......... day of ................. January ........ ................• 7nt2000 Chuck Neuberger and Kathryn M, 0 Ha11QKan_....... r before are y Mayor nit City ...•univ.1 l c .p .... rmpeelively Mayor end Cily Clerk of the City of 9ehnRUnn, n municipal corporation under the lawn of the Stale of FIorIJa to me known to be the individuals and officers described In unit who execuled the fatiguing cuavnyunm to J,ozone..Toloberg........................................................... and severally acknowledged the execution thereof to be their free act and deed a9 such officers thereunto duly nuthorlsedi and that the Official scut of said corporation Is duly affixed lhwxle.—@nd the avid curve ace is the act and deed of mid corporation. WITNESS my signature and official seal at Sebastian, last aforesaid. UNDAM.OALLEY Mf COMMI®BION f OC 712 78 EXpIR{&Juni 10.2% @P'diA R.N trig raseiss u,eaRRa,s year A_V9CI:w/041:3aI:7IMA Kathryn May "Kathy" Berry, 75, of Palm Beach Gardens, passed away March 16, 2013. She came to this area in 1973 from Pennsylvania. Kathryn had owned a motel, managed rental property and drove a school bus. She also was a foster mom for many children. She is survived by three daughters, Lori (Mark) Tomberg, Diane (T.R.) Hoffman, Charlene Tommeraas; seven grandchildren and six great-grandchildren. is From: on this Description of Property: Cemetery Purchase Terms an� The Sebastian Cemetery City of Sebastian, Florida �.' 166 Wil��II�,&A� . L. ' 20__nZ for the purchase of the following terms and conditions as stated herein: Unit This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: signature Purchaser signature The Ci;y of Sebas green to sell the above mentioned property to the above named purch er(s) on th . en and conditions stated in the above instrument. Witness .-\ City of Sebastian 1225 Main Street 0 Sebastian, Florida 32958 Telephone (561) 589-5330 0 Fax (561) 589-5570 E -Mail: cityseb@iunet January 28, 2000 Mrs. Lorane Tomberg P.O. Box 85 Wabasso, FL 32970 Dear Mrs. Tomberg: Enclosed is Cemetery Deed No. 1709 for Lot 17, Block 28, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. Ifyou wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, P. O. Box 1028, Vero Beach, Florida 32960 or you may call or call the Department of Revenue at (904) 488-9487 for more information regarding the completion of this form. We are enclosing two copies of each the receipt and ask that you sign and return to us the copies marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience. ire,;�. r D "jeft- Kathryn M. O'Halloran, CMC/AAE City Clerk KOH:hng Enclosures FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5EBA"TV noxi u. rrs¢.e nu,: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 FUNERAL HOME. ADDRESS: PHONE #: (Check One) OPEN BURIAL LOT Lot Block Unit =OPEN CREMAINS LOT Lot Block _unit _OPEN COLUMBARIUM NICHE Niche Block Unit W BURIAL DATE AND SERVICE TIME: FOR DECEASED: e e rvame 14AME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) M 141114 D tM d �t) /'�a��i F 720 �3 Name Signature Date I certify that) have determined the ownership of t above described site that all site fees and administrative fees have been paid and authorize opening of same NAME AND SIGNATURE OF LICENSED FUNERAL DIREC-f OR. Name 1A. Signature Dale 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 Ceme1 y Sexdon Date. This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Permission is hereby granted to dispose of this body. Permit No. 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. Registrar or Date Date Certificate Subregistrar Signature Issued: 1/17/00 Due: 1/19/00 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Q Approval Number: Dale 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. Method of Disposition: Xj BURIAL CREMATION Signature of Sexton or Person -in -Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Date of Disposition Sebastian Cemetery 01/19/2000 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. Dislnbubon: Whde: Cemeteryor Crematory DH 326, a97 (Obsoleles all previous editions) Yelkm: Feral Director or Dvea Disposer (aleck Number57404]00-0326-2) Pink: Loral Registrar FLORIDA DEPAK7MENr OF � Sta f Florida, Department of Health, Vital S�ics 29 17 HEALT APPLICATION FOR BURIAL - TRANSIT PERMIT A. (TYPE) - 1. Name of First - - - -Middle Last Date Month Day Year Deceased of Melissa Kathleen Kimmel January 14, 2000 Death 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Palm Beach West Palm Beach Inst. 5903 Pointsettia Avenue 3. Name of Medical Noel Palma, M.D.M.E.26 Addryf Gun Club Road Phop�Ntirllb9r88-4575 l bl1 Certifier West Palm Beach, FL 33406 Medical Examiner Physician 4. Name of Funeral Home/Direct Disposal Add rQ�,s22 N.E. 4th St. llbb Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment Scobee—Combs—Bowden Funeral Homel Boynton Beach FL 33435 1891 (561) 732-8151 5. Check a. rX-1 The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. - Box b. - 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. C. 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//JJ F.E. No./Reg. No. Date Signed Direct Disposer ��//�' '8.n'e' 1750 1/17/00 B. BURIAL - TRANSIT PERMIT 1891-00-7 Permission is hereby granted to dispose of this body. Permit No. 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. Registrar or Date Date Certificate Subregistrar Signature Issued: 1/17/00 Due: 1/19/00 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Q Approval Number: Dale 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. Method of Disposition: Xj BURIAL CREMATION Signature of Sexton or Person -in -Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Date of Disposition Sebastian Cemetery 01/19/2000 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. Dislnbubon: Whde: Cemeteryor Crematory DH 326, a97 (Obsoleles all previous editions) Yelkm: Feral Director or Dvea Disposer (aleck Number57404]00-0326-2) Pink: Loral Registrar 415349 STATEMENT DATE � 27 i3 TERMS D IN ACCOUNT WITH 7+N' e 7-45 0 60 CURRENT OVER 30 DAYS OVER 60 DAYS TOTALAMOUNT $Wadsm-o ,z CITY OF SEBASTIAN CITY CLERK'S OFFICE 4363 RECEIPT Name c5ft b ee— Ct m bs / B e.YY U ❑ Cash Date �� J I}jCheck# F-1 71 No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010343800 Cemetery Lots Lot/Niche Block Unit 001501 343805 Cemetery Fees Total Paid Initials White - Dept of Origin • Yellow - Finance • Pink Applicant 4-Z8- E? Paid by CEMETERY Receipt No ................. Dated ......1I25f OO... NO. List Price $ 750' �� Maximum No. Burial Spaces ................. Net Paid $ .750 00 Monument permitted ....................... (Data above this line for City Record only)