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Home My WebLink About4-28-35Name Unit Blocks Lot Date of Mark -out - 3. Date of Burial / /IA Z/ V Time /;C>"� zz Name of Funeral Home Authorized by o-� Titg of Jorhastian \Y D m .G L p L jj a Ss p b NO. •''1629 2nd June 98 THIS INDENTURE MADE Thla ...................... day of ............................................. A. D., 19....... between [lie City of Sebastian, a municipal Corporation existing order the laws of the State of Florlda, as Grantor and ..................................... J=than.A.. and/Dr..Judith. B. -Booth ............................................... 333 Joy Haven Dr .................................... •8ebastiany.F-L..32958......................... ........ .................................... of the County of ...I.. ��!?......................... and State of F..PSistd............................................ as Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of S ..1!.500 :9P to it in hand paid, the recelpt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and conium unto the Grantee 445..... heirs, legal representatives and assigns the following Prpry situ ated 35 is,.Sebanlan, Indian River County, Florida,. to -wit: AS of Lots) ....... , Block,28...... . UNIT 4........... .. I 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 SL Lucie County of Florida; said land now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall beused solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times In accordance with the miss and regulations, ordinances and resolutions of the City of Sebastian, Floridn, hereto- fore, now and hereafter adopted or provided for the government and operation of said cametary. The conditions, restrictions and requirements contained N this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob- serve and comply with such miss, 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 same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first pert 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. Attest. ................................................... CityClerk Sign Sea and Delivered ) In e P nm o7f,� / STATE OF Fr.onIDA COUNTY OF INDIAN RIvaR CITY OFF SEEVASTI�AN,,FLLORIDA By (�..Cg^RIRr. • . ..................... Maya, (Citur jgaul) I HEREBY CERTIFY, That on this 2.4d ...................day of ............ June ........... I ............ 7........ 1998.1 before me personally appeared ...,, Ruth Sullivan allor .......................................... and ."( M. . hr?r��.......O'Han.. ............ respectively Mayor and City Clerk of the City of 9ebeatian, a munlcipnl corporntlon unJer the laws of the State of Florida to me known to be the h.dividuuh and officers described In and who executed thc'foregoing conveyance to Johnathan A. and/or Judith B. Booth ...................................................................................................................................... . ........................................................ and severally acknowledged the =matter as such officers thereunto duly authorised; and that the Official seal of said corporation Is it all Is the act and deed of said corporation. WITNESS my signature and official seal at Sebastlan. In the t only [ Iso Iv orad last afuresald. MY COMMI Sll"11612d ti..• EXPIRES.-Ta,0 1990 Baden Tau Hoary Pub!b bm"es My commission ni rot to be their free act and deed thereto. and the said conveyance / o rids, the day and year h /. .. ...... .................... at Lar. 13 05/13/2013 14:22 Rug 24 2011 10:33PM HP LRSER.IET FAX City of Sebo.rlirvt 4epa,llcu t'rnk[Ml' Ph. or 1072) Sa'1 2545 1,41 fi 1(77,121, . 4927 Halt Thbtr for 11'fPrIIIiIWmkI purneetn re"4VIlihp h1,muevptx ➢1 Srboimmn ('c R7alrr) . Nurr : ']'hit Ir for SlhRlt hlarkcru antirr 2 MA nrrr 2 flt wer,i A. I, 2 Pnurud faondallnn 1 Dry Mix � FOU(Idaii11:1 ) T d0.Sy/ W f r 3 ,1nuc iuunllyd ' ry�ITS Burr : mku.c return to City of SeW4 Wit )✓iGlfi tai-DcSS beb➢St1pR <�POMtrrp 1x11 •rvarlh frnlr➢I Arc, sZ' VA rnas1[,bL._ Antnllne � l P ('emncrr Satan size z -C? 1-0 X 0 - `- 92209 P.001/001 P'Z Name S Delo : HIS: Ill Los 0.0.9. Lagar pesaApltfon : untr : 1.01: square pt Approved By Chackoaay : IWO.' �— E'leamielff / 5 rie v H K v at wovktr at Seas,hc4-, f4V C � WAYNE DOUGLAS BOOTH Mr. Wayne Douglas Booth, 49, died April 9, 2013 at Sebastian River Medical Center in Sebastian. Mr. Booth was born May 3, 1963 in Bay Shore, Long Island, New York and lived in Sebastian for 24 years coming from Pompano Beach, FL. He was a veteran of the US Navy having served on the aircraft carrier USS Independence. He was employed by T Kat Services for 10 years as a Painter. He was a graduate of Deerfield Beach High School. He was survived by his wife of 31 years, Vicki Booth of Sebastian; son, Timothy Booth of Sebastian; parents, Jonathan A. & Judith Booth of Gadsden, Alabama; brother, Kenneth A. Booth of Archdale, North Carolina; mother-in- law, Barbara Coon of Hudson, FL. He was preceded in death by his brother, Jonathan "Jackie" A. Booth, Jr. and father-in-law, Thomas Coon. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBASTfJ� HOW Oi>HIUN ISL1.'D 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 STRUNK FUNERAL HOME & CREMATORY FUNERAL HOME: 1691 Nn. rPntral Ave_ ADDRESS: SEBASTIAN, FL 32958 778) 589 i 999 PHONE #: ( h One) OPEN BURIAL LOT Lot 35 Block 2-2 Unit -_ OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N_S E_W_ BURIAL DATE AND SERVICE TIME: FOR DECEASED: NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Znayan Name Sign re Dee I certify that I have determined the ownership of he above described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL��; Cin rut 60arlS Name 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 the all fees have been paid: 00, e.L/y/� y/ o 0. Cemetery xt n Da e This form to be provided to Clerk's Office by Sexton for permanent record upon completion. FIDRlD.�D� lrh !,moi OF ;' State of Florida, Department of Health, Bureau of Vital Statistics HEALT BURIAL TRANSIT PERMIT DATE PRINTED: April 9, 2013 TRACKING NUMBER: 2013054352 1. DECEDENT INFORMATION Name of Deceased Date of Death WAYNE DOUGLAS BOOTH April 9, 2013 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. NodReg. 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. GARY D. EVANS F065074 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. �v//�1 tn� Permit Number: 2013-Fo41870-5067 QG / / / •j Date Issued: April 9, 2013 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 II'' 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 /' o CITY CLERK'S OFFICE 4 3 6 8 RECEIPT Name Jl F un1V 01 Date No. 0 Cash Check#(00q0 Amount Paid 001001208001 Sales Tax _ 001501322900 Garage Sales _ 001501341920 Copies/Bid Specs. _ 001501341910 LDC/Code of Ordinances _ 001501341930 Election Qualifying Fees _ 601010 343800 Cemetery Lots _ %% qq nit00LoUNiche ,35 .Block Z, Unit-1- 1501343805 001501343805 Cemetery Fees 0/C5f o.vo Total Paid 5U. Initials White - Dept. of Origin • Yellow- Finance • Pink Applicant