The URL can be used to link to this page

Home My WebLink About4-28-37Name Unit Block Lot Date of Mark -out Date of Burial_ Name of Funeral Home Authorized by C_.. Time (�PIYIPfPX1J �PP� NO. THIS INDENTURE MADE TWa .5 .................... day of ....�t................................ A. D, 1198 between the City of SebastiaN a municipal corporation '=rating under the laws of the State of Florida, as Grantor and Donald, .1.,, . Barrel.. Gloria. let•.. Bartoo..Falnily.Revocable .Marital .Deduction .Trust -and .............. Revocable Discretionary Needs Trust ...................................574. Croton. .Ave,.. Sebastian; . FL. .32958......... .... ...... ................... ....... of the County of..IDlflail.RlV2r.......................... set State of .........Florida........................... ,. P to Grantee, WlTNE99ETH3 1 000 00 That the Grantor for and in consideration of the sum of 5 ...... )....:.............. to it m paid, W, the mai t whereof is her, with ae knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee thele, hens, legal mpseseataWes d assigns the following property situated in Sebastian, Indian River County. Florida, tawit: 28 of Sebastian All of Lot(s) .3.....6&37 . , Block, ........ , UNIT .... 4 ......... municipal cemetery as per Flat Number f thereof mcordt':d N Flat Book 2, at page 65 of the public mcords in the office of the Clark of the Circuit Court of St. Lucie County of Florida; said land now lying end being in Indian River County, Florida- To lorida To Have and to Hold the same forevm; 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,erncemetery. Flab i, hemto- fore, now and hereafter adopted or provided for the government and operation of said tery. The conditions, restrictions and mquhm eents IIontamed m m this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within said cemet[ ry to ob- serve and comply with inch mica, regulations, resolutions and ordinances and the conditions of the dosed of conveyance thereof then the title of s4.Ch owner in and to said property shall terminate and the same shall tevert to the City of Sebastian, Florida IN WITNESS WHEREOF, The said party of the fun part has caused this instrument to be executed in its name and on its behalf by its h tyor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. CITY OF SEBASTIAN, FLORIDA Attest: .............................................. Hy .. r.'••.................. ... City Clerk Mayor lined, S and Dell red ❑the nee of- . ........... 7..........z .c�........ .. '.. ... `...................... III STATE OF FLORIDA t COUNTY OF INDIAN RIVER - I HEREBY CERTIFY, That on tax ........5th............ day of .....August ................................... hryn res ectire mvelpeMayoryand City Clerk of Ne CIS of Sebastian, a municil.1 corporation utter h laws of the StateofPlolds .to p y y �� Ha i me known to be Oke IndMduuh unci officers described In and who executed the torturing Donald.L._Barton,. Gloria,M,. Bartpll.F.alRily.Resocabl! .Marital. Reduction. Trust.and....... ......... Revocable Discretionary Needs Trust.... and severally acknowledged the execution thereof to be their free acl uml deed .................................................. as such offi"rs thereunto duly uuthoriced; and that the Official seal of said corporation is duly Affixed thereto, and the mid invayance is the act and deed of said corporation. WITNESS my signature and official seal at Sebu on of Iver d State of Florida, the day and yes - test aforesaid. .�a, ..r n LIN AX ISSI `P" ,t, MY fAA1MISS10NlCC 7 .... . ........ ....................................... EXPIRES June 18, 2002 Notary blic of Florida at - r �'4, am nnil oairPalst ft fta My co mon expires railm- THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA RECEIPT on thday following described conditions as stated Description of Property: Cemetery Purchase SUM OF: 19 / E for the purchase ehe (sjzpon the terms an 0 / Block ��Unit Dollars ( C/Te/an(�d CoiQti�on of sale: This contract shall be bindingu both parties, the se on P P 21e purchaser, when approved by the owner of the property above the I, or we, agree to purchase the above described property on and conditions stated in the foregoing instrument: The City of Sebastian agrees to the above named purchaser(s) on above instrument. the and terms to the FLORIDA DEPARTMENT OF HEAL'T e rTVPFI State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT /- J 7 /&' ?8 1. Name of First Middle Last Date Month Day Year Deceased Donald Louis Barton of Death Feb. 5 2002 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 574 Croton Avenue 3. Name of Medical Address Phone Number Certifier Noor Merchant, M.D. 13060 U.S. #1 Medical Examiner Physician Sebastian, FL 32958 561-589-0879 4. Name of Funeral Home/Dkaet-�l Address Fla. Lic. No./Reg. NT561-589-1000 hone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 1228 5. Check Appropriate Box a. ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. JE Tiffany was contacted on 2/5/02 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Merchant will complete and sign the medical certification of cause of death within 72 hours. C. E was contacted on medicaW%ftificatioh of cAgse of death within 72 hours. . He/she verified that Medical Examiner, will complete and sign the 6- Funeral Director/ ign re F.E. No./Reg. No. Date Signed __ 1862 2/5/02 B. C. 7 BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1 8-0 -00 6 F -JA 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-INo extension of time for filing the death certificate has been requested. pligillifflF OF Date Date Certificate Subregistrar Signature [ i Issued: 2/5/02 Due: 2/10/02 Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. Method of Disposition: BURIAL CREMATION Signature of Sexton 1 or Parson -in -Charge Jt ermit must be endor 10 days to the local ❑ STORAGE OTHER (Specify) Sexton or CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition p / h2/ 6 in the county where disposition occurred. Disposer when there is no Sexton) and Distribution: White: Cemetery or Crematory DH 326, 9/97 (Dbsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0329-2) Pink: Local Registrar INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION FOR BURIAL -TRANSIT PERMIT FORM APPLICATION FOR PERMIT Section A. 1. Type name of deceased and date of death. 2. Indicate place of death: County; City, Town, or Location; Hospital or institution (If not in hospital or institution, give street address). 3. Indicate the name, address, and telephone number of the Medical Examiner or physician who is to provide the medical certification of cause of death. 4. Indicate name, address, telephone number, and license number of funeral home or direct disposal establishment. 5. a. Check if a completed death certificate, including the completed and signed medical certification of cause of death, accompanies the pink copy of the application for Burial -Transit Permit to the Local Registrar of the county in which the death occurred. (If the completed certificate cannot be obtained in sufficient time to be filed with the pink copy of the Application, check 5b.) b. Provide the name of the person contacted in an effort to obtain the name of the physician who Is to complete and sign the medical certification portion of the certificate, and the date he/she was contacted. The person contacted must be either the physician or a responsible person who can speak for him/her. C. Check to indicate if this is a Medical Examiner case. Give the name of the person contacted who verified that the Medical Examiner will complete and sign the medical certification of cause of death and the date contact was made. 6. Requires the signature of applicant Funeral Director, FE License number, or Direct Disposer, Registration Number, and the date the Application was signed. BURIAL -TRANSIT PERMIT Section B. If it is anticipated that the certificate cannot be filed within five days from the date of death, five additional days (exclusive of weekends) may be requested and granted by checking the box provided. If no extension of time is requested, check appropriate box. The Registrar or Subregistrar who issues the Burial -Transit Permit will sicn and date the Permit Application and assign the permit number. Section 382.006, Florida Statutes, requires that a Burial -Transit Permit be obtained prior to disposition or removal from the State and within five (5) days after death. It shall be malted or delivered to the Local Registrar of the county in which death occurred within 24 hours after issuance. NOTE: It is not necessary to wait until the Funeral Director/Direct Disposer has custody of the actual body to begin the paperwork. AUTHORIZATION FOR CREMATION, DISSECTION, or BURIAL -AT -SEA Section C. Approval for cremation, dissection, or burial -at -sea must be authorized by the Medical Examiner. Space for his/her approval number and date are provided. In addition, space is provided for the name of the person obtaining telephone approval from the Medical Examiner and the date such approval was obtained. (NOTE: DO NOT HOLD UP FILING THE PINK COPY WHILE AWAITING MEDICAL EXAMINER APPROVAL.) CEMETERY OR CREMATORY Section D. Required: Signature of Sexton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton.); check the appropriate box to indicate the method of disposition; fill in the date and place of disposition in space provided CITY OF SEBASTIAN 0/139 . CITY CLERK'S OFFICE RECEIPT Name �1/ /! /. ///l/O�nD �O 0 Cash Date 6*7 YCheck# Amourd Pald 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501 341910 LDC/Code of Ordinances 001501 362100 Community Center Rent 001501 362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010343900 Cemetery Loh Lol/Niche -3T, Block �_, Unit 001501 369400 Interment Fee 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit 68M 220682 Community Center Security Deposit 680800220683 Riverview Park Security Deposit Total Paid 61 In lass White — Dept. of Origin • Yellow— Finance • Pink • Applicant