HomeMy WebLinkAbout4-23-13f~it~ of ~phtts#tttn
A.Y iG it ` ~ •l ~ ~ ~ ~ ~ ~ ~ NO. LI .t C) ~L.J'C.9
THIS INDENTURE MADE Thla .... ZOth........... day of ......July ................................ A. D.,~..2001
bet~~•een il~e City of Sebastian, a municipal corporation exist[ng under the laws of the State of Florida, as Grantor and
John A. Fredericks.
.......................................451 Arbor Street.......... ......................................................
....................................... Sehas.tian., ..F.l.orida..329.5.8....................................................
of the County of ........Indian..RiVer ................ an;i State of ....Florida
as Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $ .1.s, 5 ~ ~ ~ ~ ~, , , , , , , , , , , , , to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , , , , , , , , heirs, legal representatives and assigns
the following propertyl iuate i ~ Sebastian, Indian River County, Florida, to-wit:
> >
All of Lot(s) , ,~ ~ , , ,Block, .. , z,3, , ,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 River 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 said 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 property situated within said cemetery to ob-
serve and comply with such 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 same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the first part has caused 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 first above written.
.r.~..c
City Clerk
CITY OF SEBASTIAN, FLORIDA
B, .~~ .~.1v.7 ..1~ ~.Gw~?.....:.... .
Mayor
~-
~^
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
(((Iif~ ~4ett1)
I HEREBY CERTIFY, That on this .....2O.th............day of .......July ........................... ........ x~• •2.001
before me personally appeared ....Walter, , ~'~ .. , .Barntt_s . .......... . ... . . • .. , ..
and .S.$~.~.y . A.•...~?~?~i?........
respectively Mayor anti City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known
to be the individuals ut~d officers described in and who executed the foregoing eowveyunce to
.....................................:............ John A... Fredericks.....................................................
••••••••••••••••••••••••••••••••••-•••••• ............... and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorised; and that the OFficial seal of said corporation is duly affixed thereto, and the said conveyance
is the act and deed of said corporation.
10/06/2007 23:20 5615892583 STRUNK FUNERAL HOME PAGE 01
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
,T~
S
HOME OE VEUCAN ITUND
For information contact:
Kip Kelso -Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Ol/ice
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772J 388-8215 or 388.8214
Fax: (772) 589-5570
FUNERAL HOME: Strunk Funeral Home
ADDRESS: 1623 N. Gentral Avenue, Sebastian, FL 32958
PMONE #: 772-589-1000
(C~eck One)
~ OPEN BURIAL LOT Lot 13 Block 23 Unit 4
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: 10/1Z/07 2:00 ~.1~.
FOR DECEASED: dames Frank Barnes, ,lr.
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation\of ownership)
.Name ~ Signature
Date
I certlfy 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 FUNERAL DIRECTOR;
David L. Hincemon j~ ~ ~ ~ ~i~/I4M ~ ~a ~ .
Name Signature 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 that all fees have been paid
!~ ~ ~ ~
Cem tery exton pate
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
Ubltuar~es ~ lleath Notices ~ Newspaper Ubltuarles ~ Unlme Ubltuar~es ~ Newspape... Yage 1 ofL
~ 8~~ L-1 ~
?~
View/Sign Guestboa_k
- !~ ,* ~ JAMES FRANK BARNES, JR. Mr.
,~, James Frank "Grandpa" Barnes, Jr.,
°' ~ !; 73, of Vero Beach, FL, died October
`~a ~ 7 2007 at his residence. He was
. ~. ~ ,
` `~ :-~,~ born May 6, 1934, in Little Creek,
`~ ~ ` ~ ~\ Virginia, and lived in Vero Beach
since 1963 moving here from
~~ Chesapeake, Virginia. Mr. Barnes
t was the Owner /Operator of Barnes
- Construction in Sebastian, FL. He
,,,~ r-, ~ -, was a member of the Masonic
tf' ~~ Lodge in Melbourne, FL; a former
,_ member of the Moose Lodge
#1767, Sebastian, FL, and the
r Eagles Sebastian Inlet Aerie #4067.
__ ~ He was an avid bowler and rolled
~"~' the first 300 game in Indian River
~~ ~~=~ County; he served in the U.S. Army
`"~" ~ during the Korean Conflict.
'~ ~ r, Survivors include his wife of 48
• ,- years, Mary Barnes of Vero Beach,
FL; daughters, Rena Lynn Carr of
Sebastian, FL, Gloria Lee South of
s s' Vero Beach, FL; 2 sisters, Skinny
~~`~ Wollard, and Betty Totem;
grandchildren, Pam, Amy, Sarah,
Katie, Kristin, William, Crystal,
~ = ~'~. =~ Megan, Alicia and James. He was
predeceased by his daughter, Tina Barnes Lucas. SERVICES: A visitation will held 5-7
p.m., October 11, 2007 at the Strunk Funeral Home, Sebastian, FL. A funeral service will
be held 2 p.m., October 12, 2007 at the Strunk Funeral Home Chapel, Sebastian, FL, with
Rev. Tom Kempf officiating. Interment will follow in Sebastian Cemetery with full military
honors conducted by the Sebastian River Area Veterans' "Honor Guard".
Published in the TC Palm on 10/9/2007.
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http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=95... 10/9/2007
JAMES FRANK BARNES
ITY OF SEBASTIAN
CITY CIERK'S OFFICE 3 8 9 0
RECEIPT
c i
Name V rr~~1 ^ Cash
Date ~ a v ^ Check#
No. Amount Paid
001001208001 Sales Tax
001501322900 Garage Sales
001501 341920 CopiesBid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees
601010343800 Cemetery Lots
~
LotMiche ~_, Block _~_, Unft ,
001501 343805 Cemetery Fees r
`N/'1~, ~
Total Pa ~ l ~~
als _.._,_ ...._._ w._..,..
hits - Dept. of Origin • Yellew -Finance • Pink • Applicant
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CITY OF SEBASTIAN ~ -
CITYCLERK'S OFFICE t 3 8 91
RECEIPT
Name ^ Cash
Date 7,
Check# ~ .J
No. Amount Paid
001001 208001 Saies Tax
001501322900 Garage Sales
001501341920 CopieslBid Specs.
001501341910 LDC/Code of Ordinances
001501 341930 Election Qualifying Fees
601010343800 Cemetery Lots
LotlNiche ~~ Block ~ ~ Unit
001501 343805 Cemetery Fees
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Initials
White -Dept. of Origin • Yellow -Finance • Pink • Applicant
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
1. Name of First Middle Last Date Month Day Year
Deceased James Frank Barnes , .lr,
Deatn Oct. 7 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian f2iver Vero Beach Inst. 9335 103rd Avenue
3. Name of Medical Address Phone Number
Certifier ~'iichael A. Venazi , IVI.D. 805 83rd Avenue
Medical Examiner Physician Sebastian, FiL 772-388-2110
4. Name of Funeral Home/Direet-BispOSal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 ~1. C~otrai Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death acxompanies this
Appropriate application.
Box
b. ~ Christina was contacted on 10/8/07
He/she verified that this death was from natural causes, that there was no atxident nor other external cause of death,
and that Dr. Venazio 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 (~mplete and sign the
meth certifi i cause of death within 72 hours.
6. Funeral Director/ Si a F.E. No./Reg. No. Date Signed
Giwct.Disposec 44048 10 /7 /07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-07-0407
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.
~No extension of time for filing the death certficate has been requested.
Rleglstraror-~ Date Date Certficate
Subregistrar Signature Issued: 1017 / 07 Due: 10 / 12 / 07
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. Awaiting period of 48 hours after death is
required for all cremations.
D. CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL aSTORAGE Date of Disposition ~-'D ~/i1~0 ~•
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge
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, 6/97 (Obsoletes all previous editions) Yelbw: Funeral Director or Direct Disposer
(Stock Number. 5740-000.0326-2) Pink Local Registrar ~ ~~ „Y