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Home My WebLink About4-48-06( eme er leeb 1648 Attestl .................................................... City Clerk Signed, Sealed and Delivered CITY OF SEBASTIAN, FLORIDA Mayor STATE OF FLOIIlDA COUNTY OP' I~DIA~ RIVER October Ruth Sullivan and ,~?.~:.9.'.~!!~ ....... Dr. John W. Nevins is thc act end deed of ~ld ~raflon. ' ~tate of FlaTlY, the day and year last aforesaid. Unit Block Lot. Date of Mark-out Date of Burial Name of Funer, I. .~.~ '.-~d Time Paid by CEId~TERY Receipt No ................. Dated .............................. List Price $ .................. Maximum No. Burial Space~ ................. Net Paid $ .................. Monumem permitted ....................... NO. , 1648 (Data above tills line roi' City Record only) THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA ~.~RO~MIPT $S HEREBY ACKNOWLEDGED OF THE SUM OF: u terms and Block Description of Property: . Purchase Price ~_~ / .~ ~ Terms and Condition of sale: This contract shall belbinding 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: The City of Sebastian agrees to seI2 the abovg~h~ioned property to the above named purchaser(s) oC erm~ tions stated in the above instrument. ~~ ~ ' . Witness A. (Type or Print) State of F~cla, Department of Health, Vital Statistics APPLIC~RRON FOR BURIAL ' TRANSIT PERMIT 1. Name of First Deceased John Middle Last DATE Month Day OF Adams DEATH 10/12/98 Year 2. Place of Death County Indian River City, Town or Location 3. Narr~ of Medical Certifier Michael Venazio~ M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Check ~ a [] Appre- priete b Roseland Name of (If neither, give street address) Hosp. or Inst. Sebastian River Medical Center c [] medical certification. / 6. Place of Sebastian ~ Ipat~te cemetery/.;,,~/ Final Disposition: Cemetery L~'cr~ma~t~ - nam~'~ty: Indian River 7. Funeral Director/ .~"/ ,.~g[~,Ce /~//..~ F.E, No./Reg. No. Direct Disposer ~/' ~/ B. BURIAL -- TRANSIT PERMIT Permission is hereby granted to dispose of this body. I Medical Examiner ,N:ldress Phone Number 561+66u,-~1075 --~Physician 8000 Ron Beatt¥ Blvd,Ste BI,Barefoot Bay, FL. Address Ra. Lic. No./Reg. No. Phone Number (Area Code) 1623 N. Central AVenue 1228 561+589'1000 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Dr. Venazio was contacted on 10/12/98 within72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that He will complete and sign the medical certification of cause of death. was contacted on . He/she verified that , Medical Examiner, will complete and sign the Removal ---]from state F1 Donation Dat~ Sigr/ed Permit No. 1228-98-Oqa, q [] A five day extension of time for filing the death certificate'(exclusive of weekends) has been requested and granted as undue hardehi would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Dire( Disposer Report" will be filed with the Local Registrar of the County in which death occurred. [~qo extension of time for filing the death certificate requested. Ree~ ~1-~ ~ ~ Date O/ Date Certificate Subregistrar Signature Issued: I l-.~'l c~' Due: ' t I Signature or Medical Examiner, AUTHORIZATION for CREMATION, DISSECTION or BURIAL--AT--SEA , Medical Examiner Date . 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 ,,3 hours after death is required for all cremations. Methods of Disposition: · BURIAL [] CREMATION Signature of Sexton ) or Person-in-Charge ) [] STORAGE [] OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition ~ ,~,~5~'~.~4 ~z~,~.~',~' - Date of Disposition /c'//;'4/'//'~ ~ / This permit must be endorsed by the Secton 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. OH 326. 10196 (Replaces HRS Form 326 which may be used) (Stock Number: 5740-000-O326-2) City of Sebastian 1225 MAIN STREET g SEBASTIAN, FLORIDA 32958 TELEPHONE (561) 589-5330 n FAX (561) 589-5570 MEMO To: From: Subject: Date: Janet Isman, Interim Finance Director Kay O'Halloran, City Clerk Check Request ~ ' (~ ''~ October 28, 1997 Please issue a check as follows: AMOUNT: $200.00 Clayton H. & Veleta E. Brooks 1671 Seahouse Street Sebastian, FL 32958 Repurchase of Cemetery Lot by City. Lot 6, Block 48, Unit 4 Linda Galley NO. (lliIu of ebaslian et ery tlt e e il 1109 between the City of Sebastian, a municipal corporation existiag under the laws of the State of Florida, as Grantor and Clayton H. & Veleta E. Brooks ................. 7.~ 7. .1. . .S. .e.qh. .o. .r~ ~. . ~.t. ~.e. ¢t .......... ~ecbc~q t~an,. .~o~c~ . 3.29 ~ 8 ........................................ of the County of Indian ~iv~r an'l State of Florida · s Grantee, WITNESSETHi That the Grantor for and in considerat/on of the sum of $ ....... ~/~.../]0 ........... to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, burgai~, seB, release, convey and confirm unto the Grantee ......... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) ... ~... , Block, .. ~ .... UNIT ... ~ ......... o~f Sebastian munic/pel cemetery as per Pht Number 1 thereof recot~edxin Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Luc/e County of Flofida'~id land now lyinii/an~l being in Indian River County, Florida. t Ho th/ -- U ~~( X~ To Have and o Id same forever; provided that said property shah be used solely and exclusively fur~/~/nterment of the huma~dead~¢ shall be used, kept and maintained at all times in accordance with the rules and reguhtions, ordinances and resolution! of the City of Sebastian, F~arJ~a,~l~ereto- fore, now and hereafter adopted or provided for the government and Operation of said cemetery. The conditions, restrictions and requirements contained in tins instrument shall be covenants nmmng 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 iuch 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 rever~ to the City of Sebasthn, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this instnunent 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 wfittom Signed, Sealed and Delivered in~hl P~resenee °f: STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on thi~ .......... ?..d.}.~ ........ flay of .............. ~q?.:ij~.a..Y~ .......................... 1~. ~, respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be she individua]s and officers described in and who executed the foregoing coaveyance to .................... C~y.~on. H. . . ~ . V~ l~ t~. ~. . .B~.oo~s ., ....................................................................... ....................................................... and severally acknowledged the execution thereof to he their free act and deed as such officers thereunto duly authorized; and that the Official se~l of said c~rporatl6~ iS duly affixed thereto, and the said conveyance is thc act and deed of said corporation, WITNESS my signature and official sea{ at ~b~atlan, in the County fo~ IndianL Ri~r and State of Florida, the day and year last aforesaid. - ' Notary Publ;c, Stale of florida :My Commission Expires Od. BROOKS, CLAYTON & VELETA 1671 Seahorse St. Sebastian, Fl. Lot 6, Blk. ?~, Un. D NO. 1109 Clayton & V~leta Brooks 1671 Seahorse Street Sebas'tian, Fla. 32958 Mnximum No. Burial $1mces... ~ ............ Monument permitted... :=.~-~' ............ (Data above th~ line for C~ty R4~eord only) Lo,t # 6 Block 48 Uni ~ 4 NO. T~£ SEflAST~AN C£~ETE~Y described Cemetery Lot(a) upon th~ ternm and oondltlons ,~ ef:,~ted h~relnt Ce,.£er~l Lot(s)# g Block# Purchase Prico: ~ ~~ ? · ~r~ and'~ndiCions of uracil I, or we, agree £o purchase the above described proart9 on the ter~ a~d ~oJ~l~o~ s~a£ed in the foregoing instrumen£: The City of Sebastian agrees to sell the above mentioned property/ to the 4bove n~mm purcl~ser(s) on the terms and condi£ions stated in th~ a~ove instrument.