HomeMy WebLinkAbout4-48-37;
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PsMbYCEMC'IERYReaiplNO.�.l�.......n:i�a....8/28/87 ...............Lots �38 � 39 No.
r L�OSO.00 MaximumNO.Bmi�l$ Block
LlatPriaS ................ Pae...............IIII�C 4
Net Paid S 1 � O S O . OO . . ManumeM permitted ... .. ..... . .... . .... .. . � � "" � �
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(D�t� �bote this IIM /or C9V ��� aoly)
fditp nf �ebttstittn
�P1I[P�PX1� �PP�I No
1442
TNIS INDENTIIRE MADE 7ti4 .IBtII_...__..... dnY or ....January...� .:......................._. e. n.� u9.4_.,
beM�een ILe Clly of &boetlen� � munkipsl eorponHm enbHn6 under the 6we al the 9lete el Flarid4 �e Qranlar md
Otha F. and/or Cynthia A. Fordham
.. .. . . . . ......16 2 . . 5.:. . W i1S tss�' 'SY Y e.e.�.... ... . .. . . . .. . . .. . . . . . . ..... . .. .. . ...... ... ... ..... .
Fellsmere, Florida 32948
_ ........................................ .. ......... . ..........................................
M lhe co�o�s o� ...,..Indian, River .................. .oi s�.t� of ........�.�4L'�.5�.9........................._........
u Cnntee, WITN689BTH�
That the Ginntor Cor md 'm consideratlon of the aum of S 1),O S O. OO a�� N hand peid, the roaipt whercof is herewith ac-
k�rowkdged, doee by 1h1� instrummt gran[, be�aln, zll, alns, mnvey end mnt4m unlo the Gtentee CheiL hHre, legai repmenntive �nd assign�
the fa�owing Qt�Ny3s�wSd 39 ba�inn. I�dian RNer County, F7orWe, to-wlt:
s a
AII of Lot(e) .,..... . Bbck, .. 48.. , UNIT ... 4........ , of Sebanisn muNdpal ametery ea per Plet Number 1 tFenof ttm�ded in Plat
Book 1, �t page 65 of the Oublle acorde in the offlce o[ the Ckek of [M CireWt Court of 3L Lude CouMy of Fbrids; aN lend now lying and bci�g
In I�Mian Rhtt County, Plodda.
To Have and ta HoM lhe vme fomvee; provided lhet aoid praperty dm➢ be ueed mkly and exclusively far tM inMrment of the human dnd end ehall
be aed, kepl end ma6MniMd at all tlmee in sceordsna rkq the ruke �M reSnNtbm, ordinmme and rceoNtlone ot the City of Sebeaiaq PIorM�, Mato-
fore, nov aM hemeRer adopled or provMed fm the go�eenment end opentbn of ald cemetery. The condNbna, maldctione md ttqu4emenis contdned
ln tMe 3nthument fhell be mvm�n[e rvnn4q aith the Isnd. In ihe eve�M1 of lhe feWro o[the o�unmof any propttty ekuated Nthin aid amehry lo ob-
aerve and mmply MtA eoeh rulm, reguhtiona, roaolullons aM ordMmcea mA the condiNone of the dMA af wnwyanm lhertof then the title of such oanar
in end to mid property sha0 tttminate and the prne eha0 revnl ta the City of 3ebak4n, Pbdda.
IN WI7NE55 A'HEREOF, The eaid party of tM fiert part ha ouaed IM� intlrummt to be exmNed M ita n�me md an ite behaH by ite Msyor and
atlotd by Ita City Ckrk md ite co�ponte sai to be herelo affbeed, the day end yev flr�t Wove wdiren
CiTY OF� EA IAN, PIAAIDA
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AHe�1� -.��IAt..)L.��I..l...,��.�^E+Ei:�:�r.......... B71 .... � �
J .... . . ................
ci�y c��.t a�.�o.
9ign<d, 9enled mul Oelivered
In lhe Pop�eMe ofi /
\ .....;-� . ic.a<.._ �� �� ZC,��r�! .............. (dl8g�en1)
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$TATP. OR PIqRInA .
COONTY UF INDIAN RIVEA
I}�ERA.�Y CBATIPY. That on Ihle l8th � January 94
........................deY ...... ............................................� 19....�
brr��.� �k p«M�auY .�asKa , Lonnie R. Powell .... _,,,a Ka.thryn M. 0 Halloran
..................... ...................__. ............�.. .. ...
roprelivdy M�ym end Clly fieh ot th< City of 9eMtlisn� n munlelpnl eorparetlon vnder Ihe lewe of lFe 91afe af Floride lo m� kuovn
to bu Ilm Mdividunle anJ nfll vre d<ecd6ed in uml who esstuted lhe fwrRulne wxveyantt lo
_ ....................QCb.a..F.... andl.or..C.ynthis..A... For.dham... . .. .....................................
................. _..................................... �nd eexnlly stYnorlederd the exceatlan iFermf tn he lhek !rm eet nM deeJ
u auch uffkrrv iLermnlo duly �nlhori�cd; ��d thet the Officld xnl o( eNd rnrponliou Ie duly dflxed iherct0. �nd the �efd enn�eyantt
IR tAe nft nMI MCA Of uid mrpofeUmi. /1
WITNR99 mr d6nalnre �M otfkid �ul at 9e6s�H�n, In tl�( County ndlen River nd tdc of Flodd�, Ihe day ��d �mr
Inel efo�e�Wl. � �l'T� A n
� LINM M. fl4AEY (
AryC0AMS5q1 / CC37N77 EIlIIFF
.w.�. �e. iso�
q� wuumanwr�MManKC.nc.
M. Galley
Name
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Block
Lot _
Date of Mark-out � ,
���1�/i2 ' 30/�� ,a. ��
Time
Date of Burial
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Name of Funeral Home �
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Authorized by
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CYNTHIA ANN FORDHAM
November 10, 1938 - Lawrence County, GA
January 22, 2012 - Vero Beach, FL
Mrs. Cynthia Ann Fordham, 73, died January 22, 2012 at
VNA Hospice House, Vero Beach.
She was born in Lawrence County, Georgia and lived in
Fellsmere for 44 years coming from Buckeye, Georgia.
She was a member of First Baptist Church of Fellsmere.
Survivors include her husband of 55 years, Otha Fordham of
Fellsmere; son, Joel Fordham of Kenansville; daughter,
Wanda Walker of Fellsmere; brothers, Mark Pickron of
Clewiston, Ben Pickron of Fellsmere; grandson, Michael
Sellers of Sebastian; 4 grandchildren, 6 great-grandchildren.
She was preceded in death by her daughter, Donna Sellers
in 1987 and brother, James Duncan Pickron.
FUNERAL F
ADDRESS:
FUNERAL DIRECTOR'S REQUEST Tp CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
.u°�i
HOME OF FEUC,iN KI.V�D
For information contact:
1Qp Ke/so - Cemefery Sexton
Sebastian Municlpal Cemefery
(772) 589-2545
City Clerk's Office
City Hal1, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or. 388-8294
Fax: (772) 589-5570
PHONE #: '�X"I �
z�sg.
O�( One) 2 'I t�. � Q,e(� � �''Z
OPEN BURIAL LOT Lot J� Block `T'� Unit i
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME
FOR DECEASED: � I'�� l
. SN � � W���: Li 1 1 �
;� I�►� � r� G�
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of owners p
c�I�C� Fo��;� ��� �1,� h� ' l 2�I I�
Name Signature Date
I certify that � have determined the ownership of the above described site, that all site fees and
administrative fees have been paid and authorize opening of same.
N� AND SIGNATURE OF LICENSED FUNE DIRECTOR:
� I 1'YL ��%✓ l� �� ��( Z
Name ignature 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:
=�L,�'e�
e tery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon cornpletion.
State of Florida, Department of Health, Vital Statistics
HEALT APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date
Deceased Cynthia Ann Fordham of
Death
2. Place of Death City, Town or Location Name of (If neither, give street address)
Counry Indian River Vero Beach Hosp. or VNA Hospice House
Inst.
3. Name of Medical Melissa Dean M.D.
Certifier
nMedical Examiner r
4. Name of Funeral Home/Direct Disposal
Establishment Strunk Funeral Home
and Crematory
Month Day Year
January 22, 2012
Address Phone Number
1345 36th Street, Suite B Vero Beach, Florida 32960 �772� 567-1500
,ician
Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
1623 North Central Avenue Sebastian, F041870 (772) 589-1000
Florida 32958
5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box b� �� �^, was contacted on `� 2�� p�+ ��
(/Lr
He/she verified that this de�Nryvas fxom 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
rr�edical certification of cause of death within 72 hours.
6. Funera���l .Direct �d � ' �^ i ture �„r � � �� � F.FO22789g. Na t � .�D.ate �igned f �
Vs x l iLJ l�J L-e� u�C�
a.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-12-37
�ive (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 eath certificate has been requested.
�e�is�rar or ' ' ` �— Date Date Certificate
Subregistrar Signature �IJV Issued: 1/22/2012 Due: 1/27/2012
c.
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.
D.
Method of Disposition:
BURIAL
�CREMATION
Signature of Se�on 1
or Person-in-Charge j
�STORAGE
�OTHER (Specify)
CEMETERY OR CREMATOR��as . �
Place of Disposition
Date of Disposition �� '��� I�� � L._.
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.
DH 326, S/97 (Obsoletes all previous editions)
(Stock Number: 5740-000-0326-2)
Distribution: White: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
�a Fq- �'1`W`�a.i�:
��la� �-�
1 �� �. �
�dlsmere� �L 3 aQ�
�-� � 7, 3�` � 34
�I k_ l.(,�
�� �-
��d Alo. /�a
Yaid by CEME1'ERY Raceipt Na O 19 . . . . . . . . . . . Dated . . . . a I ? H I H �. . . . . L O t S 3 % �
"""""'Block 48
1 0 5 0. 00 M�;,,,,,,,, xo. s,u;8t s��s ...... .. ... .... uni t 4
�r rri� s . . . . . a .. . .. .. . .
1,050.00
NetPaid $ .. . . . . . . . . .. . . . . . Monument pexmitted .. . .. . . . .. . . . . . . . . . . . . .
4�� (Data above tLie llne lor Citp Record odY)
38 & 39 xo.
.� ::.1442
t - "' •
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City of Sebastian
1225 MAIN STREET � SEBASTIAN, FLOFIDA 32958
TELEPHONE (407) 589-5330 � FAX (407) 589-5570
January 24, 1994
Otha F. & Cynthia A. Fordham
162 S. Willow Street
Fellsmere, Florida 32948
Dear Mr. & Mrs. Fordham:
Enclosed is Cemetery Deed No. 1442 for Lots 37, 38 and 39, Block
39, Unit 4.
Also enclosed is a form - Return for Transfers of Interest in
Florida 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. If you wish to have this
deed recorded, you may do so at the office of the Clerk of the
Circuit Court, 2145 14th Avenue, Vero Beach, Florida.
Very truly yours,
�Q ��• �'�a.�.�r.�..
KathryLn 1K. O'Halloran
City Clerk -- . =
KMO:lmg
enclosures
. �,
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City of Sebastian
�
POST OFFICE BOX 780127 o SEBASTIAN, FLORIpA 32978
TELEPMONE (407) 589-5330
FAX A07-6BY-6670
July 27, 1989
C1t1�a & Gynthia P'ott9tiem
162 S. Willaw St.
Fell�rere, F1. 32948
Dear Mr. & Mra. Otha Fbxdk�a►n:
Re: Canetexy Ints 37,38, & 39 Bl�ock # 48
c7�it 114
In reviewing au� recostis it came tJo our attentian that you have
not m�de anY F�Y+�ta taau�d the p�unt�aee of the at�ove referenced
lots sir�ce Septaabar 8, 1988. There is a ranainir�q halance due
of $350,00.
Aocording to the ternre & oor�ditios�s of the sale you were to PaY
$75.00 per month ($25.00 per lot per tronth). If yo�u hav�e any
problaae rega�+ding this agreenent, please oontact this office;
if mt, please rsnit balance due.
Sir►cetely,
�� ��
Caml Car�ell
Fir�a[nce Disectar'
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THS SBBASTIRN C6METbRY
City of Sebastian
Sebasttan, Flortda
RSCSIPT IS 8SRE8Y RCKNOWLEDC6D OF TN8 SUM OFr
'-1re,...�, �" /���,��u.-ul� �//�C� A�2.2ara (S 7.� - � � )
�) ..�. �
FnoM:__ D� ,�f�l ,/-��i� f��i✓ �vn-�!-F,�N/
�. U. ���)C 3 3�- ��/-1 �7 �"�S ri'i c-�< � o� �
�!- �t_s��fi �� f L,
on this��/�. day of U US , 29� for the purchase of the followtng
dascribed Cemetery Lot(aJ upon the terme and coodttions as stated hereinj
Aescription oF Property:
Cemetery Lot(s)N � �},j�J 82ockq�Unitq �
Purcha9e Price: �/ �-'� �', �) L� Diollnra(S )
�/ Terms and conditiona of sale: �/
F1 �JJ�, D 0 � ,�ph � p �"a., -' � %,F ;' BLriiG� ��N-c��wlv ��"' (�/- � � '�'Xa� �- ��'"'�� /
d - ��o -.�
�1�-�- .:'Z�-f - -i
c-�
This contract sha22 be binding upon both parties, the sel2er and the purchaser,
when appmved by the owner of the property above described.
I, or we, agree to purchase the above described property on the term9 and ,
condtttona staGed tn the Foregaing tntrumenta
�'L�. / / ! t5J2 L �.�� � � ��.��"z,-<->
.
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The City of Sebastian agraea to ae21 t�ve ment�oned property to the
above named purchaser(s) on the terms and conditiona stated �n thv abovv
instrurrent.
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te �8 BalanceS `� JS. u
te 9 �- Ba2anceS at>.
ta J
te r
te 1
P�{, .%7S- a o 2
% Ba2anceS$-?%
�% Balance$ —7-$�D,
g BalancaS b�i-�
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(�d ��so� 3/�18� �� �.��s
a ( 9�. -�%oo </t�182 ,, � �f �—��
�� �c� 4'/oo.ov 9/�y�88 " �35b.
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