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Home My WebLink About4-45-06Name �/l / iG114 /l�/,�� 4�)( la /rKs Unit ter/ Block 1 Lot Date of Mark -out Date of Burial Z /t / r. - Name of Funeral Home 5 Authorized by Time ,Z /W r,> S CROF SE�TLA1V HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax February 17, 2017 Alan R. Marote 13720 10151 Street Fellsmere, FL 32948 RE: Interment Rights to Unit 4, Block 45, Lot 6, Sebastian Municipal Cemetery Dear Mr. Marote, Enclosed is City of Sebastian Certificate 2527 entitling you to full interment rights in Unit 4, Block 45, Lot 6, in the name of Alan R. Marote If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Tes a Records Clerk Enclosure CITY OF SETA HOME OF PELICAN ISLAND Certificate No. 2527 CITY OF SEBASUAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Alan R. Marote 13720 101St Street Fellsmere, FL 32948 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 45, Lot 6 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 15th day of February, 2017. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: anette William -5, MMC City Clerk Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta(cDcityofsebastian. org Funeral Home: SEAu/iNdt F!/NE�AL IlavwE Phone: 792-585 (Check Open Burial Lot / Lot f_O r Block'K5 Unit Open Cremains Lot Lot_ Block_ Unit_ Open Columbarium Niche Niche_ Block_ Unit_ (Circle) N S E W Burial Date and Service Time: /yEs ZfL// 7 Z . Deceased Name: Name and Signature of Lot Owner or Representative: (Must provide proper documentation of ownership) Print Name Signature Date I certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and orized opening of same. Name and Signature of Licensed F e 1 Dir or: Print Name llzgna a Date 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: Cemetery Sexton Certification: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Grar SEMST'LAN ri HOME. OF PElKAH 6[AND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) / 3 7 a C /C1 S 7— Address Area Code & Phone Number -7 -7z -S7/ --7(->a Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($ r� 16T) � " ) V on this 15 4h day of Pyi�t rhZ� , 20 V7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 4 , Block 4-S- , Lot(s) A�n Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Interment ignature of Purchaser City I:\W W-DATA\Ms-Cemetery\REC E I PT.d oc /W O H Circle One Disinterment TOTAL $ �q (SU• co The following documents were provided as Proof of Residency: CITY OF SEBASTIAN 10412 ADMINISTRATIVE SERVICES RECEIPT Name �1�� ❑ Cash Date oc / /S�/ ❑ Check # /1 1 � / I ,: K�redit L)Aj 1q- 4 Al x ` s LoT-(o Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees UDISZt 3439615 01C �l�p-ate �Id 1 O 31300 - Loo _ *dbOCl. co �SYY1 Total Paid`6��11dI S Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant CM OF HOME OF PELICAN ISLAND CITY OF Certificate of IN ACCORDANCE with provisions o Code dinances o City of Sebastian, it is hereby ce ' 'ed that: William J. Dair 201 _a_ Av , Seb n. FL . 958 0 h n i? DGLi r Tr 7-01 Me—msh /+vc : 10 621 Seba.S f a-A Fl, 3Z95 bTATEMENT DATE _ TERMS TO ADDRESS IN ACCOUNT WITH ,j! / - h j off,. g qo Ile a , DC5812 CFIt' [tF ~ ~~ ~~ ~ ~ ~ ~~- ~~~ ~~ ~~~~ r~~ City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. (~ r l ~ t ~Cl;. rn .~; ~ Q i r Name(s) ~.U I lyl~~ s h ~U~n u e, ~~~aStr a v~ ~L 3 z~ 5~ Address (~ ~ ,~ ~ ~5 3 - X13 l ~f Area Code &"Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: n,o/ ~~- ~~--4-a-~d Q,y~-~ /i (1~0 Dollars ($ /, f~ D ~ ~ `~ o ) on this. ~ ~ day of ~(~ u a ~ ~ , 20 D ~i for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit ~_, Block ~, Lot(s) lD Niche(s), for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Interment Temporary Marker Preparation & Installation Signature of Purchaser /W O H Circle One Disinterment TOTAL $~, DOCK , DD ~~(~ W of Sebastian The following documents were provided as Proof of Residency: I:\WW-DATA\Ms-Cemetery\RECElPT.doc ( and L'~, \ )) ~' r si ~~ ~ . ~ ~, , r~, ~i Y i ~ ~ ~, a ~~ ;, 3 N ! ~ ~ 3' • s T s • e a 8 ~t ~e ~ '~ ,~ ,. z ~g ~~ ~ y S ~_ UO_ (O~ (O~ tS~ Op_ p ~_ ~ O O O O S A ./~ A A ~NN O ~~ ~ ~ a~ c ~ o ~ ~ ~ ~ ~ ~ ~ Y 8 3Y O i 0 V ~~ m V.:r v N F\ \~ rr~~~\ ll~ ~~ N W ao W C° ~ I~ ~ A Cf m N ~~ , W City of Sebastian 1225 MAIN STREET a SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 ~ FAX (407) 589-5570 January 30, 1995 Robert & Kathryn Keel 160 Nebraska Avenue Sebastian, Florida 32958 Dear Mr. & Mrs. Keel: Enclosed you will find Check No. 015549 in the amount of $400.00 for the repurchase of Cemetery Lots 5 & 6, Block 45, Unit 4. If you have any questions, please give us a call at (407)589- 5330. Sincerely, ~~~~}n- ~'~a,P~~~.. Kathryn M. O'Halloran, CMC/AAE City Clerk KMO:lmg (ws\form-lin-ltr) ~~ ~~ 4oP °~ .Harr City of Sebastian 1225 MAIN STREET a SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 o FAX (407) 589-5570 M E M O TO: Finance ,,~~,[()7 ~~ FROM: Kathryn M. O'Halloran, City Clerk l`'b SUBJECT: Repurchase of Cemetery Lot by City DATE: January 12, 1995 Please issue a check as follows: AMOUNT• $400.00 PAYABLE TO: Robert & Kathryn Keel 160 Nebraska Avenue Sebastian, Florida 32958 PURPOSE: Repurchase of Cemetery Lots 5 & 6, Block 45, Unit 4. S M ~. Linda Galley attachment \ws-form (lck-req) 0~' b Z~ 2' . L- 536__60.0__, f~it~ of ~rhttstittn ~P11tP~Px1~' ~~~e~ NO. 1154 THIS INDENTURE MADE TWa ....$.t Yl ...... ....... day oY ........Jaritlar~?........................ A. D., 19.$$. ., 6etn-een the City of Sebastian, a municipal corporation exleting under the laws bt the State of Florida, ae Grantor and .......................Robert., and, Kathr.Yn..K2.ez...................................................................... RETURN TO ..166 Nebraska Ave .t..Sebastian,..F1.. ~.~qs Indian River ' o} ehe County or ............................................. ani store of .......... F19.r.1d&................................ 0o Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ 4OO . OO , , to it in hand paid, the receipt whereof is herewith so- .............. knowledged, does by this instrument grant, bargain, seB, release, convey and confirm unto the Grantee the 1 r. }teas, legal representatives and assigns the following property situated w Sebastian, Indian River County, Florida, to-wit: All of Lot(s) 5 & 6 Blo ck, 4 5..... ,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 Couaty of Florida; said land now lying and being m Indian River County, Florida. DDC. ST. - 4ii. S 'z 2 ~ FREDA WnGNT. Clerk of Circuit Court Indian River County ~ by ~!%%~~~~ ~c-Ct~zc~L` D. To Have and to Hokl 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 aB Tunes 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 ssidcemetery. 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 dCed of conveyance thereof then the title of such owner in and to said property shall terminate and the same shag revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed m its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hueto affixed, the day and yeaz fast above written. //l ~//// \ CITY OF SEBASTIAN, FLO A Attest: .... .~....... ..~ .: yK!.: . ~j.~L..... .... By .. ... .. .. ... _._ ...... ~_~G V :t Clerk (/ Mayor . - I~ 1=~ ~o,~ P~ca~t Signed, Sealed and Delivered + .. rl ~ in the~jresence af: r ~ '~ -('_~ ~~ ~- e~(,1.. Q ~~............~~. J~~ t ! 9 f'l~ 2:43 (~alt~ ~ce~i> ~.~' , ~ ,; ~(// 1~ ; - ' E~lt r)t ~~l~ltal f f q? } - ib"15 : , STATE OF FLORIDA ~I I) 0 `EF' o(i ~l.eti < ~ COUNTY OF INDIAN RIVER By i - ~,~, .,~ I HEREBY CERTIFY, That on this ...$.~h ............... .day .~.........JanlSar.Y................ , 1B.$$ 'D'eputy before me personally appeared ....,I'. Gene Harris Sall Maio Cit Clerk ~ ........................................... end ......Y..........r.........Y........... respectively Mayor end City Clerk of the City of Sebastian, a municipal corporation under the Iowa at the State oY Florida to me known ~ to be tl:e individuals and officers described in and who executed the fomgoing eowveyunce to ~ Robert and Kathr n ...,.,,,,,, `~ .................................................~'... Keel................................................... ..................._...... ....... ...... .................. and gEweT60y~ecknowledged the execution thereof to be their tree act end deed a~ as such otticers thereunto duly autharixed; and that the Official seal of~snid corporation is duly affixed thereto, and the said conveyance is the act and deed a} said corporation. WITNESS my signature and official seal at 3ebaptlen, In, fhbCounty -of Indian River end State of Flaride, the day e:d yea,- Q lest aforesaid. _` - I^ ' Notary Public, St a of Florida at Large. . -M3' eommisaton exPlres: Q. - NOTRRY PL'RLIC STATE OF FLORIDA NY COMMISSION E%P OEC 10,1988 ~- BGNDEO THRU GENERAL INS. UND. State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT HFOLTH DATE PRINTED: February 16, 2017 TRACKING NUMBER: 2017025963 1. DECEDENT INFORMATION Name of Deceased Date of Death PATRICIA A MAROTE February 13, 2017 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. Lie. No./Reg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lie. No./Reg. No. DAVID W. WALLACE F046853 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. 0-5039 Permit Number: February 14, 2017 �— Date Issued: February 14, 2017 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 CITY CEMETERY Method of Disposition: BURIAL Date of Disposition: 2 2 / / EDRS maintains all statutorily required information regarding the death record and related buriai transit pet mit, 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