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Home My WebLink About4-45-21Name/7 GJ Unit Block Lot Date of Mark -out 6l Z4 / -7 Date of Burial Name of Funeral Home Authorized by Time ✓' a0 re,,11.41)g,� a,- ,,e 1, : oop. CITY OF SEBASTIAN 10942 ADMINISTRATIVE SERVICES RECEIPT NameSA'SEr� NIC/ 1 D(AAA'N ❑Cash o Date / �'11 �(I Check # 77+� 1 ,❑- Credit 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 on i,yo It 34s2c6 L .°v Ug l r + iArk.4-s L* -r A I,P Total Pa a; -P. Of Initials White - Dept. of Origin • Yellow -Admin. Svcs. • Pink -Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, Cemetery Sexton F�XEI7 Sebastian Municipal Cemetery i� Phone: (772) 589-2545 Fax: (772) 228-9927 �II City Clerk's Office – Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or388-8214 ctesta(a)citvofsebastian.orp FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE 21 1+5 Lot mW Block 40 Unit 4 Lot—Block—Unit Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: Saturday,November 11, 2017 @ 1:00 PM Chapel Service followed by interment with Military Honors at Sebastian Cemetery FOR DECEASED: Edward Norman Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Rochelle Norman RocheUe Norwt.awNorw�aw Name Signature 7860 94th Court, Vero Beach, Florida, 32967 1 certify that I have determined the ownership of the above described site that all fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: William B. Whittaker, Jr. Name ck(i2P,iaKB. cbt(QittaYex, A Signature 11/7/2017 Date site fees and administrative 11/7/2017 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: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. 11/07/2017 16:04 717200 P.001/001 FUNERAL DIRECTOR'S REQUEST TO CITY OF SE 84 STIAN FOR BURIAL OPENING IN SEBASTIAN M JNICIPAL ETERY For information contact: S �. �1I !p Kelso, .Cemetery Se bastlan Municipal Cam Phone: (772) 589.254 Fax: (772) 228-9927 n 3 sty Ci Clerk's Office — Cathy Testa City Hall, 1225 Main Strt Sebastian, FL 32958 Office (772) 388-84215 or388-8214 St9stgIcilvaftabas an.otq FUNERAL HOME: Strunk Funeral H me and CrernatorV Sebastian, Florida, 3295 ADDRESS: 1623 North Central Avenue, PHONE* 772-589-1000 (Check One) 21 L� 45 XXXX OPEN BURIAL LOT Lot_i 131 k� nit 4 OPEN CREMAINS LOT LotBlock Unit. OPEN COLUMBARIUM NICHE Niche ock nit 7 @ 1:00 BURIAL DATE AND SERVICE TIME: SaturdayNovember 11, 2 IChapel Service follow with Military H 31 iors at Se a an Cemetery Interment FOR DECEASED: Edward Rorman- Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATI : (Must provide proper documentation of ownership) Rochelle Norman FAahak 1!7/2017 ate NameSignature 7860 94L' Court, Vero Beach, Florida, 32967 1 certify that I have determined the owner hip of the above descrilo c site that E I iito fees and administr fees have been paid and authorize operth g of same. NAME AND SIGNATURE OF LICENSE2 FUNERAL DIRECTOR: William B. Whittaker, Jr. VU.,B cAtto., Signature L 1 1f7l2017 ate Name Cemetery Sexton Certification: I certify that I have checked the ownershi information by viewing I ii owner's c a and confirming with office and that all fees have been paid: Cem ery'Sexton Date This form to be provided to Clerk's Office by Sexton for permanent r cord upor q mpletion. red by Rtive Clerk's Paid bY cF-~METEEY Receipt No .... ~.~8 D 9/26/88 ........... ated .............................. ust P,ce ....... Net Paid $ 325. ~ ~istop~r Ross No~ ~te~ed 9/29/88 NO. Lot 21, Blk.45 Maximum No. Bur~d Spa c~s .... .1. ........... UI2J. t 4 1191 monument mr,mttnd ....................... Edward Norman III 7860 94th Ct. Vero Beach, Fl. 32967 (D~ta nl~we fl~la line tot Clt~ P~coed only) · iig of i ebaslian (!;emelery Deei 1.!.9! NO. THIS INDENTURE MADE ~ .... ~..6.~ ........... day of .... S.~p~.~.b.~.~r .......................... A. D., 19....~..~, between the City of Sebastian, a municipal corporation existing u~dcr the inw~ of the State of Florida, as Grantor and Edward Norman III ................................... .7..8.~.0.. 94. t.h..~.t.,., ...v.e.r.o...!~e.o.c.h,...F.!......3~96.7 .................................. of the County oI Indian River Florida ............................................. an'] State ol ....................................................... s~ Grantee, WITNHSSETH~ That the Grantor for and in consideration of the sum of $ ..... ~2J~, ~0 ............ lo 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 .... hi~ heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) ...2 ].. , Bio ck,. ~4.5 ..... UNIT . .~ ........... of Sebastian municipal cemetery as per Phi Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in the office of tbe Clerk of tho Circuit Court of St. Lucie County of Florida; said hnd now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shaft be used solely and exclusively for the interment of thc 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 covcuants running with the land. In the event of the failttrc of the owner of any property situated within said cemetery to ob- serve and comply with ~uch rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner in and to said properly shall terminate and thc same shall revert to the City of Sebastian, Florida. 1N WITNESS WHEREOF, The said party of th~ first part has caused this instrument to be executed in its name and on its behaff by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year fast above written. ~// City Clerk Signed, Sealed and Delivered . ................... STATE OF FI~IDA COUNTY OF INDIA~ ~IVRR CITY' OF SEBASTIAN, FLORIDA. Mayor before me persooully appeared Ri.char.cl.. B. ,.. respectively M~yor and City Clerk of the City of Sebastian, a munieipM corporation under the laws of the State of Florida to me known to be the individuala and officers described in and who executed the foregoing coaveyance to Edward Norman III ........................................................ and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly author[zed; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance UNIT 4 BLOCK 45 LOT 21 DEED NO. 1191 EDWARD NORMAN III 7860 94th Ct. Vero Beach, Fi. 32967 Christopher Ross Norman interred 9/29/88 Name Unit Block Lot Date of MarK-out Date of Burial Name of Funeral Home Authorized by City of Sebastian POST OFFICE BOX 780127 m SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589-5330 October 7, 1988 Mr. Edward Norman III 7860 94th Court Vero Beach, Florida 32967 Dear Mr. Norman: Enclosed is Cemetery Deed No. 1191 for Lot(s) No.21 Block 45 , Unit 4 . 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. 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. Very truly yours, Elizabeth Reid Administrative Secretary LR Enc. Cloy o£ Sebastian $e~sClan, Florida RECEIPT IS ~£RE~¥ ACJCNOWLEZx~E~) OF T~E SUM OF; ~.~ ) on c~da~ o~ ~ f ~ , lgO~ ~o~ ~a pu~c~aae o~ ch~ ~o~:owin~ descrE~d Cu~c~r~ ~C(dJ u~ ~e C~ and ~d~Clona as aCaC~d hu~u~n~ ~scrlp~on of when approved by the own~p of the Pro~ert~l abov~ do$crdbed. conddt~o~ scared la Ch~ £o~golng .lntrument,r September 29, 1988 TO: FROM: FINANCE DEPARTMENT Please issue a check in the amount of $75.00 payable to: Wabasso School P. O. Box 207 Wabasso, Fl. 32970 This represents refund of an over-payment for cost of Cemetery Lot No. 21, Block 45, Unit 4. The correct cost of the lot is $325.00. DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES ,,~ VITAL STATISTICS APPLICATION FOR BURIAL-TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF CHRISTOPHER ROSS NORMAN DEATH SEPTEMBER 24, 1988 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER VERO BEACH Inst. A-1-A SOUTH OF VERO BEACH, FLA. 3. Name of Medica] [] Physician Address 464-7378 Phone Number Certifier FREDERICK HOBIN, M.E. [~3tMedical Examiner 4001-B VIRGINIA AVE. FT. FIERCE, FLA 4. Funeral Home/ Name Address 407-589-1000 Phone Number (Area Code) ~(~M~ STRUNK FUNERAL HOME, SEBASTIAN 1623 N. CENTRAL AVENUE SRBARTIAN, FLORIDA 5. Check a [] The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate BOX b [] 8. Funeral Director/ D~er was contacted on within 72 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 will complete and sign the medical certification of cause of death. was contacted on 9/24/88.' - He/she verified that FREDERICK HOBIN, M.E. , Medical Examiner, will complete and sign the medical certification. Fla. Lic. No./_.°~u.J~ Date Signed #1672 9/24/88 B. BURIAL-TRANSIT PERMIT Permit No, 1228-88-430 Permission is hereby granted to dispose of this body. [] A five day extension of time for firing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from fiting within the normal time limit If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. [] No extension of time for filing,the death certificate requested. Registrar or /~] ~ /) ,~- f~5. __~ · - . . Date Date Certificate SubregistrarSignafure (.4 ~ j ~ ~'~.. ~ Issued: 9/2/'/RR Due: c. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature , Medical Examiner Date or Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disooser. 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 aH cremations. CEMETERY OR CREMATORY Method of Disposition: ~ BURIAL [] STORAGE [] CREMATION [] OTHER (Specify) or Person-in-Charge , q . .- / Place of Disposition SE?_ASTIAN CEMETERY Date of Disposition SEPTEMBER 29, 1988 This permit must be endorsed by the Sexton or persomin-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. H RS Form 326, Oct 87 (Replaces May 86 edition which may be used) (Stock Number: 5740-000-0326-2) ~.~,