The URL can be used to link to this page

Home My WebLink About4-45-35Named Unit ` Block Lot -� �J h� ��7CS $�1� /i�V Date of Mark -out L Date of Burial 1 �o�� l l Time Name of Funeral Home Authorized by W- (r.p6 All .4i Total Paid 0. v Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT /, 81 `+ V I �fwlej4 D� C� Cc_.c_.n r j �� La.l�e rc& � t �V�/1 Cash Name 1" ❑ Date "1 -2 3 ' 13 �'Check# No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies /Bid Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche -35 Block , Unit y 001501 343805 Cemetery Fees Total Paid 0. v Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant CREMATION CERTIFICATE This is to Certify that the Remains of GENEVIM V. NICOLIIZA have this Day been cremated at Charter Oak Crematory, L.L.C., Subject to its Rules or Regulations and All Legal Requirements have been met. Cremation Number: 10711 Date of Cremation: 8 -5 -13 Date of Death 8 -3 -13 Place of Death: DANBURY, CT. Funeral Home: DANBURY, CT. City & State of EH.-. JTATEMENT JDATE - - TERMS TO t ADDRESS IN ACCOUNT WITH " .A �u a�ada DC5812 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY "OMf Di "'Ic"1"NO For information contact: Kip Kelso • Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax: (772) 589 -5570 FUNERAL HOME: ADDRESS: PHONE #: (Checiy0ne) OPEN BURIAL LOT Lot lock Unit OPEN CREMAINS LOT Lot ---Block Unit _._)PEN COLUMBARIUM NICHE Niche Block Unit W BURIAL DATE AND SERVICE TIME: FOR DECEASED: ��> l/ ,{/�co �i /o ivanie 14AME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) lqll,q 2 Fj-(4-Gt&ZZn — 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 authorize opening of same NAIv1E AND SIGNATURE OF LICENSED FUNERAL DIREG-f OR. Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership infornriation by viewing the owner's deed and confirming with Clerk's office and th -t all fees have been paid Cem tery exton Date This form to be provided VClerk's Office by Sexton, for permanent record upon completion. Titij of #rhastian 565878 TrmPtPr1 15rrb NO. l�bv THIS INDENTURE MADE TkU ....24th........... day of ..... Aug. u. s .t ............................. A. D., 19..8$., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as-- Grantor arid__ ,gyp..:' :................... Gene.vieve.. NiQ.0.1ella yac- knowledged, ��. ........................... 742 Vocelle Ave. , Sebastian, F1. , 32958 of the County of ....... ......I,ndian..R,iver........... an] Stoke of .........�lQr C? a...........as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ : O , , , to it in hand paid, the w reof is herewi does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , her heirs] pre atives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) . 3 �; . ,& 3 Block, , , �; S. , , AINIT .. , 4 .. , .... , , of Sebastian municipal cemetery as per P Num 1 thereof recorded in Plat Book 2, at page 65 of the public records in the o of the Clerk of the Circuit Court of St. Lucie Count of Flor said land now lying and Iming in Indian River County, Florida. �- ~r C DOC. ST. - AMT. _ e-5 - 2 FREDA WRIGHT, Clerk Of Mull COUR �. r � T, Indian River County - by To Have and to Hold the same forever; provided that said property shall be sed WY 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 `rdinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government d ai o 'd cemetery. The conditions, restrictions and requirements contained in this instrument shall be covenants running with the land. In the nt t failure of the owner of any property situated within said cemetery to ob- serve and comply with such rules, regulations, resolutions and inance he 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 o City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of th us s used 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 aff d, the day and year first above written. CITY OF SEBASTIAN, FLORIDA Attest: ... .... .......................0 -de t) BY ......... .................. .......... k Mayor, Signed, Scaled and eliv e in the Presence Off J . STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ........2.4.th .... • • ...day of (Titg'settl) ...... Au. gust .... ............................... I 19.8.8, Richard B. Vota ka r ,,athr n M. O'Halloran O before me personally appeared ............................ .............................. ands .......y .............................. L0 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 the individuals and officers described in and who executed the foregoing conveyance to ......... Genevieve.. ��1� 4.4.7 ea a ....................................... ............................... ............._ ...;. and severally acknowledged the execution thereof to be their free act and deed CZ as such officers 'thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance CL. is the act ' and deed of said corporation. co WITNESS my.- signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and Year last aforesaid. co { %i.\k= ................. • Notary Public, , ate of Florida r. at Large. My commission expires: NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP DEC 10,1988 - BONDED THRU GENERAL INS. UND. Raul by CEMETERY Receipt No..... S 3 3....... Dated ......8./2.4/.88 List Price $ .... 200..* " .... Maximum No. Burial Spaces .... ?...... Net Paid $ 400.00 Monument permitted ...................... Michael Nicolella interred 8/26/88 -Lot 35 Lots 34 & 35 No. B1k.45,UN.4 1185 Genevieve Nicolella 742 Vocelle Ave. Sebastian F1. (Data above this line for Clty Record only) ' Titg of Orhastian Trutr#rrg Errol NO. 1185 THIS INDENTURE MADE This .... 24.th........... day of ..... Angus .t ............................. A. D., 19..88.� between the City, of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ... ............................... Genevieve. Ni. Go. lella...:................................. ............................... 742 Vocelle Ave. .,........................... . Sebastian, Fl., 32958 of the County of ............. InUan.Uye.>r........... and State of ......... Flox Lda.. ............................... as Grantee, WITNFSSETHs That the Grantor for and in consideration of the sum of $ , A00.. 00.... 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 . , k12 r. , heirs, legal representatives and assigns the foPowing property situated in Sebastian, Indian River County, Florida, to-wit: 3 AB of Lotcs) .3 & Block 4 5 UNIT 4 , of Sebastian municipal cemetery as per Plat Number I 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. Lurie 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 inch 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 mused 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. Attests .r... ...:...(,�A,� ity Clerk SlgmKd, Sealed and Delivered in d P s resence ofs a. uzzt ................... ............................... ...... STATE OF FLORIDA CITY OF SE�BAS�TIIAN, FLORIDA � By ../ fGc; �!- !�.ol. /-� ...K .......... Mayor Mav *130 Unit B*k Lot Date of Mark-out ' -��, '� /; Date of Burial Time Name of Funeral Home Aulhiorized by J. STATE OF FLORIDA �16_ ORTMENT OF HEALTH & REHA8ILITATOERVICES /3 yS VITAL STATISTICS APPLICATION FOR BURIAL — TRANSIT PERMIT / A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF MICHAEL JOHN NICOLELLA DEATH AUGUST 22, 1988 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or INDIAN RIVER VERO BEACH Inst. INDIAN RIVER MEMORIAL HOSPITAL _ 3. Name of Medical KXPhysician Address Phone Number Certifier MELISSA L. REYNOLDS, M.D. ❑ Medical Examiner 2300 5TH AVE. VERO BEACH, FL 567 -7111 4. Funeral Home/ Name Address Phone Number (Area Code) 11NOXZI1W136Yer Strunk Funeral Home - Sebastian 1623 N. Central Ave. Sebastian Fl 407 - 589 -1000 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. Briars b 91 Sandy was contacted on 8/22/88 within 72 Box hours after death. He /she verified that this death was from natural causes, that there was no accident not other external cause of death, and that Dr. Reynolds will complete and sign the medical certification of cause of death. C ❑ was contacted on . He /she verified that Medical Examiner, will complete and sign the medical certification. 6. Funeral Director/ D*eet1Ntp-Mr ignature _ Fla. Lic. No. /Reg. No. Date Signed f / / #1672 8/22/88 B. BURIAL — TRANSIT PERMIT Permit No. 1228 -88 -388 Permission is hereby granted to dispose of this body. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing 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 a death certificate requested. /J Registrar or - T�lex.i Date 8/22/88 Data Certificate Subregistrar Signature— Issued: 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 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. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition SEBASTIAN CEMETERY U BURIAL ❑ STORAGE Date of Disposition AUGUST 26. 1988 ❑ CREMATION ❑ OTHER (Specify) Signature in Sexton ) �`Sr�) � _// % 1 or Person-in-Charge )� "Y� �'•C. 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. HRS Form 326, Oct 87 (Replaces May 86 edition which maybe used) (Stock Number: 5740 -000- 0326 -2)