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Home My WebLink About4-44-2613 November 7 Paid by CEMETERY Receipt No.... Dated N r Block Lots 26, 27, 28 List Price S $200.00 Maximum No. Burial spaces 3 Unit 4 Net Paid S EiOO ..OQ Monument permitted .Fla.t THIS INDENTURE MADE Mb ....13 day of November A. D., 19..8.7., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and J4hf..I'.•.. Tina .,I.... 334 Main Street, Sebastian, Florida of the County of Indian River and State of Florida as Grantee, WITNESSETHi 600.00 That the Grantor for and in consideration of the sum of S 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 their heirs, legal representatives and assigns the following propetietuanin S,vtian, Indian River County, Florida, to -wit: All of Lot(s) Block, 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 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 gover 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 such 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 fast part has caused 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. Attest: Signed, Sealed and Delivered In the nee of: Olitj of Orbautian hh rtirj City Clerk (Data above this line for City Record only) NO. CITY OF SEBASTIAN, FLO DA B ((M fg Mayor 1145 1145 STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 13th day of November 19.87, L. Gene Harris Kathryn M. O'Halloran before me personally appeared and y 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 John F. and Tina J. Gill and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. Notary PubUc, $Fate of Florida at Large. My commission expires NOTARY PUBLIC STATE OF FLORIDA NT COMMISSION ESP DEC 10,1988 BONDED TMRii GENERAL INS. UM). Name LJf14'I X /1 A. /41 A A /6e/ 1I /;45) Unit 1 Block l Lot 14. 7/4 Date of Mark -out Date of Burial T a Time a OD 9 7,/#1 e Name of Funeral •me PAM Authorized by X9.4/ �e!_et�� .q ✓,G� Z 0 Z i N ACCOUNT WITH £g d64$ 7.t,i i o m k y rT 3 rr �o. e4. 4 F J/Qe 1 sg ita o% s47 mdw7 /CE MA <vAi E. IL 1 l';‘ 1 Iaim t 't A: DATE 57//ftel c TERMS 1 l c 0 0 O 0 0 0 2 Z O 0l d 0 0 0 CO °O eo 3 A A NI CO Co (O (D CD 0 O W O O O CD CD wads pg/se!doo 508£17£ L051.00 pled ;unowy FUNERAL HOME: ADDRESS: PHONE Name Name //4 Cembter on FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBASTIAN NOW Di PELICAN ISLAND 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 (Check One) OPEN BURIAL LOT Lot Block OPEN CREMAINS LOT Lot g& Block _OPEN COLUMBARIUM NICHE Niche Block ff BURIAL DATE AND SERVICE TIME: S 5� /2 7>A4 *7.0/ FOR DECEASED: 4,,'L 4 /�,r (p;' Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR. Da e Unit Unit Unit Y W 7;.:74j 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 Signature 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 This form to be provided to Clerk's Office by Sexton for permanent record upon completion. ti L. Gam Harris Mayor Mr. and Mrs. John F. Gill" 334 Main Street Sebastian, Florida 32958 City of Sebastian POST OFFICE BOX 780127 SEBASTIAN, FLORIDA 32978 -0127 Kathryn M. O'Halloran TELEPHONE (305) 589 -5330 November 17, 1987 City Clerk Dear Mr. and Mrs. Gill: Enclosed is Cemetery Deed No. 1145 for Lots 26, 27, and 28, Block 44, Unit 4. If you wish to have thjs deed recorded, you may do so at the office of the Clerk of the Circuit Court, 1145 14th Avenue, Vero Beach. 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. LR Enc. Very truly yours, Elizabeth Reid Administrative Secretary RECEIPT ;S BEREAY ACKNOWLEDGED OP THE SUN OF: THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida Dollars 6 v_,.3a on a day of 1987 for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein; Description of Property: Cemetery Lot (s) M z 6 T 1-7 Blockg 4 uni tN_ Purchase Price: f Terms and conditions of sale: This contract shall be binding upon both when approved by the owner of the property s c ibed. and the purchaser, Property above described. 1, or we, agree to purchase the above describes property on the conditions stated in the foregoing .intrument: The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. A. (Type or Print) 1. Name of First Deceased 2. Place of Death County Brevard 3. Name of Medical Certifier Bhasker Patel, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, 5. Check a Appro- priate Box 6. Place of Sebastian Cemeter Final Disposition: 7. Funeral Director/ Direct Disposer B. C. D. KV Santina Sub g str Signature State of Florida, Depart of Health and Rehabilitative Services, Vital istics APPLIC BURIAL TRANSIT PERMIT b c City, Town or Location Palm Bay Methods of Disposition: .8URIAL STORAGE CREMATION OTHER (Specify) Signature of Sexton or Person -in- Charge 1623 North Central Avenue P.A. Sebastian, F1 32958 1228 (407)562 -2325 The medical certification has been completed and signed. A completed cert ficate of death accompanies this application. Karon was contacted on 05/14/36 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 BheSker Patel M D will complete and sign the medical certification of cause of death. medical certification. BURIAL TRANSIT PERMIT 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 the death certificate requested. 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. I HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740- 000 0326 -2) Josephine Gill Medical Examiner x l Physician Address n state cemet emator M Middle Last CEMETERY OR CREMATORY Signatufe F.E. No. /Reg. No. 84 IL Place of Disposition Date of Disposition Removal e /county: Indian River n from state Date Date Certificate Issued: 1 9 G Due DATE Month Day Year OF DEATH 05/11/96 Name of (If neither, give street address) Hosp. or Inst. Integrated Health Services Palm Ray Address Phone Number 5270 Babcock Street N.E. Palm Bay. Florida 32905 (407)724 -949A Fla. Lic. No. /Reg. No. Phone Number (Area Code) was contacted on He /she verified that Medical Examiner, will complete and sign the n Donation Date Signed 05/14/96 Permit No 1228 -96 -022$ 54ki atQ. i-inon is 05(0 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 HRS County Public Health Unit in the County where disposition occurred.