HomeMy WebLinkAbout4-43-08
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"P,W by CEMETERY Receipt No...~......... Datod..... .~J.J.J/.~?.......... t 8
" 200.00",' Blk.43, Un.4
ListPnce$"'iO(;~oo""" MaximumNO.BurialSpace..............M~.S. Chiyoko Michael t 229
Net Paid $ .................. Wonumentpennittod....................51i9 F h W
.Arthur L. Michael interred utc ay
8/12/89 - Lot 8,Blk.43,Un.4 Sebastian, Fl.
(Data .boy. tbII Une to, elt)' Record GAly)
NO.
32958
atitt! nf t;thustiun
C!!rmrtrry
irrll
1229
NO.
THIS INDENTURE MADE 'I1aIa .....H)..t~~....H. da)'ol .HHA-~g1;1.~.~............;..............H A. D.. 1.....~~
between the Clt)' 01 SebaatJan, a municipal corporation exlltlng undcr the lawl ot the State 01 Florid.. al Grantor and
........................... ........ ....~~.~.~.. ~~.;y.~~<?. ~~~.J:1.~~~.............................................. '" ...... ......
. . . . . ... ... ............................ 5A9. E\J, t.cb. .w'GlY.,.. .S.ebA(:l. t.:t.AJl,. ..~;J,.. ... .~4 95.6. . . . . .. . ... .....................
Indian River Florida
01 the County ot ...................................., . . . . . . . .. an'J State ot .......................................................
u Grantee, WITNESSETH I 2 00
That the Grantor for and in consideration of the sum of $ ..... ~?.. . . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant. bargaiD. sell, release, convey and conium unto the Grantee. hex... heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) . . . ~. .. ,Blode,... ~.~ .. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 6S of the public records in the ,office of the Clerk of the Circuit Court of St. Luc:ie County of Florida; said land now lying and being
in Indian River County, Florida.
Slgnw, Sealed Ilnd Dcllvered
, ~,.lli' P~.t'~....,....;............
ff~a.-.{?~~~.....
(QIitu ~eaJ).
To Have and to Hold the same forever; provided that siid property shall be used solely and exclusively for the interment of the human dead and sha1I
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 tho government and operation of said cemetery. The conditions, reltrictions 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 sha1I terminate and the same sha1I revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the first 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 fust above written.
Attestl,~... .J .L.~ .,u.. In......Ofl.a.fk.~........
.f..~r."':'":'I(.~ :Clty Clerk
CITY OF SEBASTIAN, FLORIDA
BJ ..~~.15...~..........
MaJor
STA'l'E OF FLORIDA
COUN'l'Y OF INDIAN RIVER
I HEllERY CERTIFY. That on tb1a . ~~~.J:1............... .day 01 ........... A':1.g~~~.............................. 18..~~
Richard B. Votapka Kathryn M. O'Halloran
belore me personally appeared....... ..... ............................................... and ...... ........ ...... ...... ......... ....
respectively Mayor and City Clerk 01 the City 01 ,Sebastian, . munlc1I)ll1 corporation under the laws of the State 01 Florida to me known
to be the Indh'idullls llnd officers described in and who executed the fort'going coaveyanee to
........................ ..... ..... ....~!:~:.. .q?~y'<?~~. .~;.c:~~.~.~.......................................;......................
. . . . . . . . . . . . . . . . . . . . . .. . . .. .. .. .. . . .. . .. .. . .. .. .. . .. .... and aeveraUy acknowledged the execution thereol to be their Iree act and deed
IS such officers thereunto duly author1&ed; and that the Ofl/cial seal 01 said.Corporation /s duly allixed thereto. and the said conveyance
Is the act Ilnd deed 01 said corporation.
WITNESS my ligoature and olfidal aea1 at SebaltJan. In the CoUllty 01 Indian River and State 01 Florida, the day and Jear
last alort:said.
~...
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My coDWllaalon explrell t!otary Public. State of Floridcr
My Com:ni!sion Expires Dee. 10, 1992
Bonded Thru Troy Fain a Inlurance Inc.
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Paid by CEMETERY Receipt No...~ ?~......... . Dated. .... .~.OJI.~c)'........... ~ot 8
List Price $ ... ?~9.~ ~9. ..... Maximum No. Burial Spaces B1k. 43, Un. 4
................. 12r.9
Net Paid $ ...~.~? :~?..... Monument permitted.................. .M~s. Chiyoko Michael G
Arthur L. Michael interred 549 Futch Way
8/12/89 _ Lot 8,Blk.43,Un.4 Sebastian, Fl. 32958
(Data above dill Une tor City Rec:ord only)
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tulbyCEMEfEav _No.. ?on......... .Date4..... .~!.n/.~')...........' hot B
u.t ".,. $ .. .~!!\l.: \I.I!. . . . . . __ No..-...... JIll<. 43, Un . 4
N......$ ...~~?:??..... ...._......... .............M~S. Chiyoko Michael t 229
. Arthur L. Michael interred ...................5'119 Futch Way
8/12/B9 _ Lot B,Jllk.43,Un.4 Sebastian, Fl. 3295B
(Data aboye dill noe for CltJ RecOrd 0DlJ)
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City of Sebastian
POST OFFICE BOX 780127 a SEBASTIAN. FLORIDA 32978
TELEPHONE (<407) 589-5330
August 29, 1989
Mrs. Chiyoko Michael
549 Futch Way
Sebastian, Florida 32958
Dear Mrs. Michael:
Enclosed is Cemetery Deed No. 1229 for Lot(s) No. 8 Block 43,
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 com-
pleted by the office of the Clerk of the Circuit Court.
We are enclosing two copies of Receipt No. 573 and ask that you
sign and return to us the copy marked with an "X" and' retain the
other copy for your records. . A sta~ped, self-addressed envelope
is provided for your convenience.
Very truly yours,
'1:~I\~L
Elizabeth Reid
Administrative Secretary
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PAY TO THE .~ - "'.'
. ORDER OF.
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THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
<~ ~~~ ~ e>1;oc> ~ars ($ ~o~ C)CJ )
FROM: C- 11/ 10 k 0 /'fIe-lilt-tEL
517 Fu Tefl LA/If '1
S r2-e/t5r II1/Vj F- L _ ? 2- 7 :>---;?
on this II ~ day of 41) ~ (/ Sl,__19 8/ for the purchase of the following
described Cemetery Lot(s) upon the terms and conditions as stated herein:
Description of Property:
Cemetery LOt(s)# 8 Block# 43 Unit# t{-
Purchase price:~ Lu ~ t7oto Q ----rx111ars ($ ~o. 00 )
Terms and'conditions of sale:
This contract shall be binding upon both parties, the seller and the purchaser, when
approved by the owner of the property above described.
I, or we, agree to purchase the above described property on the terms and conditions
stated in the foregoing instrument:
X L'4d. h1.' .r~"'Q.~
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.
--c~~ ~ ~'L
Witness
_ _ _______-.--...L____________--'-
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[lid
OEI'^ftTM~NT OF' Ht.Al.Th AND
ftEHl\BtUTATlVE S€RVICES
'. ,', , STATE'OF FI,..ORIDA .
. . EPARTI.!~fjT llFl!EALTH &REHABILlT~E $ERVICES
' ...... .,,' ViTALSTATISTICS
APPLICAT.IONF:OR. ~URIAL-TRANSIT PERMIT
, :~ 'i 'oi
1. g
/013
141
A.
1. Name of
Deceased
(Type or Print)
First
Middle
Last
DATE Month Day Year
OF
DEATH AUGUST 10, 1989
ART~
.i l ".' J,.;eROY,
KICHAEL
2. Place of Death
County
BREVARD
9itv" TolIVo Qr."LQ,8!~iO/l. q
MELBOURNE
Name of (If O,eit~er,givestreet addrllss)
Hosp. or
Inst. HOLMES REGIONAL MEDICAL CENTER
3. Name of Medical , 1XI Physician Address MELBOURNE, .' Phone Number
Certifier PARVESH BANSAL, M.D. '0 Medical Examiner 2202 BABCOCK STREET. FLORIDA 951-1267
4. Funeral Home/ Name '.' ..... ..... . ......., '.....< i' ,! . ,,' . ..:, Ad~r,ess Phone Number(Area Code)
~J(~Jf:X STRUNK Ft1NERAL 'HOME'!':1623' N. CENTRAI.AVE.SEBASTlAN. FLA. 407-589-1000
5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
ApprO-this applicaticm;"; lit!
priate ''/
Box b 1Kl' , SHIRLEY was contacted on 8/]0/89 within 72
hours after death. He/she verified %hat this death was from natural causes, that there was no accident nor
' "'l'othllr.externa"c:a~eof death;andthat./r, DJ-- ~SAI. will complete
. and sign the medical certification of ca.use of death.
c 0
med ical ,certification.
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
6. Funeral Director/
,Qireet QisJil9ier
~~.
Fla. Lie. No./FkIS. PJ8.
~ /~7,,2.
Date Signed
?V"'<:),Y/
B.
BURIAL- TRANSIT.PERMIT
Permission is hereby granted to diSpose ofthis'bodY.
o A five day extension of time for filing the deathcertifipate (exc'usi\le ofweekerlds) has been requestec;f and granted as undue hardship
would result from filing within the normal time Iim.it.lf the certifica!e c~not'b~filed within this extended time limit. a "Funeral Director/Direct
Disposer Report" will be filed with the;Local Registrar Qf the County inwl;lichdeath occurred.
. " I - -,'~; _ 1 .. .' ,',:, .'.,; -' " ;". .' '_' .
o No extension of time for fi' g the death certificate 'requested:' \-'i,
Registrar or Date 8/10/89
Subregistrar Signature Issued:
Permit No. 1228-8g-~60
Date Certificate
Due:
C.
, ',' '. .,..." , f ,
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT -SEA
Signature
or
Medical Examiner,
", Medical Examiner
Date
"0 " , .. . <i.m"",;,;;: ):/g~~l!authorization by telephone to
'. . . ,FunllraID,irect()r/D,i,rectD,isposer. Date
The Medical Examiner's approval must be obtained before dispo~J by any of the above methods. A waiting period of 48 hours after
death is required for all cremations, :,.;.' " ,
D.
'C.EMETERY OFl,CREMATORY ,
Method of Disposition:
fiI BURIAL 0 STORAGE
o CREMATION 0 OTHER (Specify)
Place of Disposition
Date of Disposition
SEBASTIAN CEMF.TERV
AUGUST 12. 1989
Signature of Sexton )
or Person-in-Charge )
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 may be used)
(Stock Number: 5740-000-0326-2) .
~.