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Home My WebLink About4-43-25Paid by CEMETERY Receipt No... 580 Dated List Price 200.00 Maximum No. Burial Spaces Net Paid QD...O,Q Monument permitted THIS INDENTURE MADE This 18th day of Au A. D., 19 89 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Charlotte G. Sewell and /or Lois G. Payne 13690 Old Dixie Hwy., Sebastian, Fi. 32958 of the County of Indian River ani State of Florida as Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of S ..6QQ, OO 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 j)}E i X heirs, legal representatives and assigns the following property situated in Sebastian, Indian. River County, Florida, to -wit: s All of Lot(s)4 ,UNIT 4 of Sebastian munidpal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 8 o 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 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 iuch 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 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 i Signed, Sealed and Delivered in the Presence oh r STATE OF FLORIDA COUNTY OF INDIAN RIVER dA.€4,;,e„ I HEREBY CERTIFY, That on this (Data above tlrls line for Gty Record only) fdilg of lifrrhtta #tun TPIIIPfPx1J �PP� B. Votapka 8/18/89 CITY OF SEBASTIAN, FLORIDA Lots 24, 25, 26. No. B1k. 43, Un.4 Charlotte G. Sewell1 4 Lois Payne 13690 Old Dixie Hwy. Sebastian, F1. 32958 Mayor NO. (City $eal) 1235 18th day of August 89 19...., and Kathryn M. O'Halloran before me personally appeared Richard 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 Charlotte G. Sewell and /or Lois G. Payne and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized; and that the Official seal of said- corporation is duly affixed thereto, and the said conveyance is the net 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. NEtary Public, tate of Florida at La. My' commission expires: N Public, Stale of Florid;/ hly Coi :ion Expires Doc. 10, 1992 bonded Thru Troy Fain insurance Inc. Charlotte G. Sewell Charlotte G. Sewell, 94, died Sept. 21, 2009, at her home. She was born in Carnesville, Ga., and lived in Vero Beach since 1990, coming from Roseland. She retired from the Budd Co. in Philadelphia as a cost clerk. She was a member of Roseland United Methodist Church in Roseland. Memorial contributions may be made to Roseland United Methodist Church Discretionary Fund, P.O. Box 157, Roseland, FL 32957. Survivors include several nieces and nephews. SERVICES: A memorial service will be at 11 a.m. Sept. 26 at Indian River Estates, West Chapel, in Vero Beach. Visitation will be from 2 to 3 p.m. Sept. 27 at Strunk Funeral Home in Sebastian. A service will follow at 3 p.m., in the funeral home chapel with the Rev. Anne Godbold officiating. Burial will follow at Sebastian Cemetery. Published in the TC Palm on 9/25/2009 1. Name of First Middle Last Deceased Charlotte G. Sewell Date Month Day Year Death Sept. 21 2009 2. Place of Death City, Town or Location County Indian River Vero Beach Name of (If neither, give street address) Hosp. or Inst. 7740 Indian Oaks Drive, G -320 3. Name of Medical Certifier Arthur Splendor M.D. nMedical Examiner Nr Ph Address 1265 36th Street Vero Beach, FL Phone Number 772-567 -6340 4. Name of Funeral Home /piceei`Bispo58r Establishment trunk Funeral Home 6 Crematory Address 1623 N. Central Ave. Sebastian, FL Fla. Lic. No. /Reg. No. 1228 Phone No. (Area Code) 772- 589 -1000 A. 5. Check Appropriate Box 6. Funeral Director/ Dj a ieposer B. (TYPE) a. b. Eti c application. BURIAL TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -09 -0423 El A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. EiNo extension of time for filing the death certificate has been requested. tiggist;<eror Date Date Certificate Subregistrar Signature 0 i Issued: 9/21/09 Dye: 9/26/09 c. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date 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 S IBURIAL STORAGE Date of Disposition T T d CREMATION OTHER (Specify) Signature of Sexton or Person -in- Charge DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740- 000 0326 -2) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL TRANSIT PERMIT The medical certification has been completed and signed. A completed certificate of death accompanies this Amy was contacted on 9/21/09 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Splendoria will complete and sign the medical certification of cause of de h within 72 hours. cal ceytifica of use of death within 72 hours. was contacted on He /she verified that Medical Examiner, will complete and sign the ign a F.E. No. /Reg. No. Date Signed 44048 9/21/09 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. Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar Recycled )aye Sep 26 2008 2:45PM FUNERAL HOME: ADDRESS: PHONE FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5BASTIAN 'vane HP LASERJET 3200 f u P(LKA.Iswro For informatior contact: Kip Kelso Cemetery Sexton Sefiastian Municipal Cemetery (772) 589 2545 City Clerk's Office it Hall, 1 228 Main Street Sebastian, FL 32958 Onto (772) 388 -8215 or 388 -8214 Fax: (772) 589.5570 $TRUNK F NERAL HOME Si CREME 623 No. Central Ava_ EBASTiAN, FL 32951 -t000 (Check One) X ,OPEN BURIAL LOT L l 25 Block 113 Unit 4 ._._OPEN CREMAINS LOT L Block Unit OPEN COLUMBARIUM NICHE N•che Block Unit BURIAL DATE AND SERVICE TIME: 9/27/09 3 P.M. W FOR DECEASED: Charlotte G. Sewell NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper docu ntation of cwnership) Narne Signature igna Date Date I certify that I have determined the owne ship of the above describ -d site that all site fees and aid and uthorize opening of sa NA,, AND SIGNATJ OF TENSED FUNER .49. 1 Narne ate This form to be provided to Clerk's Off,c by Sexton for perrnanert record upon completion. p.1 Cemetery Sexton Certification: 1 certify that I have checked the owners f p information by viewing the owner's deed and confirming with Clerk's office and that all fees have een paid Cern tery ex of n T CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name S f r u n k run er a. l Cash Date 9-30 09 Check# 7 5 No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche 001501 343805 Cemetery Fees Block Unit Initials White Dept. of Origin Yellow Finance Pink Applicant 4597 o2iO °O Total Paid 0/50 DO