HomeMy WebLinkAbout4-43-37
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SEBAS~
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HOMl OF PWCAN ISlAND
Certificate No. 2043
CIn' OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Diane Johnson
(name)
8125103rd Court, Vero Beach, Fl 32967
(address)
in and for consideration of the sum of 5950.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit_ 4_ Block _43_ Lot/Niche_37_
of the Sebastian Municipal Cemetery,
as maintained on fIle in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 6th day of September, 2005.
ATTEST:
rdtL W,,~
i Jeanette Williams, CMC
Deputy City Clerk
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HOM1 OF PII..ICM ISLAND
1225 Main Street, Sebastian, Fl32958
Telephone (772) 589-5330 - Fax (772) 589-5570
September 6, 2005
Mrs. Diane Johnson
8125 103M Court
Vero Beach, FI 32967
Dear Mrs. Johnson:
Enclosed is City of Sebastian Certificate 2043 for the purchase of Cemetery Lot 37, Block 43,
Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the
Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Sincerely,
Jeanette Williams, CMC
Deputy City Clerk
JW:ar
enclosure
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HOME OF PWCAN IS1AND
<If tO~
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provi[:Ofpurchase .
~e(S) d.~~
?/~r.'/~Jk~~ ~J ~~d~ Zl. 3~0,7
Address
Area Code & Phone Number
Residence Address of Intended Occupant if other Than Purchaser
,office Use Only
Receipt is acknowledged in the sum of:
~. / .' J ~ .' ~g
. . '..b' ~ fff' 44",~ ~ r- //lJ
. tJ '
on this ,~::t:lt 'day,of ~---I--' ,20~orthe purchase of the following
described Cemetery Lot(s) a lor Niche(s).
Unit-i-. BIOckA-. Lot(s) .3 7 Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations '
prescribed therefore by the City of Sebastian.
Dollars ($ ~.' t:J 0 )
,
Additional Fees paid at time of purchase:
Comer Markers (set of 4 - $20) Opening & CIOSing~~ t? ~
W~H
Cir ne
Vase and Ring for Niches (cost)
Disinterment
TOT L $1{ ; .z-.5: l> d .
Signature of Purchaser
Service fees are to be paid at time of need only
1:\WW-DATA\Ms-Cemetery\RECEIPT.doc
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEPT
3407
:~~~~
No.
o Cah
~.s6S/
Amount Paid
001001 208001 Sales T8X
001501 322900 Garage Sales
001501 341920 CopIesIBId Specs.
001501341910 LOCJCode of OrdIn8nces
001501341930 EIecUon QuaIfyIng Fees ~~67P.t?
601010343800 Cemel8Iy Lots
rIlh.~ if..? L.r .unltL
~~.37
,
001501343805 Cemelely Fees . U5:t7(.
o 4-(! A/I"~~
11)7,
Ida..
/.
Total PIId~ d /,.:1': eJ<
Mite -IIIpL .f Orilla. Y..... - F....ce . PIIk. applicant
,~ ':~"":;:~i:"?~!il':::"~1J;;'i"'^
." .
iF .~.jo/I}I 5 o~/{v e r: ). 1'110
Name
v1wet
93
.37
Unit
Block
Lot
D,ate of Mark-out
9/J../o ~-
Date of Burial .. .. 9~ '3 /D?-'. .. .
. >/. j.~
Nan:'e of Funeral,t-r{",e . .J.-!):{'
i-
l
.I
Authorized bY(
~/
,
. _~,~. t,_-, .:.
--""
/
3..;1125.
Time
.~ ~DO iJ(cIlPl:!]F..1-) .
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state of Florida. Department of Health. \rltal StalIstIcIC 15' !P
APPLICATION FOR BURIAL - TRANSIT PERMIT ~
~ 1l'~"""" <r "" "'~
, ~~t """""","
FLORIDA DEPARTMENT OF
A.
1. Name of
Deceased
(TYPE)
First
Middle
Last
Dewey
Alvin
Johnson
Date
of
Death
(If neither, give street address)
Month
Day
Year
Sept.
1
2005
Vero Beach
Address
Name of
Hosp. or
Inst.
8125 103rd Court
2. Place of Death
County
Indian River
3. Name of Medical
Certifier Michael Layton,'
Medical Examiner
City, Town or Location
Phone Number
4. Name of Funeral Homeft.\;......... t'ilpllilltl
Establishment
Strunk Funeral Home
5. Check a. 0
Appropriate 'b
Box
b.
D.
Physician
Address
1623 N. Central Ave.
Sebastian, FL 1228 772-589-1000
11Ie medical certification has been completed,and signed. A completed certificate of death accompanies this
, application.
77" Bay Street,'2
Sebastian FL
772-388-8322
Fla. Lic. No.lReg. No. Phone No. (Area Code)
lee was contacted on
He/she verified that this death was from natural causes, that there was no aCcident nor other extemal cause of death,
and that Qr. Layton wili complete and sign the medical
certification of cause of death within 72 hours.
9/2/05
c.D
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
6. Funeral Director/
lMar;!: ""ilpg\l8l'
Date Signed
9 1 05
B.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. ' Permit No. 1228-05-0379
o A five (5) day extension of time tOr 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.
DNo extension of time for filing the death certificate has been requested.
, 'f\..liI:6lrar or .
Subregistrar Signature
Date
Issued:
9/1/05
Date Certificate
Dlle: 9/6/05
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
DSTORAGE
Date of Disposition
Sebastian Cemetery
7/r~~-:
,
Method of Disposition:
dBURIAL '
Place of Disposition
DOTHER (Specify)
} if 9',t:~9
This permit must be endorsed by the Sexton or perscin-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and .retumed
within 10 days to the local County Health Department in.the cou'nty where disposition occurred.
DCREMATION
Signature of Sexton
or Perc;')n-in-Charge
Distribution:
lMlite: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Locel Reglstrer
...,.wG,..
DH 326, 8/97 (Obsoletes all previous editions)
(Stock Number: 574O-OlJO..0326-2)
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Qtitl1 Df &tbastian
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621275
12:40
NO.
THIS INDENTURE MADE TIda ........?~p.......... day ot ........$~P~.~roR~X...................... A. D.. 1989....
~ between the City ot Sebastian, a municipal corporation existing under the laws ot the State at Florida, as Grantor and
~:t{). . . i:~ ~~~~~::~.i::~::r,iO:~bC:~ :~~:~ex~-t~:t:~tl1a32 :"5 :i~ b.ex . (Da.U!;11 t.e.r)..........
.... .........-................................ . ...... ....... ........... ................... ......... .......... .........................
Indian River . Florida
at the County 01 ............................................. an.] State 01 .......................................................
II Grantee. WITNESSETH I
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 conlmn unto the Grantee theiz:. heirs, legalrepresentativesand assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
39
All of Lot(s) ~ .7. 1.~? 1 Block, . . . ~.~ .. ,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. Lucie County of Florida; said land now lying and being
in Indian River County, Florida.
DOC. ST. · AMT. . 3. 3 0
J.K. BARTeN. Cterk at Clrcuft Co1Jt
tnd\an River County - by h. ,-,IJ A .
~~-
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 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 tlirminate and the same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the lllst part has caused this instrument to be executed in its name and on its behalf by its Mayor and
attested by!ts City Clerk an4 its corporate seal to be hereto affIXed, the day and year IIlSt above written.
~.
CITY OF S~EBAB~IAN' FLO:~;~~~~~~'.:~v~: ~~"':'\"
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AM 10: 09
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Att""pp ..p P~l!f~...PP....P
Signed, Sealed and Delivered
'Ei;P.
STATE OF FLORIDA ",T'Y'
COUNTY OF INDIAN RIVER u. il. ,:,. ;1 "'T
CI [C . , , r.1 , 'I .
I HEREBY CERTIFY, That on this ...at.b............:tt'qri~~ri~k..;S'~.Jl5.~~ml;>.e;l;'................................. 19..e~
'. Richard B. VotalB"a ...:O.C, Kathryn M.' O'Halloran
before me personally appeared............ ................ ....-:-:........ . . .. . ... . . .. . . ... and .......................................
respectively Mayor and City Clerk ot the City ot Sebastian, a municipal corporation under the laws of the State of FI()rida to me known
to be the individuals and officers described in and who executed the torl'going cORveyance to
.. .......... .~~y.J~<;l.q.~..~.t:l.4! 9.~.. H:~~J.QP'. .G.!.. W;i..I?l?~Y.. .~.. M9:~.th-~. .~.~.. W;i..I?P~Y..... ... .j....... .,...............
,,'." ":"~':f'I':.,.." ' .
.. .. . ".: '~~~~~~"'~'" :r(~... .. .. .. .. .. .. .. .. . .. .. .. . ... a?~ severally ac:knowledg~ the execution. thereot to be their tree. act and deed
~: ::t~~:::~:~~~~;;:~:~:~; and that the OffiCIal seal. at saId corporation Is duly affIxed thereto, and the said conveyance
.:.Vi. c. fES~.A;.~...!rct1ldit official leal at Sebastian, in the County ot Indian River and State ot Florida, the day and 1ear
lasL.-fo d. 'r ; '.~ ~. ,
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__.". - ~..~. .~-'.. r ".c-- .'.~
'~..;,.,..i:<tt ,,';\.>:7 Notary PubU , State 01 Florida at Large.
.f.... ." My commission expil'ell MolOry Public. SfobofFJoridcr
My Commission ~xp1ret Dee. 10, 1992 .
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. 37/ 38 31
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City of Sebastian
1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958
TELEPHONE (561) 589-5330 0 FAX (561) 589-5570
MEMO
To:
From:
Subject:
Date:
Janet Isman, Interim Finance Director
Kay O'Halloran, City Clerk ~
Check Request
November 17, 1997
Please issue a check as follows:
AMOUNT:
$600.00
PAYABLE TO: Wayland andlorMarion C. Wisbey
149 Dickens Avenue
Sebastian, FL 32958
PURPOSE: Repurchase ofCerhetery Lots 37, 38 & 39, Block 43,
Unit 4 by City.
SUBMIT TO: Linda Galley
ACCOUNT NO.: 001-30-590-995 $300.00
001-30-539-995 $300.00
'.
Pitd by CEMETERY Receipt No.... .......... Dated.... .9./.8./. a9.............. Lots 37, 38, 39 NO.
.. c20000 . 0 Blk.43, Un.4
List Pnce $ . . . .'? . . . . . ! . . . . . . . Maxunum No. Burial Spaces. . . . . . . . . . . . . . . . . 1 ~). 4 n
Net Paid $ ....~ ?Q9. ~ ~~.... Monument permitted.... ~................ J\Tayland & / or Mar ion C" &
. Martha E. Wisbey
149 Dicken Ave.,Sebastian
(Data above thla line tor City Record oo1y)
OItty nr l'thuBttnu
O!tmtttry
mttb
1240
NO.
THIS INDENTURE MADB 'nail
8th
day of ....... .$~Pt.~P.1R~.~...................... A. D., lsS9"'f
between the City 0' Sebastian, a municipal corporation exlstins under the laws of the State of Florida, as Grantor and
............... .W~y;I;~~o9-.. ~n9-/p~. .~o~.r;~~.~.. ~... 0 .~.~~~~X. o~. .~.~;r:~~~. 0 ~.'.. .~.~~~~X.. ~.J?~~~~~.~.~}...........
149 Dicken Avenue, Sebastian, Florida 32958
.... ................,......................... ............................................ ..... .......................................
Indian River . Florida
of the County ot ..... 0........ . ... 0..... 0 .. 0 0 0 0............ o' anJ State of 0.... 0 . .. 0" . . . . .. .. ... o. 0 .. 0 0.0.00. . 0 .. . ... o. . o. ......
&Ii Grantee, WITNESSETH I
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, bargam, sell, release, convey and conrmn unto the Grantee th ei 1:. heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
39
All of Lot(s) ~ .7. 1.~ ~ 1 Block, . . . ~.~ .. , 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. 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 beuled 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 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 rust 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 rust above written.
Atk.t, ..... ..... .. ....r:Z.. o.~~""'"''''''
CITY OF SEBASTIAN, FLORIDA
B,~I{~........
Mayor
(CfIitu ji~al)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
I HEREBY CERTIFY, That on this ...8. t.b.............. ..day of ... Se.p.t~m'b.e;r;................................, 19. .e~
Richard B. Votapka Kathryn M. Q'Halloran
before me penonally appeared ........................................................... and .... 0 0 . . . . . . . . . . . 0 . . 0 . . . . . 0 . . . . 0 . . . . . . .
respl'ctively Mayor and City Clerk of the City of 8eballtian, a municipal corporation umler the lawll of the State of Florida to me known
to be the individualll amI officers described in und who executed the fort'going coaveyance to
............ .~~y.~.~.I!4..?If.4/. 9.~. .11~~J.cm. .Go L. W~.I?l;>.~y'. .~. .M~~.t;h~. .~.~.. W~.I?P~Y.. 0........................... 0...
. . . . . . . 0 . . . . . . . . : 0 . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . .. and severally acknowledged the execution thereof to be their free act and
deed
as such .officers thereunto duly authori&ed; and that the Oflicill.l lieu I of lIaid corporation Is duly affixed thereto, and the said conveyance
is the act a/Ill. deed .of.said corporation.
WITNESS my signature and official seal at Sebastian, in the County of Indian River and State ot Florida, the day and 1ea:-
last aforesaid.
~~;kj~~...................
My cOOWlIsa1on expires I llotory Public, State of Florida
My (ommi;;d\)n hpim Df(. 10, 1991
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WAYLAND OR MARION ~. WIlIIy
148 DICKEN AVE
SEBASTIAN. fL 328158
11.
9- ?
19 ..E!L 13 7
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~n~' ~.1 ~- 1$1'-""'- ,;-~
~-L!t3.a-f}I'~ ~ DOLLARS
,
o Southeast Bank, N.A.
IIIo\S1WIIWDIG CINIa 7.
11M NOI11l us. IIIGtWA" 1
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'.tHE SEBAS'.tIAN CEME'.tERY
CitJ/ of Sebllsdan
Sebll"dlU2, Florida
RECEIP'.r IS HEREBY ACKNOJrlLEDGED OF '.tHE SUN OF:
~ IX !f-l)~~f])f~/2Y A-A/7) 00;00 _ ~rs ($ bOO.
FROH:--.J'V:~L-A-.rJ) k;v')/oR nAf<,~~ C-, \4/J~ BEt
A-t10> I1I;f{THt9 'e:.wCS13e.'i
1+1 -y,c../(Ed A vr3.
S E... B irS, 111 #) FL. 3 2- 1 s 8
-
00
)
on this 8~ day of StCf7fCfl8e:;~ J:981for the purchase of the fOllowing
described Cemetery Lot(s) upon the tel'lU and ccmditions as stated herein:
Description of Property:
Cemetery Lot(s) II 31. :3 '8. 31 BlOCkIl t3
.
Purchase price:~~ ~l.
'.terms and'conditions of sale:
Uni tll Lf
T",r",.~
Dollars($ boo,oj) )
.
'.this contract shall be binding uSJOn both parties, the seller and the purchaser, when
approved bJ/ the owner of the propertJ/ 4tbove described.
I, or we, agree to purchase the 4tbove described property on the terms and conditions
stated in the foregoing instrUlDflnt:
(.J~ (LL,)~
'.the Ci ty of Sebastian agree. to .ell the above mentioned property to the above named
purchaser(s) on the tel'lU and conditJ.ons stated in the above instrument.
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City of ebastian
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City of Sebastian
POST OFFICE BOX 780127 D SEBASTIAN, FLORIDA 32978
TELEPHONE (407) 589-5330
September 18.1989
Mr. Wayland Wisbey
149 Dicken Avenue
Sebastian, Florida 32958
Dear Mr. Wisbey:
Enclosed is Cemetery Deed No. 1240 for Lot(s) No. 37,38,39,
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 completed by the office of the Clerk of the Circuit
Court.
Very truly yours,
t~tdL 7\4
El~za6eth Reid
Administrative Secretary
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