HomeMy WebLinkAbout4-42-14
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~ byCEMETE!lY"""" N~... .!....... . Dated. ... .1.!.lJl/.9P............_
Ust Price $..... ~.~? ~ ~9.... Maximum No. Burial Spaces.................
325.00
Lot 14 NO.
Blk.42,Un.4
Net Paid $
Monument permitted. . . . . . . . . . . . . . . . . . . . . . .
12.58
Osethie Fogleson
Vining Mobile Pk.Lot 1
11325 Old Dixie Hwy.Seb.
Harold Fogleson interred 1/22/90 (cremains)
(Data above tldl Jlne lor City Record only)
O!ttu nf &fbusttuu
(ttrwrtrry Drrb
1258
NO.
THIS INDENTURE MADE TIaJI
10th
day 01
January
90
A. D.. 18......,
between the City 01 St'bl1Stlan, a municipal corporation alltln<< under the laws 01 the State of Florida, al Grantor and
Osethie Fogleson
........................ ......... ... "'Lot.. '1';' 'Vi'it'itig' MaoiI'e' 'PIC: .......................... ...... ....... ..............
............................. .......... .~~~.2.?. 9;tA. p.~~~.~. .~~.g~~~r.~.. ~~.1;>.a.s~~.~~.,.. X~...... .~.~~~.?.............
Indian River Florida
of the County 01 ............................................. anJ State 01 .......................................................
u Grantee. WITNESSETH I
That the Grantor for and in consideration of the sum of $ .... ~.? 5. ! QQ. . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac:-
knowledged, does by this instrument grant, bargaiit, seD, release, convey and confum unto the Grantee . .Q~:r. .. heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
AD of Lot(s) . . . ~ ~. , Block, . . . ~.?. , UNIT ....;........ , of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat
Book 2, at page 6S of the pubHc records in theofftce 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 shaD be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintained at aD 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 shaD be covenants ruainJng 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 shaD terminate and the same shall revert to the City of Sebastian, Fiorida.
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.
Atte~~)),~..OIi~...
:7 ' 'f - City Clerk
CITY O~SEnAB IAN, FLORIDA
/
- f 0t-;4-
B1......................:....~................
Ma10r
Signed, Sealed and Delivered
Int p_n"4!.~.
~...~~................
STATE OF FLORIDA
COl'NTY OF INDIAN RIVER
10th
I HEUEBY CERTIFY, That on thla ...................... ..day of
(QUtll ~taJ)
January
90
II.. ...
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '.
before me personally appeared .~.tc;h~~.4.. ~~.. :v ~ t.l;ipk~ . ..... .. .. . .. .. .. . .. . .. ... and ~~ t,~Xy.n ..~.~.. Q ~ .I.I.~;J,J..9.J;' ~m..
resp,'ctlveJy Mayor anll City Clerk of the City of Sebastian, a municipal corporation under the laws of the State 01 Florida to me known
to be the Individuals IInd officers described In IInd who exeeutl-d tile for<'golng CORveyance to
Osethie Fogleson
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and severally acknowledged the execution thereol 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 lIet and dt'ed 0; said corporation.
WITNESS !Dy Ilpature and offldal It'8I at Sebastian. In the County of Indian River and State 01 Florida. the day and year
last alor~8atd.
~w,..~;.;.~i.~~~.................
My commission explrell Motary tubtK. State o' noridll
My Commission Expires Dec. 10, 1992
Bonded Thru Troy Fain .In.vrance Into
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Paid by CEMETERY Receipt No.... .~9.4........ Dated.... J/.l.Q 1.99...............
List Price $ . . . . . ~.~ ? ~ ~9. . . . Maximum No. Burial Spaces. . . . . . . . . . . .. . . . .
" 325.00
Net Pad $ .................. Monument permitted . . . . . . . . . . . . . . . . . . . . . . .
Harold Fogleson interred 1/~90 (cremains)
Lot 14 NO.
Blk.42,Un.4
(Data above dill Une tor City Record only)
12-88
Osethie Fogleson .
Vining Mobile Pk.Lot ]
11325 Old Dixie Hwy.SE
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City of Sebastian
POST OFfICE BOX 780127 c SEBAsTIAN. FLORIDA 32978
TELEPHONE (407) 589-5330
FAX 407-589-5570
January 19, 1990
Mrs. osethie Fogleson
11325 Old Dixie Highway
Vining Mobile Park
Sebastian, Florida 32958
Dear Mrs. Fogleson:
Enclosed is Cemetery Deed No. .1258 for Cemetery Lot No. 14,
Block 42, 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.
We are enclosing two copies of Receipt No. 604 and ask that you
sign and return to us the copy marked with an "X" and retain the
other copy for your records. A stamped, self-addressed envelope
is provided for your convenience.
Very truly yours,
i:4-:taL R~
Elizabeth Reid
Administrative Secretary
LR
Enc.
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f'HB SBBASf'IAN CEHBf'ERY
Cl~y of Seba$tlan
Sebastiani Florlda
RECEIP'l' IS HERBBY ACKNONLBDGBD OF f'HB SUN OF,
~~~-~
, . . ~
FROM, 0 ( ,3:-'-14 16... nr-L 6-ge>,.1
1/ 3 J.S- 0 L-J) !) i)( (e II- Lv <I.
. .
J-..:;) r , t V I N' IN'?- ~ 4> IN ~ (E. If(.
.! f 6/rS rut- #J pL '3 ")..- 7 5" d'
on thl" /0 ~ day of .J A A/()~ .1910' for the purchase of ~he followlng
described Cemetery Lot(s) upon t terms and condltions as stated hereln:
Dollars ($ '}:L:;); 00 )
Descrlptlon of P%Operty,
. . Cemetery Lot (s) , I f Block' t./ V Unl t' '-f
Purchase prlce'~~..J /;-::;-I:>~ Dollars($ 3)..-):<10 )
~I
Terms and' condltlons of salet
Thls contract shall be bIndIng upon both partles, the seller and the purchaser, when
approved by the oimer of the property above descrlbed.
I, or we, agree to purchase the above described proped:!! on the terms and condl tlons
stated ln the foregolng Instrument i
(}~~~.J- . 7~
The Clty of Sebastlan agrees to sell the above menHoned propertfl to the above named'
purchaser(s) on the terms and condItIons stated In the above lnstrument.
.4,~~ ~.~
Clty of ebastlan
~~~
tness
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HAROLD OR OSETHIE FOOLESON 07-81
11325 OLD DIXIE HIGHWAy, 589-9075
VINING MOBILE PK., LOT 1, OLD DIXIE HWY.
SEBASTIAN, FL 32958
~
2015
~21
FLoRmA.HATDW.1ANK
MaIn Office 321
,lOOl2Oth Place
\\!to Beach, Florida 32900 ,~o/N.... Q
FOR ~ #~... LzI /JI_~ r ~..,t'./ -1 (7 a--b~
i:01;?00b~b"':S8 02..0.. 2~b8~ti- 20?5 ,I, , .,. ",.-
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f~:::-",1t;'ll~!p~~ _,
FLORIDA DEPARTMENT Of
.,_::- \ 'l~ta,.!g~d.!,~ePa.~,!~!U~n~Pf!i'i'~..! Vi~1 S~.S,:_.
I. ',' . ,..,,- - AP~L:.ICATlON-FOR BURIAL'- TRANSIT PERMIT - '- .
'19-~/1 ;jl\ig1:3~ :1:'::::VlAr.T.._~:}.."... -'.:
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A.
1. Name of--
Deceased
HEALT
(TYPE)
2. Place of Death
County
I ndian River..
First---- --------Middle -..---~-Last --.-----. Date-----Month
TY:\'lR3-~ .~~(::.~ l'~:;rr.4.:f-lq~.~\ of
Osethie LeBlanc Fo leson Death
City, Town or Location Name of (If neither, give street address)
Hosp. or '".'Or: . ;tf;c'
'O....;:,,!' Insl'~2:::~; 641-~BraddockStreet
. Day-. ..Year
Se t.
11 1999
Sebastian
11,
~ri:'37th';:St;~t'" <J :e-dr- "'0'" '"~ PhOneNumbe~:~;:
Physician Vero Beach, F.I. 561-567-2277
4. Name of Funeral Home/Qil!eM gilp_1 Address Fla. Lie. No./Reg. No. Phone No. (Area Code)
Establishment ", >" -,: .',o;~- 1623 N.: Central Avenue' .-- :'..,.. . ..
Strunk Funeral I-bme .' Sebastian::;' FI' -:- .:' :'~~"~'::'_' :'"'1228 ~- 56-1-589-1000
5. C~eci(." <):''': "_ a. D__The medical ~~ificati(>n ~as.~n~leted and,,~~gned. A ~pleted certificate of de~th accomp~~ies this
A~propriat~,' '1 ~..~- ,'application, ~ '".:' . IT' >, ,;-~: . '. .' . . : . . ~ :
Box __
b; ~ __
3. Name of Medical
Certifier M u
,r.... :h~';
-::.!"':,
:";'
Bronwyn - wa~ contacted o~ . 9/13/99-
Helshe verified that this death w_JromlJatu!"81 causes, that there was no accident.no~ other extemal cause of death,
<~~nd,th~.. ___- Dr ..,Farooq ~i11 complete and s~n the medical
certification of cause of death within n hours.
C. D
was contacted on He/she verified that
---.----.- ---- .------. ,Medical Examiner, will complete and sign the
th with' nhciurs:,~..-;:
F.E. No.lReg. No.
2
Date Signed
9/11/99
6. Funeral Director/
DiJeIlt;1I ..
.~ .:
B.
Permission is hereby granted to disposeofthis body. . .'. ," . . OL "'" ':f. .... .::. ,_' Perm'it No. 1228-99-0423
o A five (5) day extension of time for filing. the' ~ath ~rtffi#a~::{~d~iv~Of~kendS) h~S.~,!~u~st~ _ ~nCt granted, sinc:e the -physician~lls
been contlilcted by the funeral director and wil! not be ,able to complete the medical certificatkmJ)f cause-of-death section of the death certificate within
n hours. ~
DNo extension of time for filing the death certificate has been requested. - h '--- --.--- ----- - - - ---,-
~::,:,S~"aw~ ~~..~~~~ '~'Q':~"::~=:il;"'\C\~
c. ; -..:; ,,1' .-.', '~':'.- AUTHORIZATION for CREMATION, DISSECTlON~()r BURIAL-AT-SEA n'''" ";.,, /,
Approval Number:
.," .
"'bate
- -
Medical Examiner, , gave authorization by telephone to
Funeral DirectorlDirect 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 cremati.ons~
D.
CEMETERY OR CREMATORY
Method of Disposition:
Place of Disposition Sebastian Cemetery
Date ofOlopos~t.., ku i(o J 199 q
'IilBURIAL
DSTORAGE
DOTHER (Specify)
} ~M';'< ~. f/AA~
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 retumed
within 10 days to the local County Health Department in the county where disposition occurred.
DCREMATION
Signatl.:re of Sexton
or Person-in-Charge
DH 326, 8/97 (Obsoletes all previous editions)
(Stock Number 5740-000-0326-2)
Distribution: 'Ml~e: Cemet8IY or Crematoty
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar
5.