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Home My WebLink About4-42-18P.Y�j►yCEMETERY Receipt No. .1 O, � r�ce s .. .......� 800:.00 N�cP�aa .........�800;,00 . . . . . . . . . Dated . . . .3 / 4_/ 9 0 . . . . . . . . . . . . . . . . . Maximum No. Burial Spaces . .?. . . . . . . . . . Momunentpermitted . . . . . . . . . . . . . . . . . . . . . . . Lots 17,18, Block 42, Unit 4 (Dats above thts line for City Record only) Mariano Vasta interred lot 18 3/6/90 rro. I259 Ann Vasta 524 N. Dol�in Cir. Barefoot Bay,F1.32976 �tf� i1f �P�'MSftMri �P)1tP�P�1,J �PP� No. 1259 THI3 INDENTURE MADE Th(� .......4.t1?.......... dny or .... March ................................ w. D., 19.90..� betaeen ll�e Clty ot 9ebastian, a municipel corporst(on e�ciating undcr the laws of the State of Florida, ae Grantor and ......................... Ann Vasta ....................................................... ................................... 524 N. Dolphin Circle, Bar.efoot Bay, F1..32976 of the County or ..... Brevard ...... ...:.............. .�:� State ar .....Florida...................................... ... ... ........ ao Grantee� WITNESBETH� That the Grantor for and in consideration of the sum of S.$ � Q; � Q,,,,,,,,,,,,,,, to it in hand paid, the receipt whereof is herewith ao- knowkdged, does by this instrument grant, bargain, sell, release, convey and confitm unto the Grantee ,, he:r ,. heirs, legal repre�►tatives and asaigns the following property situated in Sebastian, Indian River County, Florida, tawit: All of Lot(s) � �.&,j,','�' �lock, . . �+,? , , , , UNIT . , , 4, , , , , , , , , , of Sebastian municipal cemetery aa per Plat Number 1 thereof reaorded in Plat Book 2, at page 65 of the publlc records in the offlce of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being in Indian River County, Flocida. To Have and to Hold the same forever; provided that said property shatl be used solely and exclusively for the interntent of the humati dead snd 81tall be used, kept and maintainnd at all times in accordanoe with the rnles and regulationa, ordinances and resolutlons of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and opetation of said cemetery. The conditiona, restrictions and requirementa contained in this instrument shall be covenants running with tl� 1and. In the event of the failure of the owner of any property situated within said cemetery to ob- serve and comply with such rules, iegulations, resolutions and ordinances and the conditions of the dced 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 inatrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and its �rporate xal to be hereto affixed, the day and year fust above written. n�t�sc: . . . . . �%1.. . .� .'4.Q��-�.'`-� . . . . Clty Clerk Signcd, Seeleci and Delivered in the Presence ote . . . �-�L.�K-Q.r. . . .-"r-1.'-:4G .�LMR:�iZ� . . . .. . . . .. ,:.n ' � � ..,�•�:�z��:c--e.r :��G.�:�:?�....... STATE OF FI.ORIDA n.,. �u�nv no wr�.. � CITY OF SEi3ABTIAN, FLORIDA Br ... .. . .. ..� .. .........'`",..��.�.'��..... Ma�or (�"ct� p$YaI) Name �N/ O R�/L f//�— J�1��/ /�' "F �� Unit � B�o�k 7 /1 Lot � 7 Date of Mark-out 7 /�� Date of Burial �ll / /%.• Time Name of Funeral Home � � Authorized by � 5 I c i 0 m � s m f I T 'm � � � r � s °� � � � d W Q w �.Jt O �o � ,� �7 r /1� °o 0 0 0 0 0 o Z 0 0 0 o a �+ o v, v, ci, ci, o 0 0 0 0 0 0 0 (�,� W W A � A W N N O O O W CO t0 cN0 O Cr O O O O O � m � o � c�m r" n G� cn �� z 3 Ls. � �• u� � � � � � p � � m � �t r c n d � � d ° 'cpn m u, `2 O (p y � n ,�, T N c� ' � N � �i � N Z 3 � � , �� I C � p �- � n � � d � n N x � � (JZ 3 � O ° _ �o d G a . � n 1 n � � A r mmT m�m � N � � O y T � Ts �_ m � � C_71 � � � � � � �a � ( W � 1 � � R, � `�^ �! - �V � � ; N � I lJ h0 � � `V�'I V ii � � .. O a -* �N r+ � �� rt� cD d � d N�+ Oi �� N p� W � Z � � n = m � Z � � � D � D O m � . m m n D = � T z� � D c,� w N N Oo O �u C x rn iC7 > r � �'.� � 3 0� `i- � � n � iC7 �i � � � K7 .� FUNERAL DIRECTOR'S REQUEST TO CITY �F SEBASTIAN FOR BURIAL OPENING !N SEBASTIAN MUNlCIPAL CEMETERY �� HOME OF PEIICAN KIN�D For information contact: 1Cip Kefso - Cemefery Seuton Sebastian Municipal Ceme�ery (772) 589-2545 City Clerk's Office Cfty Hall, 1225 Main Sireet Sebasfian, Ft 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 STRUNK �UNERAL HOME & CR'�MA� �RY FUNERAL HOME: 1623 No. Central Ave_ ADDRESS: SEBAS�T�$�iL 3�2�958 PHONE #: (Che One� � OPEN BURIAL LOT Lot � Block � Unit OPEN CREMAINS LOT Lot Bfock Unit OPEN COLUMBARIUM N1CHE Niche Block Unit N E Wr�- q�(� BURIAL DATE AND SERVICE TIME: �ved_ �f � �' I►•�� "- l FOR DECEASED: �� l � Y �S� Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper d cumentation of owne hip) _— h�r� �r h Ir1 �' l D �?�l�- Name Signat re Date I certify that I have determined the ownership of the above described site, that alf site fees and administrative fees have been paid and authorize opening of same. N E AND SIG ATURE OF LICENSED FUNE L DIRECTO : n � � ��I �� Name � nature Date Cemetery Sexton Certification: I certify that l have checked the ownership information by viewing the owner's deed and confirming with Clerk's office an Ehat all fees have been paid� • / Jb Cem te Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon cornpletion. ,-- -- __. _- - . _ _ _ ___- �--- ... i .�:.:� � �.::- � �-_ � �� m � � �� .... _ �F � - � �i �.� _ � .� � .� � � m � , � \ � _ � .- � . � � .o � ~ � c � � � ii m i m o N 0 0 •� N Y N O m m � ,�„ . .. .;d�0 . .£� � ...�._ ,-_.� � Q :...Q Z -.Q. -_- . . Z �. m . . J . . a 1. �-. �.� . - _ , . . _� . � �.�-:� � , ,. . r , , , , .., , �� g � State of Fbrida, `rtment of Heaith and Rehabifita#tve Servi�iftaf Statistfca �/� APPLICATION FOR BURIAL — TRANSIT PERMIT � y (Type or Printl Name of Decea d Last Month 3e M�I�O VASTA OF - DEATH 1"Iarch 2 1990 2. Place of Death City, Town or Location Name of (If nefther, give street address) ��ry Indian River Roseland H°sp' °r ��. Humana Hospital—Sebastian 3. Name of Medical CertifierFarhat Khawa j a 4. Name of Funeral Home/ Di►eet-Bisp�o�er Strunk Funeral Home 5. Check Appro- priate Box � 7 B. a The medical ee this application. Examiner Pho�e 7754 Bay Street,Suite 7, Sebastian, Florida 589-3000 K PhYsician Address Fla. Lic. NoJ . hone Number (At'ea Code) 1623 North Central Sebastian, Florida 32958 1228 407-589-1000 tification has been completed and signed. A completed certHicate of death accompanies b�) _ Dr. Khawaia was contacted on 3/3/90 within 72 hcwrs after death. He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death, and that He will complete and sign the medical certification of cause of death. �� was contacted on . He/she verified that , Medical Examiner, will complete ancf sign the medical certificatfon. Place of In state cemetery astian Cem. , Sebastian,Fl Final Disposition: crematory - na ounty: Funeral Director/ ignature F.E. No./Ree�-�No► D'peet-�i'�eseF' ' 1672 BURIAL — TRANSIT PERMIT Removal from state (� Donation Date Signed 3/4/90 Permission is hereby granted to dispose of this body. Permit No.1228-90-122 ❑ A five day extension of time for filing the death certificate (exciusive of weekends) has been requested and granted as undue hardship would result from filing within the normai time lirnit. If the certfficate cannot be filed within this extended time limit, a"Funeral DirectorlDirect Disposer ReporY' will be filed with the Locai Registrar of the County in which death occurred. ❑ No ex#ension of time for fili the death certificate requested. Registrar or � �ate Date Certificate Subregistrar Signature Issued: '� J4 / 90 p�; �• AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Signature , Medical Examiner Date w Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained befone disposal by arry of the above methods. A waiting period of 48 hours after death is required for all cremations. D. Methods of Disposition: �I BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge ) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Place of Dispositbn Sebastian Cemetery Date of Disposition __March 6. 19 0 This permit must be endorsed by the Sexion or person-in-charge (or by the Funeral Director/Direct Disposer wrhen there is no Sexton) and returned within 10 days to the tocal HR3 County Public Nealth tlnit tn the Gwrrty where disposition occurred, HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be uged) � (Stock Number: 5740-000-0328-2)