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Home My WebLink About4-42-34State of Florida, Department of Health, Bureau of Vital Statistics — — — BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: June 26, 2017 TRACKING NUMBER: 2017100944 1. DECEDENT INFORMATION Name of Deceased Date of Death DONALD W BLEASDALE June 22, 2017 Place of Death - County City, Town or Location Name of facility, or street address If not a facility INDIAN RIVER VERO BEACH GRACE REHABILITATION CENTER OF VERO BEACH Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number SEAWINDS FUNERAL HOME F073380 F073380 (772) 589-1933 735 SOUTH FLEMING STREET SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No. RACHEL E. DELASHMUTT F052116 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2017-F -5135 �— Date Issued: June 22,, 2017 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY / Method of Disposition: BURIAL Date of Disposition: EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10/12 64V-1.011, Florida Administrative Code CITY OF SEBASTIAN 10729 ADMINISTRATIVE SERVICES RECEIPT Name lkitiJDS �l7If�61#0Cash Date b -019 -17 )theck#0?444 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100, Zoning Fees poiSb► 343SoS ofG� D c IL r4 BU<'A L A -r 33 �-- znp Total Pai A6e `a I itials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. - Pink - Applicant CITY OF SE HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax June 22. 2017 Maureen Bleasdale 1161 George Street Sebastian, FL 32958 RE: Interment Rights to Unit 4, Block 42, Lots 33 & 34, Sebastian Municipal Cemetery Dear Mrs. Bleasdale, Enclosed is City of Sebastian Certificate 2541 entitling you to full interment rights in Unit 4, Block 42, Lots 33 & 34, in the name of Maureen Bleasdale. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Enclosure CRY OF SEBASTI�AN� HOME OF PELICAN ISLAND Certificate No. 2541 CITY 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: Maureen Bleasdale 1161 George Street Sebastian, FL 32958 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 42, Lots 33 & 34 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 22nd day of June, 2017. CITY OF SEBASTIAN, FLORIDA �Z-14� Joseph F. Griffin City Manager ATTEST: J anette Williarn�, MMC City Clerk _ _ av of HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Il&/ r8viq6E S77eEZE-7 E'5rb4-%-77A-,v FL.oa9�r S-8/ - S- Oo Area Code & Pho Number (N / , �I6H,a,a1 ? ICFIfJ,�D vG1�1n1Y�) (003 ^^ % 3L9r7 Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: Dollars ($ a 000-00 on this ARAO) day of OLLi t= 20 /'7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 4 Block Lot(s) 33 fi 34 Niche(s for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Opening & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Interment VIP 1-f ZC17ss . 1�, " s3Q,09� ignature of Purchaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc /W O H Circle One Disinterment TOTAL 4 rr ' • City of ..;► The following documents were provided as Proof of Residency: and CITY OF SEBASTIAN 10726 ADMINISTRATIVE SERVICES RECEIPT Q Name "� 1r,-SDM-L ❑Cash Date 6/-A.2//.7 ')YCheck # (C-3 416 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 SecurityDeposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees &�bIo/r? 3Wapm Lo T- 44 Llo,cx7 L)1jrr F /.i, a L0r331- 3L{L 1 1— Total Pai 0006• d C itials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. - Pink - Applicant ~ , . , "" , "',- . . &7 4/6/90 . Paid by CEMETERY Receipt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . List Price S. ;I.., .~O.Q ...QQ.... Maximum No. Burial Spaces..........;...... Net Paid S . ~.1.~9.q ...9R.... Monument permitted....................... Lots 33,34,35'~B Block 42 . Unit 4 1270 Richie E. Havens and/or Carole A. Webb 9725 N. Marina Dr.Pelican Sebastian, Fl.32958 Point Jeffrey C. Webb interred 4/7/90 Lot 36 (Data abOve this line lor e1t)' Record only) OIitll of t'tbastiau <ltrmrtrry 111 rrb 1270 NO. THIS INDENTURE MADE 'I1aII ....~t.Q.............. day of .....A.P~.iJ............................... A. D., 1t..~~L between the City of Sebastian, a municipal corporation alstlng under the laws of the State of Florida, as Grantor and Richie E. Havens and/or Carole A. Webb ........................ '9'7ZS"N':"Ma'iiiia' 'Drive" '(Pe'ficai;' Pain.i)............ ....... ...... ..................... ........................ .Sebas.tian,.. Flo.r.ida. .329 5.8....................... ............................................ Indian River . Florida of the County of ............................................. anI State of ....................................................... u Grantee, WITNESSETH I That the Grantor for and in consideration of the sum of S .~ 1.~~9... 9.Q. .. . ... . .. ... to it in ~<! paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, seD, release, convey and confum unto the Grantee ..~..e: ?-.~ heirs, legal representatives and assigns the foDowing propert~luatet in Sebastian, Indian River County, Florida, to-wit: AD of Lot(s) . . . . ;. ~ Q~lock, . . .4 A .. ,UNIT It............ ,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. Lucle 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 shaD 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 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 arid 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, 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 afrlxed, the day and year fust above written. CITY OF SEBASTIAN, FLORIDA Attest: 9:lCu:-l-.~m....D:1I t21l/~.-.......".... U City Clerk B,&;rC7~~~';, Sign~d, Sealed and Delivered ?:~;~~~....~.HHH.HH ....._~..a..>>;~............ STATE OF FLORIDA (QIite ~taJ) COl'NTY OF INDIAN RIVER I HEUEBY CERTIFY, That on this ...... ~ ~~............ .day of ........ Al'.~.~;1;..................................~ I'. ~~ W. E. Conyers Kathryn Q'Halloran b~fure me personally appeared ........................................................... and ....................................... respt~ctively Mayor and City Clerk of the City of Sebastian, a municipal corporation unller the laws of the .State of Florida to me known to b~ the Individuals and officers described In and who executed the fOrl'going cORveyance to . . . . . . . . . '" ........ .. ........:........ ~U..c;p.;i,~. . .W... . .~~:'[~:p.f?. ~mc;l.f.Q;r: . .C.~,t;~i~. . A.... . .w.~p.p.. .............. ........ . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and severally acknowledged the execution thereof to be their free act and deed as sllch officers thereunto duly authorbed; and tbat the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the IIct and deed of said corporation. WITNESS my signature and official leal at Sebastian, In tbe last aforesaid. County of Indian River and State of Florida, the day and ,ear ~ ~ .;5-~. ~.' q' 'Uc/1U.t.'r:7..L . 'Y'" k.!..c...<.' . .L.a...-:............ Notary PubUc, State 01 Florida at . My colDIDlsslon explrell . Not., Pablic. State of Florida My Commission Expires March 26. 1993 Ionad Thru TI01 Fain. Insu.._ ",,", ,.',.CC' ;....:1. :-"."J,.,':; '. . ,. . 617 4/6/90 Paid by CEMETERY Receipt No.... . .. .. .. . ..". . . Dated... ... . ,. . .. .. . .. . .. ..... . .. . . list Price S. ;l.1 .~O.Q..:QQ.... . Maximum No. Burial SpaceJ................" Net P_u S . .1.. .3.0. .0. ...0. .0...... U em rmitted lUU . _onum pe .............;......... Jeffrey C.Webb interred 4/7190 Lot 36 ,(Data abOve Ui.. line tor Clq Reeord oaly) Lots 33,34,35'~8 Block 42 , . ::::i: E ~ Havens:!i~!. Carole A. Webb 9725 N. Marina Dr.Pelican Sebastian, Fl~32958 Point RICHTER. AND 1 OR , BB, CAROLE A. '. . 9725 N. Marina Dr., Pe11can P01nt Sebastian, Florida 32958 DEED f/1270 I Lots 33,34,35,36 Block 42 ' Unit 4 ~ !€I Jeffrey C. Webb interred 4/7190 Lot 36 IJdJf- ~ ~ ? l'; I ~---------:::--.......-"'::-_.-t ,- i' 'I, r ) 1 - " i " ~............_-----..,...,C'"-;..----.-: I, { i , i I /f ./ -,' ( ( 3 J cL~...t ~ . Jl4v~ /1~tt.""'J1;l: ~Jt1.1. roL5+-W. , $ >> AI L:. ~j) 70s ~H/) % M.eS..#,4 r~:Jr/ S . ~/ ' ~ j tr~ /,1?.lAO~/.Nf' ~ I 7- 'r tP I ~ ,. (7-/ J.t? '> ~ I r/ J :/I 7 eJ:!!!Z- N). 16 r. . l "'3) .5.l, /'IIJ c.- It. ~ /1/)/1 /H S , r~l)~ 7:;I~J!!.L ~ /'l ftf.6.. ~ ,rC;/f# J.-/-,. OlYCF ~ HOME OF PELICAN ISlAND 1/r} 33 / 1225 Main Street, Sebastian, FL 32958 (772) 589-5330 city@cityofsebastian.org December 1, 2004 Carole Havens 24456 Little Mack St. Clair Shores, MI 48080 Dear Ms. Havens: I am sorry for the necessity of our correspondence and will assist you with your requests. I am enclosing a copy of Deed #1270 indicating the purchase of lots number 33,34,35 and 36 in block 42 of unit 4 in 1990. Your son rests in lot 36. I understand you wish to sell back lots nos. 33 and 34 to the City of Sebastian, and retain Lot 35 for your personal use. Please send the original deed to receive $650.00 which is the price you paid for two lots. Please be advised that the City does allow a full burial with a cremain in one lot. This option would allow you to sell three lots back to the City instead of two for a refund of $975.00. . Also enclosed is a copy of the current rates and ordinance pertaining to the cemetery. Please advise your representative that the cost of a weekday internment is $95.00. At the necessary time, please have your representative pay the shipping and handling fees to have your remains shipped to the City at 1225 East Main Street, Sebastian, Florida, 32958. If may be of any other help to you, please do not hesitate to call again (772)589-2545. S?;~7. / A:/h Kip G. Kelso,l).. ~ ~ / ~ Cemetery Sexton Enclosures '. .,.~..."",:":";'--- (})_r7J ( H (JJJ €-VI ..s OwnS U L( f!J 4l G33!3J35@ :5/)1\ ~~tJtlob ') 2.5, l{ (3()O ~ (0 Y--: z,u M~( n S d; &/50,00 t# ,. ~/7 THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida FROM: RECEIPT IS HEREBY ACKNOWLEDGED OF TilE SUM OF: c:a.;~__ J &~~~L --- , _ Dollars ($ ~ 3(1". de) ) d:;,.Lj/ ~. &~p ~A &~ tL. if/4'/ . n /~. ) ey7~s . ~1. o/'.t>~.4l-C:'- L~u<~ V~~-d~/Z;lC: / / - // - ," ~k..:J.~~.J " /"'~~ .:3r?9.S-~' . 7 . on this &. -ct day of @'- ,J:9 It? for the purchase of the fOllowing described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: . , Cemetery Lot(s)IIS3: 37: 35: 3t Blockll ;:y,;< Unit#~ Purchase price0;;:::~~ '&4LL'.u,/ Dollars($/3?'cJ.dcJ ) Terms and'conditions of sale: otc~ ~"j/<"c_,,/ ~,d r::;,/U.<....(l &?7lL 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: ~ '~a-'-' . .~.~->c Z__/ .... 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. .Zv.-?I..;1l-L.- ~U/~_# ~City of Sebastian ~~ Witness "~~;:'-:;"~T"!r":~:::~":"', "r.~:if';;~1i~",~~}\~~~:"....t~s~f'~'i!';~~. :';''':-':~!1~_."""",..!',,-~..'W:\'''!fi.t(,J;:,~'~'-;'-~'. ;jl;_"-'~~Il1.1' _~J~~:}~)<. . . POST OFFICE BOX 780127 0 SEBASTIAN. FLORIDA 32978 TELEPHONE (407) 589-5330 FAX 407-589-5570 April 9, 1990 Richie E. Havens and/or Carole A. Webb 9725 N. Marina Drive Pelican Point Sebastian, Florida 32958 Dear Mr. Havens and Ms. Webb: , . Enclosed is Cemetery Deed No. 1270 for Lots Number 33, 34, 35 & 36, 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. ver~Yru y yours, . lJJ {)JI/~ Kathryn . O'Halloran City Clerk KMO:js enclosure (::'i:~'~"41~~~;;0~~ . . ~/7 THE SEBASTIAN CEMETERY Ci ty of Sebqstian $ebasti.an, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUN OF: FROM: ~;'k~) ~--2r/./_ /C;~jJ ~,d{LN?~ 9'7~S . ~ d~-<2~4.J , , , Dollars ($;: 3tftl. tJ a ) ~/~ · &~- d. 2I)~ o/~0~V~~) r~ .:3~9.s-R' on this &TZ day of ~ ,:i9ft:? for the purchase of the following described Cemetery Lot(s) upon .the terms and conditions as stated herein: Description of Property: .1 Cemetery Lot (s) 1133: 37: '3 s: 3t: Blockil 7" ~ Uni tll ~ Purchase price~~7'J;~/&~/.?~ Dollars($/8~t1.dCJ ) Terms and'conditions of sale: otJc-~~.~~~ 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: 9~/ The Ci ty of Sebastian agrees to sell the above mentioned property to the above named' purcbaser(s) on the terms and conditions stated in the above instrument. ~~Ab. 9(~17 ~City of Sebastian . Witness . . // - " f3-?l})P14.ft: 5' bOLJ IfflJ: t? /l,b~ L0r--88 9702S' p<'Ja'1t i ;Jl/l.P1;Y; J}?/J/i : ~84J11,t/tJ, rf ' 3;2 J.J~ ~'0r-,:"'-"---- ................. ftI. u. ..~ flJ-..l 1-.....-- i1.JoWItIUfIlA ~i ~ ct> CO lil[ Jj:r I~ tD .. ~ i~ ::s F - .. o IP i ~ ~ ~ ~~ o 1I~ '>t, - "'\ .....,' .. . :t:. E\~~*' ?'~ " ' ... o ~ ~ ...C ~Z tJ)Z~ GJ g "11 ~i!i :; 0 m ~~~ rill'"' ~~:z: Iii ffim .. N ~ .. CD M ~ ~' t_ ~ ~ ::u ~ U) I'\) ~