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Home My WebLink About4-42-35 / Paid by CEMETERY Receipt No. . . . . . ~ ~. ? . . . . . . Dated. . . . ~. ( ~ !.~ 9. . . . . . . . . . . . . . . . . Ust Price $ .;t., .~Q.Q ...QQ.... Maximum No. Burial Spaces...... ....... ... . Net Paid $ .~.,.~ 9.Q .. .Q~ . . . . Monument permitted. . . . . . . . . . . . . . . . . . . . . . . Lots 33,34,35,~a 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 tbl. line lor CIty Record only) mitv of &tbustiau <tlfwftfry Bffb 1270 NO. THIS INDENTURE MADE TILII .... ~ t.1). .. ..:, ..,... day 01 ..... A.pr.i.l............................... A. D.. 19..~Q'f between the City of Sebastian, a municipal corporation exl.tlng under the la"s of the State of Florida, a8 Grantor and Richie E. Havens and/or Carole A. Webb ...,..........,... ..... "9'7ZS"N':"Ma:i:ina' 'Drive' ..(Pe'ifcail.Poi'n.t)........... ... .... ..... ....................... .".................... ..Sebas.tian ,.. Flar.ida ..3295.8..:.................... ..,..,..,................................... Indian River . Florida of the County 01 ,............................................ an.1 State of ....................................................... u Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ .~ 1.~9.Q... 9.q............. to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, sell, release, convey and confirm unto the Grantee ..~ ~ ~ ~.:r; heirs, legal representatives and assigns the following propert~ situate! in Sebastian, Indian River County, Florida, to-wit: All of L~t(s) . ~.,~ ~. 3 QBlock, . . .4 A .. ,UNIT .4........... ,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 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 covensnts 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 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 fust above written. CITY OF SEnABTIAN, FLORIDA Attest: ~c;L~'('(J....[) :litLl,f.~~.---:. . .. U City Clerk B,&T.C7..6.~..-:- Slgnl'd, Sealed and Delivered ;;Z;;~f'd~......... ....... (/ ~r2...>>/b..... ...... STATE OF FLORIDA (QIitu jieaJ) State of Florida, Department of Health, Bureau of Vital Statistics OTICIci BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: May 26, 2016 TRACKING NUMBER: 2016084281 1. DECEDENT INFORMATION Name of Deceased Date of Death JULIA C WHELAN May 26, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER 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. DAVID W. WALLACE F046853 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: 2016-Fo73380-5130 — Date Issued: May 26, 2016 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 03/12/2012 10:30 7722287079 COS AIR BLDG PAGE 01/01 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY Ko�ocvKw,niiur+o For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 FUNERAL HOME: City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589.5570 ��//VERi"i►G /�aiJlE ADDRESS: i?3� .SGyT.s� FYs!/�Y6 S T SE6.osT�yrr FL PHONE (Chegk One) ✓✓ OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: Lot—?S' Block YZ Unit Lot Block Unit Niche Block Unit N,S_E_W_ NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Mu:Z^� proper documentation of ownership) Q 04ainn, 2 /rr Na Signature ate I certify that I have determined the ownership of the above described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERA tTOR: ��9 ✓4D ul ////D//BICE .si�„�_ �� Name Si ure t ate Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office an the II fees have been paid: Ceme46ry S xton Data This form to be provided to Clerk's Office by Sexton for permanent record upon Completion. City ojSebastian SrhasUen Crmrlery PII, N 11 772) 589. 2515 Fal M 1(772) 22N - gain \o1r ilii. Is for Inrurnlalional purpnsre reguarding Nlunumrn(s ar Sthasllan ('tnlelrrs \UIC - I lm h [air Slagle V arlrrt under 2 fl. & osar 2 (1.1 m yr 2 11, is a poured to it ud at ion ) 1'Ira.r rrtm it In ('lty Of srl'a.lun Srbasllan Centeirr, 1921 North('rnlril Au'. 321058 Al(tohun ( emeterr, Sr Von no base size 20 x 10 x 14 upright grey slant name 8 date: Ills : 11rr : Julia C. Whelan D.O.B. D.O.B. 1942 D.O.D. D.O.D. 2016 unit : 4 blk : 42 )of: 35 square foot K.G.K. checked by: K.G.K. approved: date: 2/6/17 by: Chris / E.C.M. ( I'iclurr NO "ilununleuf in quesfian ) 20 " 10 DRY MIX Foundalmn fujurrd W Chris dale 2/6/17 .Inn1 Ino.dlcd hI : Chris dal'' 2/6/17 1i,Y14AxC- D (Pip T- �/s /,r IT,=