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Home My WebLink About4-41-08Name Unit Block Lot Date of Mark-out— Date ark-out Date of Burial %l//,3 e4— Name of Funeral Nome Authorized by Time t Op DORIS MAE VILLAROSE January 7, 1925— November 7, 2015 Doris Mae Villarose, 90, of Sebastian, FL., passed away November 7, 2015 at Wave Crest Health and Rehab Center in Melbourne, FL. Patid by CEMETERY Receipt No.... L u ........ Dated ...6 Z 18 /.9 0 ...............: Lots 7,& 8 NO. 400.00 Block 41 List Price s . .. ....... Maximum No. Burial Spaces ................. Unit 4 Net Paid S. 4 Q 0• Q Q ....... Monument permitted ....................... Doris Villarose 1284 245 S.W. Caravan Terr. John Villarose interred 6/19/90 Sebastian, F1. 32958 Lot % (Data above this line for City Record only) Tifg of Orhas#ian TPiItettry Derr NO. 1284 THIS INDENTURE MADE Thla ....18th........... day of ..... June A. D, 1990..., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Mrs. Doris Villarose ..................................24.x..5 :.. �.• ..Caravan �'Terrace........................................................ ..................................ebas t.i.an.,...k'J.Qr.ida..3.2�58......................................................... of the County of ....Indian River . ani State of ......!Q.>? aid..... ................ as Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of $ R9.-.00 ................ to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee ... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Allof Lots) % Sc 8 .. , Block, . A1.... , UNIT .. 4 ..... , , , . , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 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 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 dried 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 first above written. CITY OF SEBASTIAN, FLORIDA Attest- '7�. , . ��.'. ! jj� �!'�! ...... B L� �'. c,— .......:.. . By .................. City Clerk Magor Signed, Sealed and Delivered In the P elence oft ?�Q .. ..... i ............................ ((14t rttl) ' - ) v STATE OF FLORIDA State of Florida, Department of Health, Bureau of Vital Statistics Oil d BURIAL TRANSIT PERMIT HMTM DATE PRINTED: November 10, 2015 TRACKING NUMBER: 2015168592 1. DECEDENT INFORMATION Name of Deceased Data of Death DORIS MAE VILLAROSE November 7, 2015 Place of Death - County City, Town or Location Name of facility, or street address if not a facility BREVARD MELBOURNE WAVE CREST HEALTH AND REHASILrrATION CENTER Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. NoJReg. No. Phone Number SEAWINDS FUNFRAL 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: 2015-F073380-5247 �Oplwa Date Issued: November 9, 2015 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, 10112 64V-1.011, Florida Administrative Code CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT 'i 955 Name Seawinds/Villarose ❑ Cash Date 11/12/15 ® Check # 1917 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501 362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 343805 O/C U4 1341 L8 150.00 Ll 5 rn Total Paid 11;0 -no Initials White - Dept, of Origin - Yellow - Finance - Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SAN HOMe of va GNB For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 office (772) 388-8215 or 388-8214 Fax. (772) 589-5570 FUNERAL HOME: Sf-q wiKa3 �i✓&-A4G /-lGA7E ADDRESS: 7,95- S F4- eWAev6 (JF -7-1 SEa esT/��✓ FG PHONE #. 772 `6'1933 (Check One) ��FEd,t7 /Z8 y ✓ OPEN BURIAL LOT Lot 8 Block Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: FOR DECEASED: .�a�/s Y/LLA.E'aSE Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signature Date 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 FUNE I ECTOR: SAY/l> W. Name natur Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office/and that all fees have been paid: Y1 Cemecrt' S xton -' z Date 3 7 te This form to be provided to Clerk's Office by Sexton for permanent record upon completion.