HomeMy WebLinkAbout4-41-32"3 o
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Name ANfve H. 0�6r"en
Unit y
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Date of Mark -out 1-11-19
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Date of Buria� Tim^ f �'- Oo
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Name of Funeral N9rM1,If IC
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
no, I va--)
City Clerk's Office — Cathy Testa
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or388-8214 ctesta0citvotsebastian.ora
For information contact:
Kip Kelso, Cemetery Sexton
Sebastian Municipal Cemetery
Phone: (772) 589-2545
Fax. (772) 228-9927
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue. Sebastian, Florida. 32958
PHONE#: 772-589-1000
(Check One)
XXXX OPEN BURIAL LOT
OPEN CREMAINS LOT
_OPEN COLUMBARIUM NICHE
Lot -32 -Block -41 -Unit 4
Lot -Block -Unit
Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: 11:00 AM Saturday 9/21/2019 at Sebastian Cemetery graveside service
FOR DECEASED: Anne E. Hill O'Brien
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Margaret Cutrie Marg reg t Cua tt ;yam 9/19/2019
Name Signature Date
36 Beechtree Road, West Caldwell, New Jersey, 07006
1 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 FUNERAL DIRECTOR:
Tim Marvin
Name
TM MooK
Signature
9/19/2019
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:
Cemetery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF SEBASTIAN 11884
ADMINISTRATIVE SERVICES RECEIPT
Name' tzL w- (nr P3f1 L- ❑ Cash
Data XCheck #
❑ Credit
Amount Paid
001501 362150 Non -Taxable Rent
001001 220000 Security Deposit
001501 362100 Taxable Rent
001001208001 Sales Tax
450010369900 Airport Badge
001001218010 CobraServe
001501 354100 Cade Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 220030 PD SHOP
001501366602 PD SAFE
001501 366603 PD c�OPE� y
CY` ;1 -Cl 3H3�Ca OfC gyp" �Ct.Do
�k�4f •Lcs_xa ,}��{ aC�7�1
XTotal Paid
Initials
White - Dept. of Origin • Yellow -Admin. Svcs. • Pink -Applicant
09/19/2019 8:40 A9 FAX 7725892585 STRUNK
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
For information contact:
Kip Kelso, -Cemetery Sexton
Sebastian Municipal Cemetery
Phone: (772) 589-2545
Fax: (772) 228-9927
City Clerk's Office – Cathy Testa
City Hall, 4225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388.8244 ctesta0citvofsebastian.ora
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue. Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
2QM OPEN BURIAL LOT_ Lot 32 -Block 41,Unit 4
_OPEN CREMAINS LOT
____OPEN COLUMBARIUM NICHE
Lot—Block Unit
Niche Block Unit
N S F W
fm 0001/0001
BURIAL DATE AND SERVICE TIME: 11:00AM Saturday 9/21/2019 at Sebastian Cemetery graveside service
FOR DECEASED: Anne E. Hill O'Brien
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Maroaret Cutrie Marnare cAttrie 911912019
Name Signature Date
36 Beechhee Road. West Caldwell, Now Jersey, 07006
1 certify that I have determined the ownership of the above described site that all she fees and administrative
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Tim Marvin Tx Matink
Name Signature
9/192019
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
9/l91 /9
emetery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
;;\.>".;'1
"'Paid bY~'METERY Receipt No.. ~~....... . Dated. ..~ !.~~(.~9................
dst Price $ . ~.~~: .q9..... . .. Maximum No. Burial Spaces........ ... ., ... .
Net Paid $ . ~.Q~: .Q9........ Monument permitted................ .......
Lots 31, 32
Block 41
Unit 4
NO.
(Data above thl. line for City Record ooly)
Frances Vandevent4:t?q~
1138 Breezy Way
Apt. 113C
Sebastian, Fl. 32958
atity of &tbastiun
Q!rmrtrry
D rrb
NO.
.1295
THIS INDENTURE MADE 11aIa ... .ZJ.E?~..
day of ..... ~~P.t;..~~P.~.:t;"........................ A. D.. 19. .~R.,
between the City of Sebastian, a municipal corporation existing undcr the laws of the State of Florida, 8. Grantor and
Frances Van De Venter
........................ '''Ti38' 'B'reez'y' 'Way;' 'Apt'~" iij.c..............
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~g p. ~~. 1;..~? P. ,. . Y;I, 9.+.],. ~~ . .~.4 9. ? e. . . . . . . . . . . . . . . .
of the County of ..~ndJ.~n..~.t~~r...................... anI State of ......~.~q~.~.4~.....................................
I. Grantee, WITNESSETH.
That the Grantor for and in consideration of the sum of $ ~9~.. .Q~. . . . . .. . . . . .. ... 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.. .l:t~~.. heirs,legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s)~ t.,;3.2 , Block, . ~.l. . .. ,UNIT ..~.......... , 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 shan 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 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 lUst 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 afIIXed, the day and year lust above written.
Attest;~ ~ In.: .{).;ja.1..W/?~..........
~~~~l" . City Clerk
C'T:,0MZ;~........
(OHtu ~e211)
ST fE OF FLORIDA
COl'NTY OF INDIAN RIVER
I HEUEDY CERTIFY, That on this... ..21 s t.. . . ... . .... .day 01 ...... Septembe.I'.............................J 19.9.Q
b~lllre lI1e personally appeared . ~r... .~.!.. ~9.~Y~~~... . . '" .. .... . . . . . . . . . . . . . . . . . . . .. and K~.th;r:y'~.. Q .'.a;~.l:.;J,~+.~n........
respl'ctively Mayor and City Clerk 01 the City of Sebastian, 8 municipal corporation under the laws of thc State 01 FlorIda to me known
to be the Indh'idulIls IInd officers described In ond who executf~d the fort.golng cORveyance to
............................... ........ ..Jf.:t;'!3n~.~.~. .Y~.l). .p.~. .Y~nt.~;r;......... .......................... ......................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and scverally acknowledged the execution thereol to be their Iree act IInd
deed
as such officers thereunto duly authorized; and that the Official sell I of said corporation Is duly affixed thereto, and the said conveyance
is the act and deed of said corporation.
WITNESS my signature and officIal leal at Sebastian, In the County of Indian RIver and State 01 Plorida, the day and 1ear
last aforesaid.
/Lg.,. . ..~?';e~..~./~~..................
Not Public, State of Florida at Lar,e. /.
My ormalsslon explrell r:~);D1' r.:":':", ~~1~~ c: [;':r',,!l
r.~'J ((mm:~.:'::c;1 r:.:~.':; r~ .~~ 2f\, t~~,1
e?nj-"f TI.!\! Tr-:f r('",in -:. .W .-......" !.',..
Name \..J rr" VA tV D eV-e n + -e R
Unit
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Block
Lot
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1;/),1 .,./9D
7(J, /2/
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Time
/9 \ ::;'0 II, /lI1 '
Date of Mark-out
Date of Burial
Name of Funeral Home
Authorized by
i '''',<
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~-,tc~..:- ...4/7.
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UNIT 4
BLO~
LOT 1 32
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';!;~r;~A.~;!y//,/;,.{ "
DEED 111295
Frances Van De Venter
1138 Breezy Way, Apt. #3C
Sebastian, Florida 32958
;/,':/f.-"-i:;d, ~~ - ~ t1 ~ 3J
'- -
"- -
Paid by CEMETERY Receipt No.. ~~.~.......... Dated 9/21/90
. . 400 00 ...............:..............
List Pnce $ . .
. . . . . . . . . . . . . . . . . . Maximum No. Burial S
4 paces.................
Net Paid $ .. .Q~: .Q9........ Monument permitted
fIJ~ ~ ~/ !'-cl;1.;;.k.;;.....
(Data above this line for CIty Record only)
Lots 31, 32
Block 41
Unit 4 NO.
Frances VandeventEfl?q ~
1138 Breezy Way' .
Apt. #3C
Sebastian, Fl. 32958
C!!itl1 of l'fbasttau
atrmrtrry
Irrb
NO.
'1295
THIS INDENTURE MADE 'I1aJa ... .~.l.I?t;.."....... day of ..... p~P.t~~P.I?X........................ A. D., 19..~~L
between the City of Sebutlan, a municipal corporation alstlng under the laws of the State of Florida, as Grantor and
Frances Van De Venter
................ ...... .........Ti3S..Breez.y: 'Way;' 'Ap't'~ ..ii3.C...... ...... .................. ..... .., .... .................
.................. ..............:;;.~J:?~~J.:i;.?P:". .~;I,9.r.J,.~~. .~.49.?~. .... ........ ... .....,.................. .............. ......
of the County of ".J;P:9..:!-.(:H1..~.:!-~~f"...................... an'J State 01 .... ..:f.:I;.qf".:!-.q.~.....................................
u Grantee. WITNESSETH.
That the Grantor for and in consideration of the sum of $ fI: 9.Q ...Q P. . . . . . . . . .. . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargam, sell, release, convey and COnIttm unto the Grantee ...l:t ~ f.. heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
1 )!l2 , Block, . ~.l. . .. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at age 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
iver County, Florida.
>107 .3/ StJl-ZJ !31){!)( TO {!IT;Y
3-~f-{/~
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 sha1I
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 deed of conveyance thereof then the title of such owner
in and to said property shall terminate and the same sha1I revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the iust 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 iust above written.
Attest:~~rn.,.OI.N.~..........
.~-~--"" City Clerk
CIT:,O;;;;Z;~..:.....
(QIii" JieaJ)
ST E OF FLORIDA
COUNTY OF INDIAN RIVER
I HEREBY CERTIFY, That on this ... ..21 s t............ .day 01 ...... Septembe.J;:'.............................. 19.9.Q
before me personaJly appeared . ~r... .~.!.. ~9.~1Y~1=:~.... ...... ...... . .. ... .. ... . .. . " .. and K~. th;r:YJ;l.. Q .'.<<~J;J,~+.~n.......
respectively Mayor and City Clerk of the City 01 Sebastian, a municipal corporation under the laws of the State 01 Florida to me known
to be the Individuals and officers described in and who executed the foregoing cORveyance to
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . .. . . . . . f.J; ~ ~~. ~.~ . . y ~.~. . p.~. . ~ ~ P: t.~,t;' .. . .. . . . . . . .. . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . .. 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 act Bnd deed of said corporation.
WITNESS my signature and official seal at Sebastian. in the County of Indian River and State of Florida. the day and year
last aforesalcl.
N~P.bIk.SW..~~................'.
My ommlssfon expire.. r;!'Jt~~v ti;!'!,!k, Sii3tO <;j n'j";~<Ll
f~~ {'~nlmi~5i~.~~ fEp.r.:j~~C;j fJ~;.;ri! SO; i994
2ond;;ld Thw Trc:y Fc.in ~ lr.;::vr::n~~; tI1':.
-<'
.
.
.
City of Sebastian
POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978
TElEPHONE (407) 589-5330 0 FAX (407) 589-5570
September 24~ 1990
Frances Van De Venter
1138 Breezy Way, Apt. #3C
Sebastian, Florida 32958
Dear Mrs. Van De Venter:
Enclosed is Cemetery Deed No. 1295 for Cemetery Lots 31 and
32, Block 41, 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 when
and if you have the deed recorded.
We are enclosing two copies of Receipt No. 643 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,
~fJJ f)l/~
Kathryn M. O'Halloran
City Clerk
KMO: j s
enclosure
~~':,
~
.
(,ok .~
t. I ..)
.
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
. I
FROM:
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
/~a~) ~4L~eL'-----,_.._-
t~ ,()~ 2~~y~-d~/
//,i? /.:i~ Jt~", ~ // de'-
d~~A-/.' ///'--a_d~
on this /':lld~ day of ~~ 19f'd for the purchase of the following
described Cemetery Lot(s).upon the terms and conditions as stated herein:
Dollars ($ ~1d.~
)
r:t.~-?l- ~p ~
.302- Y...S'-S:-
Description of Property:
Cemetery Lot (s) fI 1...1/' ^ 3c2 Blockfl ~ /
Purchase Price: r~ tfi,::'?~e~
Unitfl .y
Dollars ($ 'Ytft'. t:;z7 )
Terms and' conditions of sale:
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:
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.
fL~~/~h~
~lty of Sebastian --i
L/
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State of FIOrjd~artment of Health and Rehabilitative sere Vital Statistics
~L1CATlON FOR BURIAL - mANSIT PERMIT
~ 3d-
(j ~I
flf
A.
1. Name of
Deceased
(Type or Print)
First
WILLIAM
Middle
CHARLES
Last DATE
OF
VAN DE VENTER, SR. DEATH
Month Day
9/20/90
Year
2. Place of Death
County
INDIAN RIVER
3. Name of Medical
Certifier
NOOR MERCHANT, M.D.
4. Name of Funeral Home/
Direct Disposer
STRUNK FUNERAL HOME
5. Check a 0
Appro-
priate
Box b e
City, Town or Location
Name of (If neither, give street address)
Hosp. or
Inst. 1138 BREEZY WAY-APT. 3-C
Medical Examiner Address Phone Number
7744 BAY STREET
X Physician SUITE # 2 SEBASTIAN, FLORIDA 32958 407-589-0879
Address Fla. Lic. No.1 Reg. No. Phone Number (Area Code)
1623 N. CENTRAL AVENUE
SEBASTIAN, FLORIDA 32958 #1228 407-589-1000
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
. SEBASTIAN
LYDEE was contacted on 9/20/90 within 72
hours after death. He/she verified that this death was from natural causes, that there was no accident
nor other external cause of death, and that DR. MERCHANT will complete
and sign the medical certification of cause of death.
c 0
medical certification.
was contacted on . He/she verified that
,Medical Examiner, will complete and sign the
6. Place of SEBASTIAN
Final Disposition: CEMETERY
7. Funeral Director/
BirecI UISpu:se!'
In state cemetery/ SEBASTIAN, FLORIDA
county: INDIAN RIVER COUNTY
F.E. No.1 Reg. No.
1/1672
Removal
from state Donation
Date Signed
9/20/90
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228-90-4~~
Permission is hereby granted to dispose of this body.
o A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
o No extension of time for filin he death certificate requested.
Registrar or
Subregistrar Signature
Date
Issued:
9/20/90
Date Certificate
Due:
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
Signature
or
Medical Examiner,
, Medical Examiner
Date
, gave authorization by telephone to
Funeral Director/Direct 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 cremations.
D.
CEMETERY OR CREMATORY
Methods of Disposilion:
a:SURIAl
o CREMATION
o STORAGE
o OTHER (Specify)
4? <;. x:;;.?'
Place of Disposition
Date of Disposition
SEBASTIAN CEMETERY
SEPTEMBER 22. 1990
Signature of Sexton )
or Person-in-Charge )
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 returned within 10 days to the local HRS County Public Health Unit in the County where disposition occurred.
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
J.