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HomeMy WebLinkAbout4-41-36RECORD VERIFIED 0 T i t ij of # P fi a s t i M ri JEFFREY K. 13ARTON 6.0 CLERK CIRCUIT COURT 0 AT y p INininNI DIWCD n� — t 2 9 8 THIS INDENTURE MADE This ......9.t1 ........... day of ..... October ........................... A. D., 19.90., between the City of Sebastian, a municipal corporation existing under the laws of the State. of Florida, as Grantor and Mr. Jack Rera .......................... z"MTUR9 _�0 ........... . ................................. ............................... 1017, "Seamist. Lane Sebastian, Florida 32958 ............. ............................... .............. ............................... of the County of . Indian ..Riv.er ....................... and State of .... F1. orida....................................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ 800: OO • • • . • 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 . , .Y11 S.. heirs, legal representatives and assigns the following prope3ysitu tied in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 17., 3 8 , Block, .4.1. , , , , UNIT ..4. • , , , , , , • , , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded i 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 ing in Indian River County, Florida. N CT CD 00 1^ N DOCUIeWARY STAMPS �. O _. p' ` JEFFREY K. BARTON, CLERK 01� INDIAN RIVER COUNTY `» cn To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human de d and shall Cif 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 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. ........... By .. City Clerk Mayo Signed, Sealed and Delivered ir(tbe Presence of: J ... .).. ......... ................. ((Qttg Ytt1) � . Q . ..... _ . 6e.3 STATE OF FLORIDA COUNTY OF INDIAN RIVER 9th 890 I HEREBY CERTIFY, That on this ........................day of .......... October ........... .............................., I ...., before me personally appeared .....W.r..E.,C,onyer,s..,, .. and ..Kathryn,.O'Halloran., respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals and officers described in and who executed the foregoing conveyance to ............. ............................... Mr. ....J a c,k.. R e r. a.................................................................... ......................... ............................... and severally acknowledged the execution thereof to he 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 and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River. -and State .ot.); lorida, the day and yea; last aforesaid. No Public, State of Florida at, Large.y' My commission expires: Pio r.ted'ihru Troy fcin - ta;urorve� ;ne. Certificate No. 2378 CITY OF S �B STTI N Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Margaret E. Rera 382 Periwinkle Drive Sebastian, FL 32958 In and for consideration of the sum of $600.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 41, Lots 35, 36, & 37 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. This Certificate supersedes Deed #1298 cited in Indian River County Clerk of Court Records, Book 0924, Page 0605. CONVEYED THIS 20th day of May, 2013. OF hEBASTIAN, FLORIDA ' CAI Minner City Manager ATTEST: Sally k, ,Maio, MMC City Clerk Name Unit_ Sl Block 7 / Lot' Date of Mark -outs 2' Date of Burial ��.',� !�G Time Name of.Funer4l Horne,­-­ Authorized i Namei4-/&_ Unit Block Lot 31� //j( Date of Mark -out Date of Burial e/ / 3 Name of Funeral Home Authorized by Time l oC) CITY OF SEBASTIAN CITY CLERK'S OFFICE 4382 RECEIPT Name 61,re �� ❑ Cash ?t Date �° " 1J �(Gheck# /OZ No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies /Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lofts / / Lot/Niche 3 4 Block V r' Unit 4 001501 343805 Cemetery Fees afc, o.00 I JQ 00 (�� Total Paid • Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant 10 -3 605 STATEMENT I DATE TERMS TO ADDRESS IN ACCOUNT WfTH Zill i7- a ad s DC5812 Crematory No. F063605 Certificate of Cremation THIS CERTIFIES that the human remains of John A. Rera who died Tuesday, December 11, 2012 was cremated at the Cremation Tribute Center St. Petersburg, Florida on Sunday, December 16, 2012 and these are the cremated remains of said deceased Cremation Tribute Center By Darby Cummings Funeral Director Lindsey Baxter FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ItOMf vi Pill'" ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1 225 Main Street Sebastian, FL 32958 Office (772) 388 -8295 or 388 -8214 Fax: (772) 589 -5570 FUNERAL HOME: ADDRESS: PHONE #: `- f;, %— p / -A/L% e //a (Check One) QP-EN BURIAL LOT Lot Block Unit OPEN CREMAINS LOT Lot Block Unit _—OPEN COLUMBARIUM NICHE Niche Block _Unit W BURIAL DATE AND SERVICE TIME: 5 11:00,4 FOR DECEASED: ame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signatur 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 NAIAE AND SIGNATURE OF LICENSED FUNERAL DIRECZOR. Name /i -Signature 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 fees have been paid -5-120 / Cem cry Se on Date This form to be provided to Clerk's Office by Sexton for perrTlanent record upon completion. Lots 35,36,37,38 -"PStr y CEMETERY Receipt No. ........ NO Block 41 .... � ..... Dated ..,,10 /9/90............ ::�— Unit 4 , List Price $ . 8.Q Q r Q Q....... , Maximum No. Burial Spaces ................. Net Paid S . 80Q Q� ....... Monument permitted ......... 1298 .. .............. Mr. Jack Rera /eEe-/9 A eT E0 "'f'14'_Y6 1017 Seamist Lane (Data above this line for City Redd only) Sebastian, Fl. 32958 Ti#u of orhas#ian (�rmettr Berb NO. t2�8 THIS INDENTURE MADE This ......9th........... day of ..... Oct.ober........................... A. D., 18. 90.0 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Mr. Jack Rera 10il, *Seamist­ * Lane ............................ ............................... .............. ............................... Sebastian,.. Florida 32958.............. ............................... of the County of .Indian ..River ....................... ani State of .... F. 1. orida....................................... as Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of $ .... to it in hand paid, the receipt whereof is herewith so- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , bi S, , heirs, legal representatives and assigns the following propeI sitt@a;ed in Sebastian, Indian River County, Florida, to -wit: Ali of Lot(s)3 7., a8 , Block, Al.... , 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. Attest:C ... / '. :. :.. t . .............. CI Clerk ty Sealed and n- ►:.. - - -a Presence of ME STATE OF FLORIDA MUMMY nra rMnrA CITY OF SEBASTIAN, FLORIDA By --' ...... C ✓%� .Ma o y (41[fu 'Srul) B. BURIAL — TRANSIT PERMIT Permit No 1228 -96 -0489 Permission is hereby granted to dispose of this body. ❑ 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. ❑ No extension of time for filing the death certificate requested. Date Date Certificat Subregistrar Signature. Issued: �d f �4 Due: d G C. AUTHORIZATION for CREMATION; DISSECTION or BURIAL —AT —SEA Signature Medical Examiner _ Date or Medical Examiner,. 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. Disposition: Place of. Disposition Sebastian m P t P r Y ® BURIAL ❑ STORAGE Date of Disposition . QCtober 2A-, 1996 ❑ CREMATION ❑ OTHER (Specify) 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) ff. State of Florida, Depa t of Health and. Rehabilitative Services, Vi t>tistics APPLICN FOR BURIAL TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased Jack Rera DEATH 10/21/96 2. Place of Death City, Town or Location Name of (if neither, give street address) County Hosp. or Inst. 1017 Seami Lane 3. Name of Medical X I Medical Examiner Address Phone Number Certifier 2500 S. 35th Street - Physician — 4. Name of Funeral Home/ Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) Direct Disposer Strunk Ellnecal Homes P-A- 1623 North Central Avenue qAhq_qtian, Fl 3299A (407)562-2325 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b ❑ was contacted on. 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. will complete and sign the medical certification of cause of death. c F0 WAItan was contacted on10123/96 . He /she verified that Charles A. Diggs, M.D., A.M.E. , Medical Examiner, will complete and sign the medical certification. 6. Place of Sebastian Cetlletery Ins to cemetery / Removal Final Disposition: 11A 9vepatory -pa county: Indian River from state Donation 7• Funeral Director/ F.E. No. /Reg. No. Date Signed .DireetBispvser� "4Vnatur -"Re 114 Z.. 10/23/96 B. BURIAL — TRANSIT PERMIT Permit No 1228 -96 -0489 Permission is hereby granted to dispose of this body. ❑ 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. ❑ No extension of time for filing the death certificate requested. Date Date Certificat Subregistrar Signature. Issued: �d f �4 Due: d G C. AUTHORIZATION for CREMATION; DISSECTION or BURIAL —AT —SEA Signature Medical Examiner _ Date or Medical Examiner,. 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. Disposition: Place of. Disposition Sebastian m P t P r Y ® BURIAL ❑ STORAGE Date of Disposition . QCtober 2A-, 1996 ❑ CREMATION ❑ OTHER (Specify) 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) ff.