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Palel by CEMEmRYRecelpt No.. ?........ Dated.. ~t.U/~.~................. Lot.
Us! Price S.. ~~~':'b~""" Maximum No. Burial Spacel................. ~~~~ 4
Net Pald S .................. Monument permitted .. . .. .. . .. .. . .. . .. . .. . .
1427.
NO.
'"
.'
(D." .bon tfIl. line lor at, Reeord oaIy)
.
CltUll I1f &thasfhttt
i fIb
14.2.7
Q!fmttlfY
NO.
THIS INDENTURE MADE 'l1oIa
13th
....... d.y 01 ..~~~.~.~~~~.r:............................ A. D. I~~...,
beh,'..n ,he City 01 Srballl.n, . munlelpal eorpor.tlon ""..tin. ander tbe 1.11" 01 the St.te 01 Florlcl.. a. Grantor .ntI
Colleen Dosek
........ ................ ....................... 20tO' 'In:'lid'Wiiy' 'S.tk'~~.t';"N~ E.:...................... ....... ..............
..................... .................... .... . .l:'~1.'!I.. ~~r.,.. ;F:~.<?~.~~~...~~?~.~.. ............................................
Indian River . Florida
01 the COIInty 01 ............................................. .n'J 81.Ie 01 .......................................................
as Gr.ntee, WITNB88ETH I
That the Grantor for and In conslcleratlon of the sum of S '" 9.QQ ~ .Q9. . . . . . . . . . . . . . to It In hand paIcI, the recelpl whereof II herewith ao-
knowledpd, doel by thlllnstrument pant, barplir, lillO, reJeallll, convey and confirm unto the Grantee .1) ~ r. . .. heln,,,,,1 repretlllltatlYel and a.1
the followlna propW~ dtUllted In Se~,lncllan RIver County. FIorlcla, t......lt:
AD of Lot~ ~ BJock~~.. ,UNIT ..... ~. . . . . .. ,of Sebastian municipal cemetery as per Plat Number I thlireof recorded In Pial
Book 2, at pap 65 of the pubUc recorclt In the omce of the Clerk or the CIrcuit Court of St. Lucie County of FJorlcla; .1eI1and now lyina and bel..
In Indian RIvm County, FlorldL
'"
To Have and to HoleI the lIIDte forever: proftled that salcI property shaD he used solely and excludvely for the Interment of the human dead and shall
be used, kept and malntalned at aU tlmelln accordance with the rule. and reprlatlons, ordlnat1cel and reIOJutlonl of the City of Sebaltlan, Florlcla, hereto-
fore, now and hereafter adopted or proWlecl ror the sovernment and operation of salcI cemetery. The conditiont, rellrletlon. and requlrementl contained
In this Inttrument lhall be covenant. runninl with the land. In the event of the faJJure of the owner of any property situated within salcI cemetery to ob-
lIIlm and CIImply with iudl rules, resulatlOllt, resolutlonland .Ordlnancel and the condltionl of the deed of comeyance thereof then the title of such owner
In and to said property shaJJ terminate and the .me .haD revert to the City of Sebastian, FJorlcla.
IN WITNESS WHEREOF, The said party of the first part hal caUJed thlllnstrument to be executed In itl name and on It I behalf by itl Mayor and
attested by It I City Clerk and itl corporate lIIlal to be hereto afftxed, the day and year first above
Att.stl~m...D..tI~~....
City Clerk
(Grift .$tal)
STATE OF FUJRIDA
COl'NTY OF INDIAN RIVER 1
3th September 93
I HEREBY CERTIFY, Tttat on this ....................... .d.y 01 ..................................................., It....,
brfore me penon.lly .ppea..d . ~?,I,1.~.~~. .~.~.. ~<?~~~~.............................. and ~~.~~~.r.~. .~~.. ~.'.~~.~~~~.'!-~..
re.pretlvely M.yor and City Clerk 01 the City of Seba.tI.n. a munlel,..1 eorporatlon under the I.,," 01 the St.te 01 Florlela to me known
10 b. the Indlvidu.l. and offl..rt desrrlbetl In .nd who "".euled the forr.oln. eOlly",.n.. to
Colleen Dosek
. . . . . . . . . . .. . . . . . . . . . .. .. .. . . . .. .. .. .. .. .. .. .. .. .. . .. ... .nd ...er"'y ..knowled.rd the ""ecutlon thereol to be their free .et and deed
.. .ueh offl.e.. tllereuuto duly .ulhor.....1 .nd tb.t the Offld.1 .eal of .ald eorporatlon I. duly afn"rd th.",to. and the said eonv.y.nee
I. the lie! and deed of ..lei corpor.tlon.
WITNESS my .l....hlre .nd offiel.1 _I .t Srb.atl.n, In the County 01 Indl.n River anti St.te of Plorld.. lhe d.y .ntI y..,
...t "'..r....d.
H JOANNE 8AHDI8lO
"*Y 1'ldo-lIlIII1I.......
.. CanlnIIItlon e.- APR .. ttlN
OOMM' CC oa-.
Name
'.
.,
Unit '4
. .';;'~
Block
.,39j
1;.ot a,. ~,
Date of Burial
~. Li<>/~?
'"jl '?'-.. -. -.' ..
, 1'-
lili)..J~'3
I I
Time
~ Q() p_rn
Date of Mark"out
::::~~~,
"
j)eed.:/t /~;l1
m... ......... &/Jeen
· 10 {3~ Sf~ ME.
. m cl3~, ,.pI- ~d?~5
1..I)'I-1~ pjccJ.:YI, ib?iJ.t/
iJurKoek-j()k<<ed. Q/;,,2-jtI3
~
/o~sI~ iJ,rJ:;6 ~ -
i
\.... -
Paid by CEMETERY Receipt No. .7.? ~ .. .. .. . .. . Dated .. ~ (.~ ? /93 .ao& ,,~
List Price 900 . 00 .. .. .. . .. .. .. .. .. .. .. . Lo t 'i1P.T' t:XJ
$ .. .. .. .. .. .. .. . .. . Maximum No. Burial S ce Block ~ ~
900 00 pa s................. . ,,:1 :..n
Net Paid $ .......:.......... Monument permitted Un1 t 4
~~ .......................
(Data above dlls line lor City Record only)
NO.
1427
.
.
111
,
THE SEBASTIAN CEl€rERY
CITY OF SEBASTIAN
SEBASTIAN, FLORIDA
..
OF XHE SUM OF:
Dollars (S0d ~)
Description of Property:
Cemetery Lot(si ~39 . ~BI0Ck c{l3
Purchase Pr~~~ Dollars (
Xerms and Condition of saLe:
'rhis contract shaLl. be binding upon both parties, the seller and the
purchaser, when approved by the owner of the propertg above
described.
I, or we, agree to purchase the above described property on the terms
and conditions stated in the foregoing instrument:
'rhe City of Sebastian agrees to sell the above mentioned property t:o
the above named purchaser( s) on the t:erms and condit:ions stated in the
above instrument. '
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tness
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I'r L ,e ~tlo
City of Sebastian
POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
September 17, 1993
Colleen Dosek
2010 Bradway Street, N.E.
Palm Bay, Florida 32905
Dear Ms. Dosek:
Enclosed is Cemetery Deed No. 1427 for Cemetery Lot 39, Block 23,
Unit 4.
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. 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.
We are enclosing two copies of Receipt No. 779 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,
~~~/2~A-
City Clerk
'\
KMO:lmg
enclosure
(\ws-form-cem.rec)
.
.
779
It
THE SEBASTIAN CEMF:rERY
CITY OF SEBASTIAN
SEBASTIAN, FLORIDA
CEIPJL:;THERE. BY ACKNOWLEDGED OF
, n
,V: L€-r!td Y
I
THE SUM OF:
FROM:
Dollars
(st:!d ~
)
on this j3Y.b- day ~~\
following described Ceme ry Lot(s)
stated herein:
, 19 ~ for the purchase of the
upon the terms and conditions as
Description of Property:
Cemetery Lot(s} ~____ Block
Purchase pricd-- _~/y
Terms and Condition of sale:
3 9 Unit 'i
Dollars (S9~~)
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 ab e described property on the terms
and conditions stated in the for 0 g instrument:
...
The City of Sebastian agrees
the above named purchaser(s)
above instrument.
sell the above mentioned property to
the terms and conditions stated in the
($(l~ ~.
Witness
[~~1
State of Florida, Department of Health and Rehabilitative Services, Vital Statistics
APPLICA"FOR BURIAL - TRANSIT PERMIT .
'/-J7 -;2 3
)
A.
1. Name of
Deceased
(Type or Print)
First
Paul
Middle
David
Last
Rock
DATE
OF
DEATH
Month Day
09/10/93
Year
2. Place of Death
County
Brevard
3. Name of Medical
Certifier
D.J. Wickman M.D.
4. Name of Funeral Home/
Pil'ut Disl'03er
City, Town or Location
Name of (If neither, give street address)
Hosp. or
Inst.
Medical Examiner
Address
Phone Number
M.E.
1750 Cedar Street
~'l"{,JJ -/ I
Fla. Uc. No.lR8!t. ~J&. Phone Number (Area Code)
~;/~
Strunk
5. Check
Appro-
priate
Box
Funeral Homes
a 0 The medical certifICation has been completed and signed. A completed certificate of eath accompanies
this application.
1623 N9rth Central Avenue
b 0
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.
Anita
D.J. Wickman, M.D., M.E.
medical certification.
Cemeter
was contacted on 09/11/93. He/she verified that
, Medical Examiner, will complete and sign the
c []
6. Place of Sebastian
Final Disposition:
7. Funeral Director /
D~t niQpnQar
Indian River
F.E. No.l~.
167
Removal
from state
Donation
Date Signed
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228-93-0408
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 norma~ 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 filing death certificate requested.
Registrar or
Subregistrar Signature
Date
Issued:
Date Certificate
Due:
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.
Methods of Disposition:
~ BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition ~1" 'i .1hfl~'n_.J
Date of Disposition ~J.-..; I~, /993
Signature of Sexton ) I'::. ~
or Person-in-Charge) ~~,~' J .4L1 .13 'I ;(. '-1 ' 1-..
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is noo:ton)
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)