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Home My WebLink About4-36-30 r - Paid by CEMETERY Receipt No... ....... .'. Dated.., .~Y~?/??............... List Price $ . . . . . ?~q : ~ . . . . . Maximum No. Burial Spaces. . . .. . . . . . . .. . . . . 500.00 LOta Blo .- Unit 4- NO. .1522 Net Paid $ Monument permitted. . . . . . . . . . . . . . . . . . . . . . . (Data above thIs line lor City Reeord only) QUIl! of &rbustiuu 1,...., ....."! tJi~~ <1rtmtttry m t tb NO. 27th December 95 A. D., 19.,..... THIS INDENTURE MADE TIaII ".,' day 01 betwe.n 110. City 01 Sebnstlan, a munlelpal eorparatlon exlatlng under the laws 01 the State 01 Flo.lda, u Grantor and Keith Westfall . b29 . Cownie 'iane . . . . . . . . . . . ' , , . Sebastian,. . Florida, 329.58. . ' , 01 the County of''.. ..~\1<n~~..~V~:r;...."..,.......... an I State of ". .F.lo.ri~a.......,........,........,....",........ .s Grantee, WITNESSETH, That the Grantor for and In consideration ~f the sum of $ ..... .~99. '.99. . . . . . . . . . . . . to it In~nd 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: All of Lot(s) . . ~9. .. ,Block". ~~ . .. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded In Plat Book 2, at page 6S of the publie 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 sal)le forever; provided that said property shall be used solely and ex elusively for the Interment of the human dead and shall be used, kept and maintained at all times In aecordance with the rules and regulations, ordinances and resolutions of the Clly of Sebaslian, 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 covenanls running with lhe land. In Ihe event of the failure of the owner of any property sltualed wilhin said cemetery 10 ob- serve and comply with sueh rule., regulations, resolutions and ordinances and Ihe conditions of the d~d of conveyance thereof Ihen the tille of sueh owner In and to said properly shalllermlnate and the same shall reverlto the Cily of Sebastian, Florida. IN WITNESS WHEREOF, The said party of Ihe first pari has caused Ihis Instrumenl to be exeeuted in its name and on ils behalf by its Mayor and attested by its Cily Clerk and lis corporale seal to be hereto aFfixed, the day and year first above written. Attesl. :~~.,m.()l/~. ....' /J~ Clly C1erlr Signt"d, Scnled unci Delivered .X?;:.~................ r(;1/.~ ~..d.7.~..:.~.~.~:._. .......... (QIitv ~elll) STATE OF FLOnIDA COl'NTY OF INmAN RIVER I HEnERY CERTIFY, That on thia ...).7~P......d.y of ..~~.~~~.~............................. 19.9?, b..ru'e me personally app.ared .1\r.~h~. .~... ~ir:ti.OIl, and Ka.th~ .~:. .~.'.~.~~.~r:.~Il......... "spI'clively Mayor and City CI..k 01 the City of Sebastian, . municl"al co'"O..tlOII und.. Ihe In'. 0' the Stale 01 Florida to me kllown to bt, lhe Indh'itlullls llncl officers described in and who executt.'d the forqroing CONveyance to .K~~t.1~l ~~.!?~X?U.................... ..................................... and seve..lly acknowledged the execuUon thereof to be their 're. or! and deed as sllch offleer. th...ullto duly aulho.bed; and that the Official se,,1 0' soid corporalloll I. duly affixed therdo, and the .oid conv.yanee if; th~ net I'ml dred of ,aid corporaUon. W \TN ESS my signature ond official leal at SebuUan, In Ihe lasl .'oreoald. ::. ?;;'~,=" M~ c";=~:;s~ ~~4__ <)onllES: June 18, 1l\l18 . ._ "';;:;':':::. ...:"'''1IOl\ "'"' NOIIIy NlIIc........ r ~E SEBASTIAN CEMIf'ERY CITY OF SEBASTIAN, FLORIDA 0710 \ - REC,EIPT -- . OF THE SUM OF: (6!J()~ ) FROM: on thisc9 7:}b.- day of) h , 19n for the purchase of the following described Ce tery Lot~/Niche(s+ upon the terms and conditions as stated herein: Description of Property: Cemetery LottaJ7::~:S Purchase price}' IJi ry- Block ,::Jo Unit l:L. Dollars (@/).fr) Terms and Condition 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 the above named purchaser(s) above instrument. sell the above mentioned property to the terms and condit'ons stated in the L~ .qL~ ~itness ~,. / .-._--~._..._---_.. , ' . . . City of Sebastian 1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 0 FAX (407) 589-5570 January 9, 1995 Mr. Keith Westfall 1329 Cownie Lane Sebastian, Florida 32958 Dear Mr. Westfall: Enclosed is Cemetery Deed No. 1522 for Lot 30, Block 36, Unit 4. Also enclosed is a form - Return for Transfers of Interest in 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, P. O. Box 1028, Vero Beach, Florida 32960. We are enclosing two copies of Receipt No. 876 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 convemence. Sin~re" WadAf'_J7? D'l/rll/!,u c Kathryn M. O'Halloran, CMC/AAE City Clerk KOH:lmg Enclosures Paid by CEMETERY Receipt No.... .~?? .. .... . . Dated List Price $ 500 . 00 .................. 500.00 Name Unit Block Net Paid $ ~ ..-, . k'.'. ..","'::L-'.,'cr /' 1..~/r;.:;:. ~. I ~/ EsT ;::,q 1)- 'I 3tp Lot 30 Date of Mark-out Date of Burial Time ;(1.. /J r)?~? ,'i1 , . """"f ' Name of Funeral Home ,.' Authorized by. ',~' .-,{ ? ,/:,:.~ W~fl?tU1 Me;Jh j3~q Cown;eLJJ S6~ai1; f:L ~8 Lo+30J31~301 Un;~ 4 ~1S. tu~aJ!)~ 1o?~/95 '-, - 12/27/95 .............................. Maximum No. Burial Spaces Monument permitted ... .................... (Data above this line lor City Record only) s. ~1Jed /~ Ic<!c11/i5 s. Lot 30 Block 36 Unit 4 NO. lr'-r'~ , \)G~ - State of Florida, Departme~f Health and Rehabilitative Services, Vital Statistics APPLlCAT-=OR BURIAL - TRANSIT PERMIT . /~ 3[ /3 3rt o ~( A. 1. Name of Deceased (Type or Print) First Middle Last Vlestfa 11 DATE OF DEATH Month Day Year 8r~an f<.ei tr 12/15/9~ 3. Name of Medical Certifier Medical Examiner Name of (If neither, give street address) Hosp. or Inst.Tndi ;"''''1 Phone Number 2. Place of Death County City, Town or Location Inc.:; an Ri'ler Vero Beach Freder"CK Hco~n. M.J.. M.E. 4. Name of Funeral Home/ Direct Disposer Physician Address 2500 ~~ 35th. ~tr~~t Fert ~lerce F ~r'~8 .., a~" r' .Afi7JA :~-7~79 Fla. Lie. No./Reg. No. Phone Number (Area Code) 5. Check Appro- priate Box a 0 1623 North Central Aver.Je P.ft Sebastian~ ~1 32958 1?~ The medical certification has been completed and signed. A completed certificate of death accompanies this application. St;u;-'~ F'..;neral Hcmes~ 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. Helen Fi"edenCK HODF1, M.G., t~.E. was contacted on2 / 1 c; /95 . He/she verified that ,Medical Examiner, will complete and sign the c~ medical certification. 6. Place ofSebas t , an Final Disposition: 7. Funeral Director / ~ireet Di5~03e'1" Cemetery Ind~an R,ver Removal from state Donation Date Signed 12/19/35 FE No./Reg. No. Jrv72 ' 'I'~ B. BURIAL - TRANSIT PERMIT 1""8-3/:;-(\"'/:;. Pe 't N -- oJ u::l..-' rml o. 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 filing the death certificate requested. J<<.gisl. ell \Jr Subregistrar Signature Date ,~, / .. I., .... Date Certificate Issued:~ 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. CEMETERY OR CREMATORY Methods of Disposition: . BURIAL o CREMATION o STORAGE o OTHER (Specify) ~. /) ...- Place of Disposition 5' ,C /J,rf '/ ,1'1 Jo/ c.,~,;,IJ,e/.c::/f! II. I Date of Disposition / f1, /;t. D /9--;- Signature of Sexton ) or Person-In-Charge ) ~i~ r ,;I(~ 7' 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.