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Home My WebLink About4-35-03Name ' 1 DYv-%Q"� Unit Y Block 3,I Lot \_� c u..<, C_ VN FU-1,1 Date of Mark -out l " 2-5— Date of Burial Name of Furneral Home ` Y G ` L— '56-'L-C1 Authorized by Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta ftityofsebastian.orpi Funeral Home: Cox-Gifford-Seawinds Funeral Home Address: 19YO 20`h Street, Vero Beach, FL 32960 Phone: 72-562-2366 (Check) XX Open Burial Lot Lota Block35 Unil—q- Open Cremains Lot Lot Block_ Unit_ Open Columbarium Niche Niche_ Block_ Unit_ le) (CircN S E W Burial Date and Service Time: Thursday, May 15, 2025 11:OOAM Chapel Deceased Name: Thomas Housch Name and Signature of Lot Owner o presentative: (RMst provide roper do .uMarshall Miesi) 5/13/2025 Print Name Si nature 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 authorized opening of same. Name and Signature of License alai Director: R. Marshall Voyles, Jr. `\\V(� VV �(I //\-- 5/13/2025 Print Name Sighature Date 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 Certification: /4Gv1_1, lls .S/1 /2OZ_sue ,e'erf/ metery SextgDale This form to be provider) to Clerk's Office by Sexton for permanent record upon completion. Paid by CEMETERY Receipt No. .~~.r. ...... .D.ted.... 9n:{.~~..... ............ Lots .3,4,5,6 NO. 9 000 00 15,16 18,19,20 Ust Price S .. . .. . ~. .. ..:.. .. . Maximum No. Burial Spaces.. .... .. ..... ... . 9,000.00 Net Paid S Monument permitted. . . .. . .. .. . .. . .. . .. '.. . . 1469 (D.ta .bon tIll. line for Clt, Reeord only) C!!Ull nf &tbastian -.Qt t m t t try IIttb '11469 NO. THIS INDENTURE MADE 'I1da 2nd ..... day of September 94 A. D. I..... ,,' bet...een the City of Sebaltl.n, . m"nlelpal eorporatlon exlltlne untkr the I.... of the 8t.te of Florid.. .. Or.ntor and . . . . . . . . . . . . . ... . . . ... .. . . ... . . . .. .. . . . . .. . . . .tQIJlInY. . & . .Ann. .Ho:Ul!! cb. . . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . .."... ..... ......... 206 36th Avenue . . . . .. . . .. ..... . . . "............... ..... ... Ver.Q. . Belil.~h.,. . .F-lor-ida. .32.968. . . . . . . . . . . . . .. . . .. . . . ....... ... . . . . . . ... of the County of .....Jmn.liln..Ri.v~1;.................. anI 8tate of ....FlQr.i.4a....................................... u Orantee, WITNB88BTH. That the Grantor for and In consideration of the sum of S ..~... 9 ~ 9. ~ ~ 9 . . . . . . . . . . . . to It In hand palc1. the receipt whereof Is herewith .e- knowled3ed, does by thlllnstrument.....nt. bafllalit. ..D. relea.., convey and conflrm unto the Gr.ntee . th!!J~ heln, 1ep1 reP"'_tatives and .sslgns tt ,f9f:vgr:4':r:~ ~t~~ {nt:"ttn11t:i ~~ 8'ut. Florida. to-wit: AD of Lotll) . . . . . .. . Block, . . . . . . .. . UNIT ............. . of Seb.llian municipal cemetery as per Plat Number I thereof recorded In Plat Book 2. .t Jl88Il 65 of the pubDc recorda In the office of the Clerk of the Circuit Court of St. Lucie County of Florida: ..Id land now lying and bellll bt Indian River County. FlorldL To Have and to Holc1the same forever; provided that said property shaD be used IOlely and exclusively for the interment of the human dead .nd shall be used. kept and maintained .t aD times In .ccordance with the rules and regulations. ordinances and resolutiona of the City of Seballian, Florid., hereto- fore, now .nd hereafter adopted or provided for tho lovernment and operation of said cemetery. The conditlooa, remlctlons and requirements contabted In this instrument shaD be coven.nta runnln& with the land. In the event of the failure of the owner of .ny property situated within said cemetery to ob- ..rve and comply with inch rulea, reaulatlOlla, resolutions and ordinances and the conditlona of the deled of conveyance thereof then the title of such owner in and to said property ahall terminate and the ..me shall revert to the City of Seballian, Florida. IN WITNESS WHEREOF, The said party of the flrll part has cou..d thla btIlrument to be executed bt Ita n.me and on Its behalf by Ita Mayor and .ttested by Its City Clerk and Its corpor.te ..al to be hereto affixed. the day .nd year first above written. Alte.t'o~Jd" .n1./Jj/~~.... """7~ CI~t.er" CITYO~~ B'~......~....................... Maror .n D.llver.d nee I ~/.__ y~"""'" -..;f.~..... (Grilli ',al) ST TE OF FI.ORIDA COLTNTY OF INDIAN RIVER 2nd September 94 I HEREBY CERTIFY. That on thla ...................... "day of ................................................. ". I...... b.fn.e me personally appeared.... ~~.~.~~~ ..L.~.. ~~.J?t~O.t,1....... .......... and .~~.~h~y.r:t.. ~... ..q.~ ~~P~!=:~.r:t. re.pertiv.ly M.yor and City Clerk of the City of 8e.....tlan. a munl.II.al rorporaUnn umler the In'a of the State of Florida to me known to be Ihe Indlviduall ond offl.... described In and who ."ecuted the 'orrlolnl cURvey.nee to Tommy & Ann Housch ..................................................................................................................................... . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . .. . .. .. . .. . .. . . . .. . . . . ., and sevcrally acknowledsffi the e"<<utlon thereof to be their f... act and deed as .nch offle... ther.unto duly aUlhorlaed; and that the Official ...1 of laid corporaUon II duly affl"ed the..to, and tbe ..Id .onve,ance I, 110. act .nd deed of 1.1eI corporation. WITNESS my algaalure and official _I at Sebaltlan, In the I..t .for..ald. CITY OF SEBASTIAN 1 3 8 5 6 ADMINISTRATIVE SERVICES RECEIPT Namesikdt� f a{? C ❑ Cash Date H S I S �Q 9Wheck # I ❑Credit L) 4 B35 L2 Amount Paid 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent _ 001001 208001 Sales Tax 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001001 220030 PD SHOP 001001220033 PD COPE 001001 220032 PD EXPLORER 010043 535270 PD UNIFORMS 601010 343800 CEMETERY LOT SALES 001501 343805 CEMETERY FEES E 15 00 14� ► I Total Paid5� Initials White - Dept. of Origin • Yellow - Admin. Svcs. • Pink • Applicant