The URL can be used to link to this page

Home My WebLink About4-35-40Name Gt_11n ry� , ROIL v,-_)Lr- Unit Block w Lot Date of Mark -out Date of Burial -3/ /�� `1 Name of Furneral H o me Authorized by J crei� al:v_q Vi5 N ee d � Y)SCV1,000 Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: City Clerk's Office Bridget Eakins ii l che(V 09 City Hall, 1225 Main Street 1 Sebastian, FL 32958 Phone (772) 388-8216 beakins@citvofsebastian.org Funeral Home: � go (', Address: Phone: (7111 `1 _ �"t ti�ti-IGe 1.�1 - 1 Cc) (C}�eck) ��// Open Burial Lot f Sj,� Unit Block -35 Lott O Open Cremains Lot Open Columbarium Niche Unit Block Lot Unit Burial Date and Service Time: We a 3! 1 1! 2 Deceased Name: r I � e. Mv �(jiuna- Name and Signature of Lot Owner or Representative: (Must provide proper documentation of pwngrship) JC 1 '1�01 M Z/ ) Print NJ*Si7 ature 21-110 -13Yd MCArO( Vero �ft Address (ii2) 4 We i j 4Phone Number Block Niche t Qam 2 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 Licensed Funeral Director: 1 OM �171v) Print Name Signature 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 Certification: emetery, - -3 Date / This form is to be provided to Clerk's Office for permanent record upon completion. Neea �MCY�000 Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: City Clerk's Office Bridget Eakins City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8216 beakins@citvofsebastian.ore 1 90mr, FuneralHome: � tAI Address: 9,35 1 Reml((�i C)e�, Phone: �,� "l l��l i)� U-F-I(Q - I P4 Cc I1 (Check) /1 ✓ Open Burial Lot � � O f 5�,� Unit � Block.,b LoC'io Open Cremains Lot Unit Block Lot Open Columbarium Niche Unit Block Niche_ Burial Date and Service Time: Deceased Name: ArII ne. N1 1'1rr Name and Signature of Lot Owner or Representative: (Must provide proper documentation o wn rship) JC I 2 Print N e Si a Date 21 2.1-110 13Yd MCAMC Address C-4%ei 14Phone Number 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 Licensed Funeral Director: Print Name Signature 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 Certification: Cemetery Date This form is to be provided to Clerk's Office for permanent record upon completion. CITY OF SEBASTIAN 18065 FINANCE DEPARTMENT RECEIPT Name Qr\&!r- ❑ Cash Date I (� �D ❑ Check #o --LAS r q r ❑Credit 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001 208001 Sales Tax 450010 369900 Airport Badge 450010 362521 AP Shade Hangar Rent 450001 208045 Airport Sales Tax 001501 347557 Community Center Revenue 001501 341920 General Fund Copies 001501 354100 Code Enforcement Fines 601010 343800 Cemetery Lot Sales 001501 343805 Cemetery Fees 480010 341920 Bldg Dept Copies PD Shop with a Cop PD COPE PD Cadets PD SRT Amount Paid Total Paid =J Initi White - Dept. of Origin • Yellow - Finance Dpt. • Pink - Applicant 1,- I~' . !'sid by CEMETERY Receipt No. ...1....... Dated.... ).(~!.~?.............." Lot 4.0 . 500 00 nlock List Price S . . . .. ..:. . . .. .. . . . Maximum No. Burial Spaces. .. .. .. .. .... .. . Uni t NetPaldS ..??~:.?~...... NO. Monument permitted....................... .1483 (Data abon this line 'or Clt, Reeord only) QJ:Uu of &rbulItiuu Q!tmtttry II ftb '1483 NO. THIS INDENTURE MADE TIIII .......J~th... day 0' .....~.a~l1:a.~.Y............................ A. D~ I'.~.~.., beh....n the City 0' Sebutlan, a municipal corporation ""latin, under the law. 0' the Stale of Florid.. aa Grantor and Arline Raynor ......................... .....,.......... ... "1033' 'P)1tllie.tt~ "AV~t1"1:re"""""""""""""""" ............... ... .S~~~,~.~~~.n".. ~~.<?I?~~~.. .~~95.~...............,... ..................... 0' tbe Count, 0' .... .J;mi.:i-.!Jn..Riy~r................... an'l State 0' .......... F10.rida................................ u Orant... WITNESSETlII That the Grantor for and In consideration of the sum of S . .~Q.q ...QR......... ...... to It In hand paid, the receipt whereof Is herewith ao- knowledged, does by this Instrument grant, bargaiD, ..n, rei...., convey and confirm unto the Grantee.. h~~.. heirs, legal representatives and aaslps the foDowlng property situated In Sebastian, Indian River County, Florida, to-wlt: AU of Lot(s) . . ~.q.. ,Btoclc,.. ~.~ . .. ,UNIT ...~......... ,of Sebastian munlc:ipal cemetery II per Plat Number 1 thereof recorded In Plat Book 2, at PIlle 6S of the pubHc records In the of8ce of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being In Indian RI_ 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 aU times In accordance with the rules and regulations, ordinances and reoolutlons of the City of Sebastian, Florida, hereto- fore, no.... and hereafter adopted or proYlded for the government and operation of said cemetery. The conclltlon., restrictions and requirements contained In this Instrument shan be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to Db- ..rve and comply with inch rules, regulations, resolutions and ordinances and the condltlons of the de'ed of conveyance thereof then the title of such owner In and to said property .haU terminate and the same shan revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The sald party of the first part has Clused this Instrument to be executed In Its name and on Its behalf by Its Mayor and attested by Its City Clerk and Its oorporate seal to be hereto affixed, the day and year first above written. Atl.stl~ 1~.)?1..D/r{u~.. ~ I City Clerk CITYO~?~ By ............................::::::0...... . . .. .. . . Mayor SIBned, S.aled and Dellv.red tl~'#:f:t:= l STATE OF FLORIDA COl'NTY OF INDIAN RIVER I HEIlEBY CERTIFY, That 011 thla ....11 th.. . .. .. .. .. ..d., 0' .., January. . .. . .. .. ...... ............ ........., 1.95., b,'"re me personally appeared ......~':.~~~~..~....,~.~r:~.i.o~.... .............. . and .1{~.~hr.y.~..~:...Q.'.~~.P~~.~.~. r.sp,..Uvrly Mayor and City CI.rk 0' the City 0' Sehastlan, a munl.lllal eorporatlon under the In's of the State of Florida to me known to be the Indlviduul. "lid offl.e.. described In .nd who ex..ut..... the 'on.galnB cu.v.yan.. to Arline Raynor (QIitv ~rltl) ................................................................................. ............................................ . . . . . . . . . . . . . , . . . . . . . . . . . .. . . .. . . . . .. .. . . . . . .. . . .. . . . . ., and aenrally acknowJedBed the .x..,.,Uon thereof to be their fr.. art and d.ed IS slleh ome.rs tllereuntu duly authorlsed; and that the Om.lal ..01 0' said corporation Is dul, amxed thereto, and the aald .onnyance Is the act and d.ed of aald mrporaUon. WITNESS m, Ilgnature and or'lelal aeaI at Sabaotlan, In the 'ut aloreaald. and year Name 94n?€ .5' ~ AJ Ale/C Unit 'f - Block 3j Lot I./D Date of Mark-out I / /0/7.5-' I 1/1L//9S- Time ;... j. () () /) /. .,~ ,( cJ/ A I)'FA ;! I Date of Burial ..".,......- I.. . Name of Funeral Home ./~I /.. /( . .-,'::.--:,;~/,/~, ',: /"1 / :;? /{~> 1 . Autlionzed-by.,,-,~0,..,~;r~-:/ <:,.,,1--1...- ../>1..-1 ,i - I I i J ~ed JJJ. J~<gj ~, 1ftL'tJ flOr'; Pr' Ii l1? I03~ -=RJrve:Ho Pve :sew~+)ofI, ~L~CfSO lot tJo\"D)~35j U-n;+1 '- - ''-, - Paidb y CEMETER Y Receipt N B 35 0....... D 1/9/95 UstPrice$ 500.00 .......... ated...................... Lot 40 .................. ........ Net Paid $ 500.00 Maximum No. Burial Spa Block 35 . . . . . . . . . . . . . . . . . . ces . . . . . . . . . . . . . . . . Uni t 4 Monument permitted ................ ... NO. 1483 (Data above this llne tor City Record only) " . . Z35 THE SEBASTIAN CIIETERY em OF SEBASTIAN SEBASTIAB, FLORIDA Dollars (s6'mrJ FROM: on t:h::i..s h~ day ~1tt. ~9~ for the purchase of the following described C 'tery Lo't ( upon t:be 'terms anti contlltions as s'tated herein: . Des=ipt::ion of Prope~ Cemet:ery Lot:(S)~ B~ock , d l'tf') . Purchase Pride: ~. ~ 0~ Unit:./ : Dollars (s6tJo. ~ Xenos aDd !!l:;c:ion ;;;~ih3 X1l:i.s contract shall be binrHng upon bot:b. parties, the seller and t:b.e purchaser, when approved by t:b.e owner of t:b.e property above described. I, or we, agree to purchase the above described property on t:b.e 'terms and conditions s'tated :i.:l1 t:b.e forego:i.:l1g .i.nst~en't: ClVh/ /JJt ' I? ~ ~ The Ci1:y of Sebastian agrees the above named purchaser ( s ) above ins'trument. sell t:b.e above mention proper1:y"to e terms and cond'.' s"tated in the . . ,-1Y 0" "'\ " IJI (J ~ ~Q' .,~ 1-0'1 S' ~Q "'~ 0" PELJC~" {o'-'" . City of Sebastian 1225 MAIN STREET a SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 a FAX (407) 589-5570 January 18, 1995 Arline Raynor 1033 Palmetto Avenue Sebastian, Florida 32958 Dear Mrs. Raynor: Enclosed is Cemetery Deed No. 1483 for Lot 35, Block 35, 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 Ci~cuit Court, 2145 14th Avenue, Vero Beach, Florida. Very truly yours, 'A&:l;,~ m. O'l/an,., A... Kathryn M. O'Halloran City Clerk KMO: lmg enclosures O. Last Raynor / //d !3 3S L/Lj Month Day 01/08/95 Year [lP.~] State of Florida, Depart. of Health and Rehabilitative Services, Vitalatistics APPLlC~ FOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (Type or Print) First James Middle DATE OF DEATH Medical Examiner Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial Hospital Address Phone Number 1300 36th Streett Suite 0 Vero Beach, FlorIda 32960 (407)770-2664 Fla. Uc. No.1 Reg. No. Phone Number (Area Code) 2. Place of Death County Indian River 3. Name of Medical Certifier Nancy R. Cho, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral 5. Check Appro- priate Box City, Town or Location Vero Beach Physician Address 916 17th Street Homes, P.A. Vero Beach, FI 32960 130 (407)562-2325 a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. b Dl Ginger was contacted on 01/09/95 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 Nancy R. Cho, M.D. will complete and sign the medical certification of cause of death. was contacted on . He/she verified that , Medical Examiner, will complete and sign the c 0 medical certification. 6. Place of Sebast ian Cemetery Final Disposition: 7. Funeral Director / Direct Disposer B. Permit No. 0130-95-0017 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 fo g the ~t c rtificate~ue ed. Registrar or Date Date Certific Subregistrar Signatu . Issued: Due: Indian River F.E. No.lReg. Removal from state Donation Date Signed 01/09/95 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 ~lJ \... ~~ Date of Disposition ~^......... · a....'"'\ l (\ 0 N'r\ ~..u..... _\ I' ,Iqq~ Signature of Sexton ) or Person-in-Gharge ) .Aa"''';'' ~ (\ \"'~ IlL 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) (Slock Number: 5740-000-0326-2) 3.