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Home My WebLink About4-34-07Paid by CEMETERY Receipt No 1,000.00 List Price $ Dated 8/24/94 LoAlll & 7 NO. B1 34 Maximum No. Burial Spaces Unit 4 Net Paid $ 1,Q00.00 Monument permitted (Data above this tine for City Record only) 1467 f�itg of Orbttstittn !rmrtrr Ertl! NO. 1467 24th August 94 THIS INDENTURE MADE Tlda day of A. D., 1i , between the City of Sebastian, • municipal corporation existing under the laws of the State of Florida, as Grantor and Maur.ie.. &..Joan..LaRo.a 155 Midvale Terrace Sebastian.,..F1.orida..32958 of the County of Indian River anal State of Florida u Grantee, WITNESSETH• That the Grantor for and in consideration of the sum of $ 1 t 000.00 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 their heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 6 & 7 , Bbdr 34 , 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. Lurie County of Florida; said land now lying and being in Indian River County, Florida. To Have and to Hold the name forever; provided that said property shall be used solely and exchuslvely 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 contakred in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within salt 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 Clty 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 ha Mayor and attested by its City Clerk and its corporate seal to be hereto affbred, the day and year first above written. Attest r< /.IGCC. ..21.1. 0/441.6.44_-- ' Signed, Sealed and Delivered In the Fracnee of, STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF S B B AN, FLORIDA e:cv;—.. :_.? • Mayor (City deal) I HEREBY CERTIFY, That on this 24th day of August 94 if...., before me personally appeared Arthur L. Fiction and Kathryn M. 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 Maurice & Joan LaRosa and severally acknowledged the execution thereof to be their free set and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is duly affixed thereto, and the saki conveyance is the net and deed of said corporation. WITNESS coy signature and official seal at Sebastian, in the County of Indian last aforesaid. 1 I.MQ4 M. GALLEY W COMIINONfCCWI5724 OWNER Jar 11, kW I dllaaRawPetssIAlluasllaa vet and //Florida, the day and year • 47/ ota Public, State of Ida at Large. My talon expl Linda M. Galley Name .TD A/, Fd /"05A fr. io 3 Me S. Unit ?� Block d / Lot 7 Date of Mark -out Date of Burial Name of Funeral Ho Authorized by Time //; tea/' JOAN LA ROSA Mrs. Joan La Rosa, 76, died June 24, 2011 at Indian River Medical Center, Vero Beach. She was born in Bronx, New York and lived in Sebastian, FL for 19 years coming from Maywood, New Jersey. She obtained her Degree in Nursing from Bergen Community College located in New Jersey. Prior to retirement she worked at Indian River Estates as an RN. She was a member of St. Sebastian Catholic Church, Sebastian. She was a former member of the Italian American Club, Sebastian. Survivors include her son, Peter and his wife, Rene La Rosa of Sebastian; daughters, Alice La Rosa of Sebastian, Laura Green of Clifton, NJ, Joan La Rosa and her fiance, Richard Crapella of Totowa, NJ and Theresa and her husband, Joseph C. Natale of Maywood, NJ; brother, Richard Hopkins of Sebastian; grandchildren, Jimmy, Megan, Gina, Kimberly, Kevin, Krissy, Anthony, Tyler and Nick; great grandchildren Anthony and Ariana. She was preceded in death by her husband, Rocky La Rosa and grandson, Anthony La Rosa. CITY OF SEBASTIAN CRY CLERK'S OFFICE RECEIPT 4311 Name ilk kaSa Date l49- .30 -11 No. 001001 208001 Saks Tax 001501 322900 Garage Sales 001501 341920 Copies/Bi Specs. 001501 341910 LDCICode of Ordinances 001501 341930 Elector Qualifying Fees 601010 343800 Cemetery Lots Unit Lot/Niche Bock 7 3'1 001501 343805 Cemetery Fees 11 Cash n S. Check "1 [ 4103 Amount Paid o/c 150,0 Total Paid l50 o0 nNals White - Dept. of Origin • Yellow - Finance • Pink - Applicant TYPE State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Deceased loan Middle Last V. LaRosa Date of Death Month Day Year June 24, 2011 2. Place of Death Ciry, Town or Location County Indian River Vero Beach Name of (If neither, give street address) Hosp. or Indian River Medical Center nst. 3. Name of Medical Certifier Richard T. Penly M.D. Address 1265 36th Street Vero Beach, Florida 32960 Phone Number (772) 567 -6340 n Medical Examiner Physician 4. Name of Funeral Home /Direct Disposal Establishment Strunk Funeral Home and Crematory Address 1623 North Central Avenue Sebastian, Florida 32958 Fla. Lic. No. /Reg. No. F041870 Phone No. (Area Code) (772) 589 -1000 Check Appropriate Box a. ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. c. US n was contacted on 10 12-7120i1 He /she verified tha9 IS death from tural causes, that there was no accident nor other external cause of death, and that — r e1'�TL�^ will c mplete and sign the medical certification of cause of death within 72 h was contacted on He /she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. 6. Funeral Director/ r diignat • `14'^,M„xs F.E. No. /Reg. No. F044048 UT21170 1 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -11 -300 • A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. O No extension of time fo l ing t - .eath c eltit has been requested. ^ al^' - -kr or Date Subregistrar Signature Issued: 6/24/2011 Date Certificate Due: 6/29/2011 AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date Medical Examiner, , gave authorization by telephone to Funeral Director /Direct Disposer. Date The Medical Examiners 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. �. CEMETERY OR CREMATO'p`- �-1 ^,s�`� /�� Method of Disposition: Place of Disposition ,.'IJC��,Y,,l,��'`J /1J'IfnM. ,t �) BDRIAL STORAGE Date of Disposition ' 1/(W .�.� t t ab CREMATION DOTHER (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 County Health Department in the county where disposition occurred. DH 720. 8/97 (obsole @a all previous eons) (Stock Number. 5740-00043262) DisVTution: White Cemetery or Crematory Yellow Funeral Dlreclor or Direct Disposer Plnkr Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY $EBASTUW HOME PELICAN ISLAND FUNERAL HOME: ADDRESS: PHONE #: For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax: (772) 589 -5570 5frtin it E&cner &I *23 Mo. Cen -h-al Ave, 5&q_ 1000 (Check One) V OPEN BURIAL LOT Lot 7 Block 34 Unit 4-1 OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit NS E W BURIAL DATE AND SERVICE TIME: (P -30-11 ?a moo ¢uvr FOR DECEASED: 3J JQVI Lo_kOSQ Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name Signature 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. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owners deed and confirming w h Clerk's office and that alt fees have been paid: krp�Kelsoo &AIWA em ! ery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.