HomeMy WebLinkAbout4-34-09E,A
4.- IX 11i k6r,
Unit
Block
Lot
Date of Mark -out
Date of Burial Time
Name of Funeral Home
Authorized by 7Z
7 - 3c P.M,
.J
Paid by CEMETERY Receipt No... ~2....... Dated..... ~.(.~?/ ?~..........,.. ~o ts 9_0
1 800 00 Block ~
Lbt Price S . . . . ! . . . . . ... . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . .. . Uni t 4
Net Paid S ..~. ~ .~?~ :.?~...
NO.
.
Monument permitted. .. .. . .. .. . . .. .. .. . .. . .
1468
.
(Data aboye thl. One 'or CIt, R4!e0rd only)
CltUy nf l',haslhlU
<1!rmrtrry
It rrb
1468
NO.
THIS INDENTURE MADE 'I1oIa
26th
................. .... day 0'
August
94
A. D~ 1.......0
bet,.e.n 'he City 01 Sebastian, a munlelpa! eorporatlon e"l.tln. und.r the law. 0' the State 0' Florida, a. Grantor and
.................... ........... ...Ml'... . Edmund..C.o. . Po.lakQw.ski................................... ..... ..............
1018 S. Wren Circle
............... ...... ........ .........Bar.efoot.. Bay....FLg.r-ida. -3297.6.... ...................... ....................
01 the County of . .I.~~;i~.~.. R~.y.~;r::.......... ............ an'l State 0' ..~;I,~:t:'.tfl~.........................................
a. Grant... WITNESSETH,
That the Grllltor for and bt consideration of the sum of S ~ .'. ~R9.! ~9.. ... ., . .. .. .. to It bt hllld paid. the receipt whereof is herewith ac-
knowledged. does by this btstrument 'grant. barplit. ..0, re...... convey IIId confirm unto the Orantee ., !t.~ ~.. heks, Iopl repreaentatiYeI and assigns
the foUowing property situated in Sebastian. Indian Rmr County. Florida. to-wlt:
AD of Lot(s) ~ ~.~ ~ ,Block..~;..... . UNIT ...~......... . of Sebastian munldpal cemetery IS per Plat Number I thereof recorded in Plat
Book 2. at p.. 65 of the public records in the omce of the Clerk of the Ckcult Court of St. Lude County of Florida; Mid land now 1rin8l11d being
in Indilll RiYer County. Florid..
To Have and to Hold the same fo_; proYided that Mid property shaD be used IOlely and exclusiYely for the interment of the humlll dead and shall
be used. kept and maintained at aD time. bt accordance with the rules and regulations, ordinance. and relOlutions of the City of Sebastian. Florida. hereto-
fore. now and hereafter adopted or provided for the government IIId operation of Mid cemetery. The condition., restrictions and requkement. contabted
bt this instrument shaD be covenants runnbtg with the land. In the event of the faJJure of the owner of any property situated wlthbt Mid cemetery to ob-
serve IIId comply with Such ru.... regulations, relOlution. and .ordinance. IIId the condition. of the deed of con...Ylllce thereof then the title of such owner
in and to Mid property shall terminate and the .me shall revert to the City of Sebastian. Florida.
IN WITNESS WHEREOF. The said party of the fkst part h.. Clu..d this btstrument to be executed in It. name IIId on It. behalf by It. Mayor and
attested by Its City Clerk IIId its corporate _I to be hereto afftxed, the day and year fkst above written.
Alle~<. ......In.C)#~.......
;;;-J.~ Cll, Clerk
=~~
........................ .... ..............
Ma,or
Sign..!. Sealed alld D.llvered
";1.;;.-:~~d*.................
~..l!'4~p.
STATE OF FLORIDA
COl'NTY OF INDIAN RIVER 26th August 94
I HEREBY CERTIFY, That 011 thla ....................... .day of ...................................................0 It....o
b,'"re me perlOnally .ppe....d :~.':~~.':l.':.. ~~.. ~~~.~.~~~............................ ancl Ka.~.l?:,:y'~.. ~.'.. .~. ~ ff~~Jl?;r:a.~...
r..pt'ellv"y Mayo. .nd City Clerk 0' the City 0' S.baatlan, a munlell,al eorpo.allon und.r th. I..... 0' the State 0' Plorld. to me known
to be the Individual. and offle... dearrl"'" In ond who exeeutt'" the 'ore'goln. eo...y.nce to
Mr. Edmund C. Polakowski
(Glifv ~~al)
. . . . . . .. . . . . . . . . . . . . . .. . . . .. . . .. . . . .. . . . . . .. .. . . . . . .. . .. .nd .eveea!ly acknowledged th. exeeutlon thereo' to be their 'reo aet and deed
os ."eh offlc... t1l..""nto duly .uthorlaed; .nd that the Omelal ...1 0' ..Id corporation la duly a,n"ed the..to, ancl tbe said eon.ey.nce
I. the aet and deed of aald eorporatlon.
WITNBSS my .Ipatu.. and oIlI"al ...1 .t Sebaltlan, In the County 0
I..t alo...a1d. .'
. lINDA M.1IAll.EY
. . MY CJlIMI8IlII 'CC m7M
EllI'IR!I: ......11, -
. _1llIa.., NIl........
I
-
J)eed Dc), J%"6
RbJ\D~b k~dC/.
IDI~ (5. Wren C/rcJe
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City of Sebastian
1225 MAIN STREET CI SEBASTIAN, FLORIDA 32958
TELEPHONE (407) 589-5330 CI FAX (407) 589-5570
September 2, 1994
Mr. Edmund C. Polakowski
1018 S. Wren Circle
Barefoot Bay, Florida 32976
Dear Mr. Polakowski:
Enclosed is Cemetery Deed No. 1468 for Cemetery Lots 9 & 10,
Block 34, 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. 820 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,
Kathryn M. O'Halloran
City Clerk
KMO:lmg
enclosure
(\ws-form-cem.rec)
.
.
Oc2D
THE SEBASTIAN coo.mY
CITY OF SEBASTIAN
SEBASTIAH, FlORIDA
($ /1Jt), ~
on 1:b.is c2 Ii? ~ day o~
f0220wing described Cemete
stated herein:
(
, 29 ff for the purcl1a.se of the
upon the terms and conditions as
Description of Proper-ty: ~ ./ , /
Cemet:ery Lot:(s) ~, B:?ck.~!J;: Unit:--)L
Purchase Pr:i.C~ .-'8fJ-I/cvx;I~AJ Dollars (sL'ltJtJ.}ft)
Xerms and Condition of sal.e:
Xhis contract shal.2 be biDding 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 forego:izJ.g instn;ment:
4kA4 ~/(fiPtf~~-<~
."
Xhe City of Sebastian agrees
the above named purchaser ( s )
above instrument.
sell the above mentioned property to
e terms and condi . ons stated in the
L1L d.*
tY~ tness .
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Flo:i:ida.Memorial
pO .Box 1776
Cocoa FL 32923
(4467)
II
60522000 03
01130521 C
II
Branchpay!> 1..(800)444-6899 Another service of Gelco Information Network, Inc. Eden Prairie, MN
PAY TO THE
ORDER OF
City of SE:!b~~~ian Cemetery
1921 J.\J,ftnt:~6l.1five>
Sebast;i..aP-iF'L3;a958
~ ~~~~~eatures~~
Details on back. i~"~
~
Cents*************************************
$**150.00
NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE
SIGNATURE OF DRAWERS AUTHORIZED REPRESENTATIVE
PAYABLE THROUGH
First PREMIER Blink
SIOUX FALLS, SO
78-858
'9i4
%~~~~~~~n:e~~:::p=;m~~Jh~~r:ud:,~::=:e=:~~~~~J~r~n~~~~~~~~ ~:~~~~Cs~f:~jsstatement.
III 0 ~ ~ ~ 5 b ~ ~ 2 ? III I: 0 Ii ~... 0 B 5 B 5 I:
2500000 b 5 5111
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
'1,31}-'D,
Burial - Transit Permit
Name First
EDMUND C. POLAKOWSKI
Date of Death
JiANUARY II, 2006
Place of Death
X>>J,XDtlJlMXlr Village OSSINING
Manner of Death ~ Natural Cause 0 Accident
Middle
Last
Sex
IlALE
Age
92
If Veteran of U.S. Armed Forces,
War or Dates nIl
Hospital, Institution or THE PINES
Street Address 19 NARRAGANSETT AVENUE
o Homicide 0 Suicide 0 U~determined 0 Pendi~g _
Circumstances Investigation
Medical Certifier Name
.., RAFAEL SOLTREN, M.D.
Address
100 SOUTH HIGHLAND AVENUE,
Death Certificate Filed
x>>Jl,XiX\JltlliXlKVillage OSSINING
iii Burial Date
OE...ntom. bment JANUARY 15, 2006
. Address
o Cremation
Title
OSSINING, NEW YORK 10562
District Number
5905
Cemetery or Crematory
SEBASTIAN CEMETERY
Register Number
3
SEBASTIAN, FLORIDA
Date
Place Removed
and/or Held
Address
,ct Ii] Transportation
a by Common
.:::::::: Carrier
:!j:::::::: 0 Disinterment
Date
en 13 2006
Destination
Melbourne,
Date
Point of
Shipment Delta at LGA,NYC Flight #615
Florida Delta Fli ht #409
Cemetery Address
.. ::.. D Reinterment
Permit Issued to WATERBURY & KELLY FUNERAL HOME INC. RewflIwg>n Number
Name of Funeral Home '
Address 45 SOUTH HIGHLAND AVENUE, OSSINING, NEW YORK 10562
Name of Funeral Firm Making Disposition or to Whom Tel. 321-636-8943
Remains are Shipped, If Other than Above Florida Memorial Funeral Horne
Address 5950 S US Highway #1, Rockledge Florida 32955
Date
Cemetery Address
District Number 5905
Place VILLAGE OF OSSINING
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition / /),-j b Place of Disposition 5 k. IS ~s;;;,.:v a E )v7 e "1':i e 1/ _
I "'_ (address) I
iI H, / -f ,& '-- e. 3")1 ~ 0 r:: 9
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ,,..( / j:J ~, ~:::' I- <, C )e - .
(please prmt)
Signature Title 5 ,e )( ;70' -t '
(over)
DOH-1555 (02/2004)