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Home My WebLink About4-34-26 ~ 8~'- Paid by CEMETERY Receipt No. . . . . List Price $.. ~! ~~.~:.9~... . 1,000.00 NetPatd$ .................. .......Dated.....~.+/.H?4............... Lots '}.- "ic 26 Block Maximum No. Burial Spaces... .. ... ..... ... Uni t 4 NO. Monument permitted....................... '14'14 (Data abon lbl. line for Clly Reeord only) en Uy nf &t bustiun . I 14 'f,l O!rmrtrry IIrr~ NO. 1st THIS INDENTURE MADE TIaIa ...................... day 01 November 94 A. 0.. I........ bel,,'..n 'be elly of Seblltla... a munlelpal corporation al.tlnl under lhe law. 01 the Slate 01 Florid.. II Grantor and Diane Ford . .. ............................................ 249"' Detm'ar' . S'trl:!e't. ......................................................... Sebastian, Florida 32958 ............................................. ............................................ ............................................ 01 the County of ....... ;J;~.c;1.:i,!:HL~;I, Y:~.J;.. ............... .n'( Slate of ..... ..fJm:: i.d.~.... ... .... .. .... .. ... .. ...... ...... II Grantee, WITNESSETH I Tbat the Grantor for and In consideration of the sum of S '" ~.\ 9.9~: .Q9.. .. . .. . " . to It In hand paid, the receipt whereof Is herewith ac- knowledged, does by this instrument grant, bargaID, ..n, relea.., convey and confirm unto the Grantee ., h~ F. .. hein, legal representatives and assigns lhe foDowing property situated In Sebastian, Indian RIver County, Florida, to-wlt: All of Lol(s) .~ ~.~ ~ 6, Block, . . . . . ~. ~ ,UNIT .....4....... ,of Sebastian munldpal cemetery II per Plat Number I thereof recorded In Plat Book 2, at page 65 of the public records In the office of the Clerk of the Circuit Court of SI. Lude County of Florida; said land now lying and belllll in Indian River County, FloridL To Have and to Hold the same forever; provided that said property shall be u.... solely and exclusively for the Interment of the human dead and shall be DIed, kept and maintained at all times in accordance with the roles and replatlons, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of saJd cemetery, The conditions, restrlctlons and requirement. contained In thl. Instroment shall be covenant. runnlns with the land. In the event of the failure of the owner of any property situated within saJd cemetery to ob- serve and comply with such roles, regulations, resolutions and ordinance. and the condition. of the doied of conveyance thereof then the title of sueh owner In and to said property .hall terminate and the same .hall revert to the City of Sebastian, FIorIclL IN WITNESS WHEREOF, The saJd party of the first part has caused this Instroment to be executed In Its name and on It. behalf by It. Mayor and attested by It. City Clerk and it. corporate seal to be hereto affixed, the day and year first above written. AU..tr ~ALL. -.OJ. .():tla1L~......... --r- City Clerk C<~,o~~. Ma,or Sllned, Se81ed and Delivered ".. =.~.... . ...;T: .Jj~~~ "........... ..,.. (QIitv 'eal) ATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on thl. .......1 s. t.. ..... ... ..day of ............ .Noy.em.beI:........... ..... ......... 1.94. , b.lore me perlonally appeared . ..~~~~.1!~.. ~: J~.~.~.i~~.......................... and K~ ~.l:J.;Y.~ ..~.'...9. ~ ~~P.<?r;~~.. rel"eetiv.ly Mayor and City Clerk of the City ot Seba.Uan, . munlel,.ol eorflOratlon und.r the I..... of the Slate of Florida to me known 10 be the I"dh'idual. ond olffeers de.erlbed In .nd who exeeuted tbe lon'lOinl ""aveyanee 10 ............................................... P:j..~"~. .:f.Q~P,............................. ..... .................................... .. . . . . .. . . .. .. . .. . . .. .. . . . . . . .. . . . . .. .. .. .. . . .. . .. .. .... and .evenlly aeknowledled tbe execution thereof to be their free .el .nd deed as s"cb olffeers lbereunto duly aulhorlzed; and that the OHlciol .eal of .ald corporal Ion I. duly affixed thereto, anll the said eonveyance I. the oct ond deed 01 laid corporation. WITNESS lu' oforo:aald. ,~,-:: -:, - " . Name ,if,) 1''J'.l -/ / i /i 1(:, -; l:; ().5 7-- Unit 4 Block I 3'1 Lot ::~,:,"..' Co Date of Mark-out I D - -;:; I - :j '/ Date of Burial /1-/ - ~r ~,;/ Time / I~~~ " .3 () 1..-' (..'.'. 'l Name of Funeral Home (1i<' - C;"i/~ti?/ t ...,(/~-) ~....; " 'I /' ;c'{_=~{~~,'*<l: "^,, Authori~-oYc::::::' C"-_: "c::(./'l l>Cl . . an Of SEUST~ ~;{~j . '\~:~~~;~ili~;;:f.::~;~' ~~ . ' HOME O.fPELlCAN ISUiHD INVOICE CITY OF SEBASTIAN TO: Ms. Diane Ford INVOICE: 05-063 249 Delmar St Date: 10/25/2004 Sebastian, FL 32958 Amount: $ 225.00 AMOUNT DESCRIPTION DUE 1 Repair of marker at Sebastian Cemetery Unit 4, Block 34, Lot 26 225,00 DUE UPON RECEIPT TOTAL AMOUNT DUE 225.00 Remit To . CITY OF SEBASTIAN . Finance Department 1225 Main Street Sebastian, Florida 32958 Account Numbers: Dr: Cr. 010059534685 ""f~. wi: ~ ~-----Z;-'''''~--_ =. ,. ~,~;;:~?-7"7":~:" - , - .~ < .... ,c" ..~.:..-;;; :c""~ ~ [ CI1Y OF ~ .-<~-. '.."~,.,.'~.~-,,.. .:. .. .. ....__..-~-~ ---~ -- - . _._- HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 a (772) 589-5330 - Fax 772-589-5570 October 21, 2004 Ms. Diane Ford 249 Delmar St. Sebastian, FI 32958 Dear Ms. Ford: Re: Sebastian Cemetery Unit 4, Block 34, Lot 26 It is with regret that we inform you that the marker and/or vase on your Sebastian cemetery lot was damaged during the recent hurricanes. The city has made arrangements with a local monument company to repair the damaged markers at $225.00 per marker and $20.00 per vase. According to the rules and regulations governing the cemetery (copy enclosed), interment site owners are responsible for damage to markers and/or vases, therefore, we are enclosing an invoice for the reimbursement of this fee. Thank you in advance for your cooperation in this matter and I would like to assure you that the upkeep and maintenance of the cemetery is very important to the City. If you have any questions regarding this matter, please do not hesitate to contact me at the cemetery or by telephone at 772-589-2545. Sincerely, Kip G. Kelso, Jr J( ,e t t. Cemetery Sexton / } Enclosure --~ ~-~ ~~. . ~""_. ~ _00. _ -..... ~ I.~l~l ~~ ~~L~_",:_h~. : iri:: .,.",""'~.- -, -- , ~.~-""'.:""C.."-' '"~.~;.,~ ~~!ift ;~~;;..;..::~~...>>,~- 5:. [lD.~] State of Florida, Department of Health and Rehabilitative Services, Vital Statistics APPLlC& FOR BURIAL - TRANSIT PERMIT . tj-.11 -2-6 A. 1. Name of Deceased (Type or Print) Rrst Middle Last DATE OF DEATH Month Day Year MARY ELLEN POST October 28. 19S Name of (If neither, give street address) Hosp. or Inst. 2. Place of Death County Indian River 3. Name of Medical Certifier Michaela G. Scott, M.D. Physician 4. Name of Funeral Home/ Address Direct Disposer Cox-Gifford 1950 20th Street Funeral Home Vera Beach FL 32961 1 a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. City, Town or Location Vero Beach Medical Examiner Indian River Memorial Hos ital Address Phone Number 1460 36th Street (407) 562-77~ Vero Beach Florida 32960 Fla. Lic. No.lReg. No. Phone Number (Area Code) 5. Check Appro- priate Box .- ... b 0 X Michaela Scott, M. D. was contacted on 10 '31 'S4 within 72 hours after death. Hel she verified that this death was from natural causes, that thert wa~ no accident nor other external cause of death, and that 5he will complete and sign the medical certification of cause of death. c 0 medical certification. was contacted on . He/she verified that ,Medical Examiner, will complete and sign the 6. Place of Final Disposition: 7. Funeral Director / Direct Disposer Burial Removal o from state o Donation Date Signed B. BURIAL - TRANSIT PERMIT Permit No. .......cc CAC 0 Permission is hereby granted to dispose of this body. .L,*~,.r4"~ 19.., 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 c .. te requested. Registrar or Subregistrar Signature Date Issued: 11/04/34 Date Certificate Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature or Medical Examiner, , Medical Examiner Date , 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: III BURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition vthJf7~__ Date of Disposition {ltJlI JA'nk. I 0~~ I 1'l<?1( ""J Signature of Sexton ) or Person-in-charge) ~jLv.<~' ,4 /~.L 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. (l HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number. 5740-000-0326-2)