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HOME Of PELICAN ISlAND
Certificate No. 20461
CITY OFf SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Karl H. Axelson
(name)
7526 Cedar Bark Road, Micco, FI32976
(address)
in and for consideration of return of Deed #1471 is entitled to full interment rights in
the Sebastian Municipal Cemetery for the following plot:
Unit_ 4_ Block _34_ Lot)_39_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 21st day of September, 2005,
ATTEST:
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1 This is a replacement Certificate for Deed # 1471
issued on October 26, 1994.
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Unit
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Lot
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Date of Mark-out
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Date of Burial
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Time
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Name of Funeral Home
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Authorized by ,...><, //1" ",' t!iL <
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~xel"'D(\-,- ~r\ W: J)ud )0[), 11\-11
\40 ~\~ \ef(
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.. Lot0 ~q ~40
~!C(Jc 34-
Ll(\'j t- 4
~;nCl. Pxelwn -' 'In+eyreJ lo/~6/q+ '44~
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Paid by CEMETERY Receipt No. 823 10/21 /94 -
. .. . .. . . . . .. .. . . Dated. .. .. .. .. .. . . < Lot s 3 9 & 40
List Price $.. ~.~ 9.Q~ ~ .q9.... . ................. Block 34
MaxImum No. Burial Spaces .
Net Paid $ ..1,000.00 ........ -...... .Dnl t 4
l1aJ il;Z:;~ M,,"orn~t ,,_od, .. ., . ..... .. , ..... ,.. .
NO.
1471
(Data above this line for City Record only)
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HOME Of PELICAN ISlAND
1225 Main Street, Sebastian, Fl32958
Telephone (772) 589-5330 - Fax (772) 589-5570
September 21, 2005
Karl H. Axelson
7526 Cedar Bark Road
Micco, FI 32976
Dear Mr. Axelson:
Enclosed is City of Sebastian Certificate 2046 entitling you to full interment rights in Cemetery
Lot 39, Block 34, Unit 4. Also enclosed is a copy of the Rules and Regulations governing the
Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
0'. ? t?Jl1
Sally Mai~C
City Clerk
SAM:ar
enclosure
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CITY OF SEBASTIAN
CHECK REQUEST
Accounting Use Only
Input Date 9/21/2005 Fiscal Period
Document # Entered By
Document Amount # of Lines Total HC Hash
To Be Completed By Department
Due Date 9/23/2005 Single Check Y/N Y Vendor Number
Organization Object Project
LN TC Reference Code Code Code Amount
601011 534959 $500.00
Number of Lines Amount $500.00
Description Buy back of cemetery lot described as Unit 4, Blk 34, Lot 40
Copy of original Deed # ,1471 attached.
New deed to be issued showing ownership of Lot 39 only.
ISSUE CHECK TO
NAME Karl H. Axelson
ADDRESS 7526 Cedar Bark Road
CITY Micco /\ State F1 ZIP CODE 32976
DRAW CHECK FRol\( J SEE BE~QW
APPROVED BY -,./y) VI/. .t!( rv; _ DATE 9/21/2005
BUDGET APP - /J
c=:::J MAIL ATfACHED DOCUMENATION (Except for remit slips, requesting department should attach
a copy of docwnentation along with the original)
~ OTIfER INSfRUCI10NS Please make copy of check:
Wt1y IlL ~t1Justtnn
enemetery
meeb . NO.
14',1
THIS INDENTURE MADE 'l1oIs ...',
26th
dAY of
October
94
A. D~ 1'".. ".
between the City of S.butian, a municipal corporation e"lallng under the lawa of Ihe Slale of Florida, .. Grantor and
of Ihe Counly 0' ,Jml:j..~n..R:i-.v~r..,
.. Granlee, WITNESSETH,
Thai the Grantor for and in consideration of the .um of S .~. ~ .Q9.9 :.9~ . . . . . . . . . . . .10 II in.hand paid, the receipt whereof i. herewith ac-
knowledged, doe. by this Instrument granl, bargain, sell, release, convey and confirm unto the Granlee .~~. ~ . . .. behs, legal representatives and assigns
the following property situated In Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) .~?~~.O, Block, ... .~~.. ,UNIT........~.... ,of Sebastian munIcipal cemetery as per Plat Number I thereof recorded in Pial
Book 2, at page 6S of lhe public records in lhe office of the Clerk of the Chcult Court of St. Lucie County of Florida; said land now lying and beIng
in Indian River County, Florida.
. Ka.r.l, ,H... AXl'!l$Qn......,.....,...,
140 Coply Terrace
,Sebastian,.. .F.l. .32.9.58.....,'..
......"......... ani Slale of ..."fl.<?!;I..da
To lIave and to Hold the same forever; provided lhal said property .ball be used solely and exclusively for the Intermenl of lbe human dead and .hall
be used, kept and maintained al .11 times in accordance with tbe rules and regulations, ordin.nces .nd resolutions of the City of Sebastian, Florid., berelo-
fore, now .nd bereafter adopted or provided for lh. governmenl and oper.tlon of said cemetery. The condItions, restrictions .nd requhemenl. contained
in tbis instrument shall be covenants running witb the land. In tbe event of tbe failure of the owner of .ny property situated within said cemetery to ob-
serve and comply with Ncb rul.s, regulations, resolutions and ordinances and tbe conditions of the deed or conveyance thereof then the litle of sucb owner
in and 10 said property sball terminate .nd lh. same sball revert to the City of Sebastian, FlorId..
IN WITNESS WIIEREOF, The said party of the fllst pari has caused this Instrument 10 be executed In Its name and on its beh.1f by its M.yor .nd
attested by Its City Clerk and its corpor.te seal to be bereto affixed, the day and year first above written.
AlleSI;~~,)U..,{).//~
V Clly Clerk
"~,o~~
Mayor
Slgn('d. SeRIM nnd Dellvend
tl:n the relCe e of, / ~
". ,. ;u:':~Cf:~(.,~~1""""""''''
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STATE OF FLORIDA
COl'NTY OF INDIAN RIVER
I })EUEBY CERTIFY, That on thla 26.t;n ,..,,,,,d.y of .Oc,tqpeX....,..""..."...",...""......, 1.,9.4,
b.fnre me peraonally appeAred .l\r.t.h~~. ,L.... .Fi,r,~io.n,. .",.,.."" and Ka.~~~x~. .~:. .?.'.~.~.~~?r.a~..
r..p,'clivrly Mayor ond City Clrrk of lb. City nr Seba.lIon, . munlclp.1 corporation undrr Ihe I....s of Ihc Slale of Florida 10 me known
10 bl' the indlviduuls Ilull offlcrrs descrlbc.-d In bnd who execult.d the fO[("R'olng cORveYftnce to
(Qlitv ~rlll)
,.K~!,l.. ,If,." .~.X.~~!l.<?ry........."..... .,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and s~vtralty acknowlf'dgNl the ext'cutlon thereof to be theIr fret" Ad and cleecJ
os .lIeh office.. lhrreonln duly aUlhorlud; and Ihal Ihe Ortlrial se.I of aald corp()l'atlon Is duly arflxed tb.relo, and the said conveyance
I, lh. Rei .nd deed of said corporation.
WITNESS my signature and otrlclal
lost .for..ald.
Il"~"~'~ lINDAM. llAllEY
"''''', MY COIMSSION , CC 375724
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f ",' lIoolIM"""IIDlIry_~
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THE SEBASTIAN CEMETERY
em OF SEBASTIAN
SEBASTIAN, FLORIDA
OF XHE S1JM OF:
Dollars (S /t1c1() , ~
FROM:
on t;bis / /,;..;.:- day 0
following described Cemetery
stated herein:
, 19 ~ for 'the purchase of 'the
upon the terms and conditions as
Description of Propert:y: . I
Cemet:ery Lot: ( s ) ~ i .t/() Block ,q"'f Unit: .z/.
Purchase pric~~~~ Dollars (s/t1M. ~)
Xerms and cOaz:;Jr )5;: 091h
Xllis contract shall be binding upon bo'th parties, 'the seller and 'the
purchaser, when approved by 'the owner of 'the property above
described.
I, or we, agree to purchase t;h.e above described property on 'the terms
and conditions stated in 'the foregoing instrument:
!<hLP Ii ~
~-1t...c.....I .~
property to
stated in the
The Cit:y of Sebastian agrees
the above named purchaser(s)
above instrument.
.
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:c,f" OF PElIC"'~ ,S'-'-
.
City of Sebastian
1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
October 27, 1994
Karl H. Axelson
140 Coply Terrace
Sebastian, Florida 32958
Dear Mr. Axelson:
Enclosed is Cemetery Deed No. 1471 for Lots 39 & 40, 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.
ve~y ;rUIY., yours, .
%d'.,~_,~m- 0 f/aDPA-
"
Kathryn M. O'Halloran
City Clerk
KMO:lmg
enclosures
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State of Florida, Department of Health and Rehabilitative Services, Vital Statistics
APPU.N FOR BURIAL - TRANSIT PERMIT .
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A.
1. Name of
Deceased
(Type or Print)
First
Janina
Middle
Last
Axelson
DATE
OF
DEATH
Month Day Year
10/21/94
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
Noor Merchant. M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes,
5. Check a 0
Appro-
priate
Box
City, Town or Location
Medical Examiner
Name of (If neither, give street address)
Hosp. or
Inst.S b to R' M dO I Center
e as Ian Iver e lca
Address Phone Number
Roseland
Physician
Address
7744 Bay Street Center #2
Sebastian Florida 32958 407 589-0879
Fla. Lic. No.1 Reg. No. Phone Number (Area Code)
1623 North Central Avenue
P.A. Sebastian FI 32958 1228 407 562-2325
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b]Q
Pl'lm was contacted on 10/22/94 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 thatNoor Merchant, M. D. will complete
and sign the medical certification of cause of death.
c 0
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
medical certification.
6. Place ofSebast ian
Final Disposition:
7. Funeral Director /
Direct Disposer
Indian River
F.E. No.1 Reg. No.
.,
Removal
from state Donation
Date Signed
.,
B.
BURIAL - TRANSIT PERMIT
Permit No.1228-94-0495
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 for filing the death certificate requested.
Registrar or
Subregistrar Signature
Date
Issued:
/ ~,4 2./9t'-
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:
. BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
~~ 'J,Kk?
Place of Disposition
Date of Disposition
54AI'1~77;q,4/ (!,tAI'J~ Ti...ey.
lo/~,At~ .
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 HRS County Public Health Unit in the County where disposition occurred.
HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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