HomeMy WebLinkAbout4-33-15
r.1d by CEMETERY Receipt No.., ~Q,..... Dated..~ 1.~.~9.4................... LIt ~ 5.
900 00 B oc
List Price s,.,..... .'.....,.., Mulmum No. BwlaISpaces...,............. Un! t 4
Net Paid S .. ..~~~:,~,~...., Monument permitted.......,....,....,:....
NO.
1456
(Dat. .boYe tltla line lor aq Jlec!ord oaI1)
mUg nf &rhasthttt
O!rmftfry
Iffll
1456
NO.
THIS INDENTURE MADE 'I1aII
9th
.... day 01
May
94
A. D.. 1.......,
bel..-een lhe Clly of Seltaatl.... a ..unl~1paI eorpor.tlon ""Iatlng ander the I.w. 01 the State 0' FIo,Id.. .. Gr.ntor and
Alma Rossman
",.".,..,...,......... ............. .......... 121'1' 'Cl(l'\l~I(' 'Dr:l:~e'"'''''''''''''''''''''''''''''''' .......................
...., ................. ...... ................. ,~8:r.~.~~~.~..~8:r.L~~. .~~~?~.... ,.,..'.......... ....... .....................
of lhe CRab' of .........l.od;l,an.JU.v.e.J:............... .n:1 Slate 01 ..I!'.1.9.r.i~A.........................................
.. Grantee, WITNB88BTH,
That the Grantor for .... In conalderatlon of the sum of S ..,..... ~ Q9. ~ 9.Q. . . . . , . . . to It In hind paid. the ..celpt whereofl. herewith IC-
tnowJedaed. doea by thillnltrament put. barpIft, IOn, relealB, COMOY .nd confirm unto the Grantjt.~?-: . . . " heln, Iepl....-tatml and uatpl
the followirll property altueted In Sebeatlan, Incllaft RJqr Coanty. FtorId., to-wlt:
An 01 Lot(.) ..~, ~ .. ,Block,..;i. ~ . .. ,UNIT . ,4 . . , , . . . . ,. ,of Sebaltlan municipal cemetery II per Plat Number I thereof ",cordecIln Plat
Book 2, at .... 65 of the pubHc ..corda In the oMce of the Clerk of the Clrcult Court of St. Lode County of FIodde; _Id land now Iyina end beIlII
In Indian RMr CountY. FlorIda.
To Haw Ind to Hold the aarne fo_; proYided that said property allan be aeed aolelyand ellcluamly for the Interment of the hulll81l dead .nd aban
be used. kept and meIntaInecI It aU tImea In aec:ortIenw with the ralet.nd ftilUlettMIa, ordlnancea .1Id reaoladont of the CIty of Sebeatian, FlorIde, heteto-
fore, now Ind hereeftel adopted or protIcIecI for the ao-t .... operltlon of said cemetery. The eoadltlont, reatrlc:tIona end .....melltl contalnecl
In thla inItrument aha. be COWMnta rurmIns with the land. In the emit of the f.... of the owner of any property altueted within said cemetery to oil-
_ and comply with iuch ra.... ftilUlatlon.. molatlona .nd ,ordlnallcet and the conditione of tha deecI of conftYlllce thereof then the title of IOIch owner
in and to said property allan termlnlte and the _me aheII revert to the CIty of lIebeltlen, FlorIda.
IN WlTNESS,WHEREOF, The said party of the Ont part ... call1ed thillnttrament to be execated In It I name end on Ita behalf by Ita Mayor and
atteated by It. CIty Clerk end Ita corporate aeaI to be hereto afllxed. the day and ,ear flnt .00.... written.
Atte.tl?~ad~. m.. .{).tla.fm~..
--,- - CItJ C1erlr
c:om~~..
Mqor
1I1gned, Se.led and Dellyered
~~....~..........
~cr'f.,..K~..............
(Grifv ".1)
STATE OF Ft.oRJDA
COUNTY OF INDIAN RIVBR
9th May 94
I HEREBY CBRTIFY. That on tit.. ....................... ,d.y 01 ,..,....,.........................................., I.....,
....,0,., me peraonaJly .ppeared ...... A.~~.l:I.~~. .~. ~.. ?~.~.t~~~..........,...,..,...., and ,.~~~l:I.~"~. .f:'.~.. ~~.~~g<?~~~
reapreti~.ly M.yor .nd City Clerk 01 the Clb' 01 Se....tI.... . _nlelll81 eorpor.tlon under the Ia...a of the State of FIorkla to _ Ir_
10 be lhe lndlvidu.la .nd 01'"'-'" described In .nd who exeeuled the lor_mln, "".v..,.anee to
ALma Rossman
.......................................................................................................................................
.. .. . .. . .. .. .. .. .. .. .. . .. . .. .. .. .. . .. . .. .. . .. .. .. .. .. '" .nd .....r.lly ackoowled,...J the exeeutlon thereol to .... theI, free act and deed
IS auch olllc:ers ther~unto duly aulhoriaed I .ad that the Ofllel.1 ....1 01 aald eorporatlon Ie duly .ffl.ed therete, .nd the aald eonv..,.a......
I. the act .nd deed 01 aalel eorpontlon.
WITNESS my .....ture llId offleJaI _I at Se....tJan. In the County of Indian
1..1 alCIrd8Id.
Q) l.IIIM M.lW.l.EY
: . MV~ 'caMt7DI'IRES
_"11M
____-.11II:.
Name ;,;:'/ i-I "'; (, I '\
,,L) .
/::: (") 0::; -S /,t"""j,l:;'s ~/../
Unit '/
Block "3 -::s
Lot I i-'
Date of Mark-out
--- I I
j / 7:<11.
Date of Burial
.. /
-., I
"'\.1 'fl if ~/
Time
/
l)' , /.-"
Name of Fun,~al H9me / }7i,:' v fiX..'.
,'" .- ---.\>(/ ,. , - j":. ~::- -<.:{~.
Authl:>riz,e.d~'7."<h' ;::c/ 'I?';G!>~:--':".../ I
\ /' ,.
) I \)
J
~af)) R 1l'Ytt
1e9 , I LhlLl~:brl ve
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~j /<$, lJhd 03, dni) 1
J~UJ~ ~ (jjqhl
-:Deed J.4 .
/4CJt
'- -
'- -'
Paid by CEMETERY Receipt No... ~9.~......... Dated 5/9/94
UstPrice$ 900.00 .............................. Lot 15
.................. MaxJm N B . Block 33
NetPaid$. 900.00 um o. urialSpaoes.................Unit 4
/J ,;1 ~~. ..J1./YV..... _'. J Monument permitted
Lf...{/ I 1-'tK.- ~, ~ . .. .. .. .. .. .. .. .. . .. . ..
(Data above thfJ IJne lor Cit)' Record oD.ly)
NO.
1456
. .
.
.
807
THE SEBASTIM CEMmRY
CITY OF SEBASTIAN
SEBASTIM, FLORIDA
OF XHE SUM OF:
Dollars (S@'J. ft-
)
FROM:
on tltis day or
rollowing described Cemete
stated herein:
Description or ~roperty:
Cemetery Lot ( s). .. /5. Block
Purchase Pri.~ -' J/vduj )#/
xerms and Condition or saLe:
for the purchase of the
e terms and conditions as
3 ~llarU:;$9Ja fr'J
Xhis contract shaLL be binding upon both parties, the seller and the
purchaser, when approved by the owner of the propert:g above
described.
I, or we, agree to purchase the above described property on the terms
and conditions stated in. the foregoing instrument:
/U~~_.u/ ~~~_ I
Xhe City of Sebastian agrees to sell the above mentioned property to
the above named purchaser ( s) on the terms and conditions stated in. the
above instrument.
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City of Sebastian
1225 MAIN STREET C SEBASTIAN, FLORIDA 32958
TELEPHONE (407) 589-5330 C FAX (407) 589-5570
May 11, 1994
Alma Rossman
1211 Calusa Drive
Barefoot Bay, Florida 32976
Dear Ms. Rossman:
Enclosed is Cemetery Deed No. 1456 for Cemetery Lot 15, Block 33,
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. 807 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.
yours,
m. {)ifdbtA-
Kathryn M. O'Halloran
City Clerk
KMO:lmg
enclosure
(\ws-form-cem.rec)
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A.
1. Name of
Deceased
(Type or Print)
Fir:st
FranCIS
Last
Rossman
LIS
(333
tli
MB%t906.Rr4
Year
[.~l
State of Florida, Departm*f Health and Rehabilitative Services, Vital SI'stics
APPLlCA"FOR BURIAL - TRANSIT PERMIT
Wood Middle
DATE
OF
DEATH
3. Name of Medical
9fo1if~rMerchant, M.D.
Medical Examiner 7744 Bay Stretfdress
Sebastian, Florida 32958
Name of (If neither, give street address)
~~~P'S'~bastian River Medical Center
Phone Number
2. Place of Death
<ffl8iYan River
City, Town or Location
Roseland
5. Check
Appro-
priate
Box
a 0
()
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Pam
Physician
~~r~~s North
Sebastian,
(407)589-0879
4. Name of Funeral Home/
~l BI:s er
;:ft'i'uf1KJJ~uneral Homes, P.A.
C t 1 A Aa. Lic. No.1
en ra venue
Fl 32958 1228
Phone Number (Area Code)
b ~
05/08/94
was contacted on within 72
hours after death. He/ she verified that this ~~ !IRlrl!tu'r1~JulMl. mouses, that there was no accident
nor other external cause of death, and that 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 ceftification.
SceastiaB Cemetery
6, Place of
Final Disposition:
7. Funeral Director/
Sireet Diel5eeer
Indian River
F.E. N~~~a. Me:
Removal
from state Donation
DB!f/8i~7~4
B.
BURIAL - TRANSIT PERMIT
1228-94-0203
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 "Funefal 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 r
Subregistrar Signature
Permit No.
~~~d: S_ ~ -9'1
Date Certificate
Due:
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT-SEA
Signature
or
Medical Examiner,
. Medical Examiner
Date
. gave authorization by telephone fo
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:
121 BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition
Date of Disposition
1t:!j'HT,' "'" 0"..,,, I."I! '!
"""'r~..., t;f,tt;q~
I
Signature of Sexton )
or Person-in-Charge )
'" "1 .
. .~,:..&.,.. J (.~~
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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