HomeMy WebLinkAbout4-33-25
- - ----,---
Paid by CEMETERY Receipt NO...f;9.~... ..Dated.... ....~(.~y~~.. .......... iOltsk2.26
1,800.00 oc .
LIlt Price s......... ...... '.;' MlllbnumNo. BIlriaISpacet................. Uni t 4
1,800.00, .
Net Paid S .................. Monument permitted. . . . .. .. .. . .. .. .. .. .. . .
~~ #1'<
NO.
1453
(!tUg of .,balltian
mttll
'1453
(!ttmtttry
NO.
THIS JNDBNTUilB IIADB TIoII
21st
March
94
A. D.. I.......,
d., of
beh"HII the CIt, 01 .....ttan, . _nklpal eorporat..... ftllt~. ....de" the ta... of the St.te 01 Florid.. '" O....tor and
., . ... ,... .".,....,.,.,..............:..... ~~rti'~r~t6g~gB.YCd ~ .~~~I.C?S;,. ~~y,~~~~.. ~~8.~.<?~:....................
..,..'. ....... ...... ... ........... .......... .B~:-:~.f.<?~~.. ,~~y.,,: ~~~~.~~~ .}~~?~..,................... .......... ,..........
01 the CooontJ' of ..,Ind!a,D..Riv.eJ::..................... .n:l St.te 01 ........,Flo.r.:t.da.................................
.. 01'llntee, WITNJUlSBTM.
That the GrMtor for IIIId In Clll\sidentioll of the oum ofS ......\ ,.~9.Q...QQ.. ......to It In hand paid. the teeeiptwhereoflsherewlthac-
knowlet\ae4, does by thillnstru..m pant, baqIIft, .a. ...., COn"y UIcl confirm UIIto the Gnmee ..t: \t.~~. ~ heln, lepl repre_tat'" IIIId .......
the folio,"", pro,,"y lI....edln Seballfan, Indian RInr CoUllty. FIorlda.lo-wlt:
AUon.ot(~)~l+.~f), Blode, . ;n.... . UNIT ..!t.......... . of SebuttaJI munldpat cemetery as per Plat Number I theoeohecorcled In Plat
Book 2, at pap 65 of the pubHc records In the oftlce of the Clerlt of the CIrcuit Court of St. Lucie County of Florida: salcIIatulllOW \yIna and bel..
In Indian Rhw County, Florida.
. .
To HI" and to Hold the ame fo_: proYided that salcI property..... be used solely IIIId exctuslYety for the Intermetlt of the human dead UIcl shall
be used, kept lltltI IIIIIntaIned at all times In aecortIance wItII the rules and fIlIUtatlolll, otdlna_s and resolutions of the Oty of Setlallfan, Florida, hereto-
fore, now attd hereaft. ItIopted or prcwIdecI for the Icnwmnent IIIId operation of IIioI cemetery. The COIIdltlons, reltrlc:tJonslllld requirements COIItalned
In tlds Instru..m ..n be co_ts runninJ wItII the Iatul. In the _lit of the faIIur, of the owner of any propert, situated within IIioI cemetery to 011-
sene dd comply with iuch rutes, fIlIUiatiollS, moIutloRlattdord\nance,1IIId the condition, of the ..... of COIIftJII\ce thereof then the title of ouch owner
In and to salcI property ohaII twmJnate IIIId the _ shall men to the City of Sebeatlan, Florida.
IN WITNESS WHEREOF. The IIioI party of the fInt put hll c:ausetl thlo Inltru..m to be executed In Its name Iftd on It, behalf by Its M.yor IIIId
atteltecl by Its CIty Clerk IIIId Its corponle _I to be hereto afIIxecI, the day and ,., fInt allo" written.
Attest. ~~~~,-/!J:.D.~.~..
~'7'~.cltJ' Oerk
CITY OF ~LOaIDA
.,~?~
M.TOI'
III.nr<!. Se.1ed and Delivered
In~he P or.
...... /" . ....~..........,
..... . . . ..(/..n;.~...........
(GIifv ~.I)
STATE OF FI..oRIDA
COUN'I'Y OF INDIAN alVBa 21st March 94
J HERBBY CBRTln, That on thil .......,.......,....... .d.y of ...........".......,................,..........,.., I.....,
before me personally appe.red ..~~.~~~~..~....,~,~~~.~.<?~........................... .nd ~~~.J:1.:I7".~..!;f.~..~~.~~~~.C?r;~~.
relpt'ctively M.yor end City Clerk of the CIty of Sebastian, a maolelll8' eorf'Or.tlon under the la",s 01 the State of PIorida to me known
to be tbe Indlvldu.ls nncl olllffrs tlest:rlbetl In and who neeuted the lort'lOl", e...veynn"" to
Simeon J Gagnon and/or Lavinia Gagnon
. . . . . . , . . . . , . . , , . .. .. .. . . . .. . . .. .. , .. .. .. .. , . .. . .. .. .. .. and sereratly acllnowledvd the neeut..... thereol to be their lret! .d Ind deed
as sum olflee.. thereunto duty .uthorlsetl, anti that the Orllel.1 ..,,1 01 Mid corporation I. dul, aln"ed the",to, and the IIltI eonvey.nee
I. the nd .00 tketI of Mid corporation.
WITNESS my s....t1t... .ntI ofllclat ... .t 8ebutlao, In the
I.ot .Iordlld.
(;) LIIM M. M.I.EY
lift CIIIIBlII' llaMI18IWS
......
-----...
---.J
Name
,/., " /.". P, (" 0
J I,f J ",.... j
/ '
(:r 0.- G ,. .-; {) (1
\,,)
Unit
I!
~f
Block
'-"']1 .,.-;:\
..- ...
_...__..~._-, ..-...---. -- -~_._."--'-" - _.,..~...' -.,.- ---. - ..
.,- '~, mDen.:J. f lAv; f\ia.
~~~~"L9iLP
Ln+6 ~6~~
~\E)aJL o~
LLV1.. ~ Jf
La.vi VJia G~no n- i nb--( J 4-/' /p!qb LA a!-o
~ ~J~ #,;..oN Lt>r2)
Lot
o~: )
Date of Mark-out
I / ..2./;' lOG)
;~/ '
, i
:2/' / //()()
/ ,I
Time
Date of Burial
Name of F'unenil Hom~'1 ' !-5Th:. )1 ,,) r ' l
AuthO.tedl>y',t:;,,~~ /~rJ;/ u.. ,
/,'
'-, -
/",,: /'} /J /~i, ;/"
r ,
Cl.t
,
J)ud. ~. J~5 "
C(rf
'-. -'
Lots 25 & 26
;Block 33
Maximum No. Burial Spaces................. Uni t 4
'd CE . E05 3/21/94
Pai by METERY Recelpt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
., 1,800.00
Ust Pnce $ . . .. . . . . . . . . . . . . . .
1 ~800'~OOl.
Net Paid $ ..................
~;) 4J,t.
NO.
Monument permitted. .. .. . .. . . . . . . .. .. . . .. .
\
1453
(Data above this line tor Clt)' Record 001)')
.
.
'805
THE SEBASTIAN CEMmRY
CITY OF SEBASTIAR
SEBASTIAH, FLORIDA
FROM:
on this~/~ day 0
fo1.1.owing described Cemet
stated herein:
for the purchase of the
e terms and conditions as
Description of Property:
Cemet:ery Lot:(S}~ ~!o . Bl~ 33 Unit: ~
Purchase Pri.C~J~~ Dollars (s/yt1lJ.P-r
rermspLbl:JZ::[ ~ /ft1
This contract sl1a.1.l. be binding upon both parties, the se1.1.er 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 foregoing instrument:
i4'~ ?-.~~
The City of Sebastian agrees to sell the above mentio
the above named purchaser ( s) 0 the terms and condit
above instrument.
~.~4y
c:J'i.tness
~ '
- -------r-c-~ ':-''''':'~{~~-~Ji,-;B~:'i~;,"
.
,'1y 0
~ "
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i,f rJ . ~
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o~ PFLlC~"'" \L,'_
.
City of Sebastian
1225 MAIN STREET [] SEBASTIAN, FLORIDA 32958
TELEPHONE (407) 589-5330 [] FAX (407) 589-5570
March 22, 1994
Simeon J. & Lavinia Gagnon
438 Barefoot Blvd
Barefoor Bay, Florida 32958
Dear Mr. & Mrs. Gagnon:
Enclosed is Cemetery Deed No. 1452 for Lots 25 and 25, 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.
Kathryn M. O'Halloran
City Clerk
KMO:lmg
enclosures
FLORIDA DEPARTMENT OF
. S~., f F;IOrid, a, D.~p~.rtment Of,H, ~alth~; Y,ltal ~. tics ,
~~P.UCATION FOR aURIAL,-.TRANSIIPEWrr -
"'~-- .~ ~.~,_.! ",.'" : <..:~,.,., ~ ......'.'-..._:~~.__:.;:::r - ')~i
1-_ ~.s-~ ~t
/3 33
t;~
HEALT
'-- .....
A.
1. Name of"
Deceased
- Middle .- - ---- ., last
Simeon
;"~~J~~~=""~ >~-;:~~ :,
.C t.
Gagnon .
Date
of
Death
(If neither, give street address)
-Month
Day
Year
Jan.
27
2000
2. Place of Death
County
I ndian River
3. Name of Medical
Certifi~r N. Noor Merchant, M. D.
Medical Examiner Physician
4. Name of Funeral Home/lMeel Bi..l'u~c11 Address Fla. lie. NoJReg. No. Phone No. (Area Code)
Establishment ,;,1 623N. Central Ave.
Strunk Funeral Homer ,-" . ~e~~stian, .Ft 1228--561-589-1000
5. Check a. 0 The .me~fical certifi~tion has been completed and ~<~ned. A,com~te<!,~~,~~~e,gf ~~~~h accompanies this
Appropriate application.. " ' .", . _.:_.: .;,;- " _ '.~..; ,
B~ ,~
City, Town or Location
Address
Name of
Hosp, or
, Inst Sebastian
7744 Bay Street
Sebastian, FI
River Medical Center
Phone Number
,-" Roseland
561-589-0879
')s.,b. 'Hl Jp-annie was ~~~ on 1/28/00
He/she verified that this, death was fr9m natural causes, that there. ~ ,00 ,ccident nor other extemal98use of death,
and that Dr. Merchant will complete and sign the medical
Certification of cause of death within 72 hours. . "
.-;.1'
c.D
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
&.ired B:~t''''''''''
Date Signed
1 28 00
6. Funeral Director/
B.
BURIAL- TRANSIT'PERMIT
Pennission is hereby granted to dispose ofthis body. , ,_Pennit No. 1228-00-0050
o Afive (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.
~ No extension of time for filing the death certifiCate has been requested.
~I~lldl vir
(~
Date
Issued:
,I,;? 7/'; ~ ' ~::~ ceiri 3 / C4
Subregistrar Signature
C.
.........;,-
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number:
Date
- y,
Medical Examiner, , gave autho~ation by telephone to
FuneralDiredorlDirect 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.
Method of Disposition:
l!:J BURIAL
CEMETERY OR CREMATORY
Place of Disposition
Sebastian Cemetery
D.
DSTORAGE
Date of Disposition
:fdru.t.n(j- I &,O{)O
)
DCREMATION
Signatl.:re of Sexton }
or Person-in-Charge ~~ .1., (.t~~ ~
This pennit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and retumed
within 10 days to the local County Health Department in the county where disposition occurred.
DOTHER (Specify)
DH 326, 8/97 (Obsoletes all previous editions)
(Stock Number 5740-??o-o326-2)
Distribution: White: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar