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HomeMy WebLinkAbout4-33-33Unit Block 53 Lot Date of Mark -out Date of Burial ` /!S -J� -Time %� �° e! Name of Funeral Home Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE 4921 RECEIPT Name �- 0 Cash Date 12- ` )(Check# No. 001001 208001 001501322900 001501 341920 001501 341910 001501 341930 601010 343800 Amount Paid Safes Tax _ Garage Sales _ Copies/Bid Specs. _ LDC /Code of Ordinances Election Qualifying Fees Cemetery Lots ``11 _ Lot/Niche -33, Block Unit T 001501 343805 Cemetery Fees ! 0, 0 CN _ _ _ Total Paid t5an Initials White - Oopt. of Origin • Yellow - Finance • Pink - Applicant Annie Mae Mann Mrs. Annie Mae Mann, 85, went to be with the Lord on September 10, 2014 at Sebastian River Medical Center, Sebastian, FL. She was born in Tarpon Springs, FL and lived in Sebastian, FL for 33 years coming from Miami, FL. Annie was a member of Cornerstone Baptist Fellowship, Sebastian, FL. She was a loving mother, grandmother and great grandmother with a generous and caring heart, always showing concern for others. Survivors include sons, Phillip D. Mann of Sebastian, FL, Daniel Mann and his wife, Marie of Keystone Heights, FL and William D. Mann and his wife, Denise of Lakeland, FL; daughters, Martha Kaszok and her husband, Stanley of Palm Bay, FL and Wanda Arma and her husband, Alberto of Sebastian, FL; 17 grandchildren, 22 great grandchildren. She was preceded in death by her husband, Arthur Rodney Mann, Sr.; sons, Arthur Rodney Mann, Jr. and Robert Mann. n FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8295 or 388 -8294 Fax: (772) 589 -5570 FUNERAL HOME: Strunk Funeral Home and Crematory SEBASTIAN ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE #: 772 -589 -1000 (Check One) X OPEN BURIAL LOT Lot 33 Block 33 Unit 4 OPEN CREMAINS LOT Lot Black Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: MONDAY, 9/15/2014 12:00 NOON CHAPEL FOR DECEASED: Annie Mae Mann Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Martha Kaszok Name .7►-iartFta Xaszok 9/10/2014 Signature Date I certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Name TimoLhy W. Wary n 9/10/2014 Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cem ery ex n Date This form to be provided to Jerk's Office by Sexton for permanent record upon completion. State of Florida, Department of Health, Bureau of Vital Statistics FIFE BURIAL TRANSIT PERMIT I- I HFALTH DATE PRINTED: September 10, 2014 TRACKING NUMBER: 2014131261 1. DECEDENT INFORMATION Name of Deceased Date of Death ANNIE MAE MANN September 10, 2014 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral HomelDirect Disposal Establishment Fla. Llc, No./Reg. No. Phone ryumber STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589.1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral DirectorlDirect Disposer Fla. Lic. NoJReg, No. TIMOTHY W. MARVIN F022789 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2014- FO41870 -5139 , Date, issued: September 10, 2014 Meade Grigg, State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY �A 00 0 � Method of Disposition: BURIAL Date of Disposition: 20 EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10112 64V- 1.011, Florida Administrative Code fa Paid by CEMETERY Receipt No... � Dated ....12 � 13 / 9 3 LO 3 & 34 NO. 1000 00 B33 List Price $ ........'.......... Maximum No. Burial Spaces ................. Un r 11 Net Paid S .100 . 0 . 00 1437 ........... Monument permitted ....................... (Data above this line for City Record only) Titp of #rhttotittrn (1�r m r t r r # Bred NO. 1437 THIS INDENTURE MADE TWs 13th December 93 dayof .............. ............................... A. D., 10......, between the City of Sebastian, a municipal corporation existing under the laws of the State of Florlds, as Grantor and ............................... Mrs r.. Annie- Mae.. Mann ............................... ............................... . 850 George Street ....... ..........................Sebas tian,.. Flo-rida -.329 5. 8........................ ............................... of the County of .....Indian River...._..... an State of Florida ... ............................... as Grantee, WITNESSETHe That the Grantor for and in consideration of the sum of $ 11q00.00 to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , ,her heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Ali of Lot(s) 3 A94 34 Block, 3 A.... , UNIT , 4 . , . , , , , , , , .. f Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Rook 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements contained in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob- serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner in and to said property shall terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. Attest:,....`cXtt h.01 .?ett City Clerk CITY OF SEBASTIAN, FLORIDA By.. ...... ............... Mayor Signed, S end Delivered In the esenc ofr (Clu Meal) ... .......�t/r...... GU/... STATE OF FLORIDA COUNTY OF INDIAN RIVER 13th December I HEREBY CERTIFY, net on this ........................day of ..................... .............................., 19..9 3 before me personal) n Lonnie R. Powell y appeared Kathr n M. O. Halloran ............................ ............................... end ........ Y............................. respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals end officers described in end who executed the foregoing conveyance to ............ ........................Mrs.,.. Annie• Mae..klann............ .................... ............................... ........................ and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized, and that the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the net and deed of said corporation. WITNESS my signature and official seal at Sebastian, In the Cou ty of Indian aver and 3 Florida, the day and yea- NO aforesaid. LINDA M. GALLEY ft's ..... ...... .................. MY COMMISSION 1 Cc3mlI EXPIRES Note Public, State o orhla at Lan y, •f ,Aare 10, 1901 My c Isalon expires �. s� •• aDNDED MUIaDY rM1a161sUWCE.INC. �Rf,tA Linda M. Galley wafmi 4,1f);, wae Jed-# 1-'-137 �e-b 0,� -+an, F� •3�5� (�ann 3r in�erred p- ), 1)93Zo�,3Y Paid by CEMETERY Receipt No....?$? .... • . • .. Dated ....l 2 3-/-93 List Price $ .1 OOO.00 • • • • • Maximum No. Burial Spaces . Net Paid $ 1000.00 . • . • Monument permitted .. . (Data above this line for City Record only) Lots 33 & 34 Block 33 No. Unit 4 1437 ff • IPT .ZS HEREBY W/ .i FROM: on this .L�L� day following described stated herein: THE SEBASTIAN CEMETERY CITY OF SEBASTIAN SEBASTIAN, FLORIDA OF THE SUM OF: I ars 19 for the purchase of the ery Lot(s) upon the terms and conditions as Description of Property.- Cemetery Lot(s) Block V Unit Purchase Price: Dollars erns and Condition of sale: This contract shall be binding 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 foregoing instrument: The 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. // mess �Y O Qgst�. City of Sebastian 1225 MAIN STREET o SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589 -5330 o FAX (407) 589 -5570 December 21, 1993 Mrs. Annie Mae Mann 850 George Street Sebastian, Florida 32958 Dear Mrs. Mann: Enclosed is Cemetery Deed No. 1437 for Cemetery Lots 33 & 34, 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. 789 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 O'Halloran City Clerk KMO:lmg enclosure ( \ws- form - cem.rec)