HomeMy WebLinkAbout4-32-19
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Paid bYCEM~~E;Y ;~ceipt No... .?...... Dated.. fJ.n'!/?J................ ~~~~.&20
Li,t Price $ ......:.... .. ... .. Maximum No. Burlal Spaces...... ....... .... Uni t 4
Net Paid $ .8.0n, 00........ Monument permitted.......................
NO.
01408
(Dala above thl. \Ine for CIty a.,oord only)
Cltitll nf &rbustiuu
Q!.rtttrtrry
m rrb
01406
NO.
THIS INDENTURE MADE 1'IU .....
14th
d8Y of .......
June
93
A. D. 19......,
belween Ihe City of Sebastian. a municipal corporation exl.Ung under Ihe law. of the State of Florida, .. Grantor and
...... .... ....... ...... ..............E\lgen~ ..S....Ro.land.. ........... ....... ........... ........ .......................
607 S. Easy Street
...................................... ..Sebas ti.an.,.. .Florida..32.9.5 8.....
Indian River Florida
of the Connly of ............................................. InJ Stale of .......................................................
II Gronlee, WITNESSETH.
That the Grantor for and in consideration of the sum of $ ..~ ~9.'. 9.Q . . . . . . . . . . . . . . . to it in hand paid. the receipt whereof Is herewith ac-
knowledged. does by this in!!trument grant. bargain. seU. rei..... convey and confirm unto the Grantee .l:t.~!3.. .. heirs. Iegel representatives and assign,
the following property situated in Seba!!tlan. Indian River County, florida, to-wit:
All of Lot(s) . ~ ? ~.~ q Block, . . ~ ? .. ,UNIT ..~.......... . of Seba!!tian municipal cemetery as per Plat Number I thereof recorded in Plat
Book 2, at page 6S of the publlc record, in the office of the Clerk of the Circuit Court of St. Lucie County of Fiorida; said land now iying 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 ,hall
be used. kept and maintained at all times in accordance with the rules and regulations. ordinances and resolutions of the City of Seba!!tlan. Florldl, hereto-
fore. now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, re!!trictions 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-
..rve and comply with ;uch 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 Seba!!tlan. Florida.
IN WITNESS WHEREOF. The said party of the fIr!!t part has caused this instrument to be xecuted in it. name and on its behalf by Its Mayor .nd
atte!!tOO by its City Clerk and its corporate ...1 to be hereto affixed, the day and year first a7wrltte
CI7JTO~ SEn
Atte'I~~)-rJ .()!ltlt4tt<~... By
(J City Clerk ./
Rigm.d, Seftlerl IInd Delivered
In the Presence of.
'(lJ~... C~.........
C.m~dd
COl'NTY OF INDIAN RIVER
(CIIitv ~eal)
I HEIlERY CERTIFY. Thai on thll
14th
. .day of
June
93
19.. ..,
b,"o.e me personolly appeAred .L.o.n~~~...R.'...P.o~~.l.l........ Ind ~li~.h.ry~..~.....<;>.~ff~P.Or:li':l.
respt....Uvrly Ma)'or Rnd City ('Irrk of the Cfty "f SehR~th,", 8 munlf'it.nl r:orporntiun tlndf"r the laws of thl" State of Plorlda to me known
to bl. the Individuulll und o"icrn described In ond who execuh'd the fOft'solnl Cf).v~Yllnt'e to
Eugene S. Roland
. . . . . . . . . .. . . . . . . . . . . .. .. .. . . .. .. .. .. . . .. .. .. .. . .. .. .... ond severAlly acknowledged Ihe execuUon thereof to he Ihelr 'ree oct ond deed
e. s"ch office" IhNeunlo duly Ruthorlzed; and thlt the Offlclol seol of ..Id ....r""roUon I. duly Irrhed therelo, 8ml the s.ld ..on.ey.nce
,,, the lIet and deed 01 saId corporation.
llNlM ... tDHIL
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~~""'.IUN ".tIN
coa.u.CC 0IJ7..
,.ear
WITNESS my slgnllure Ind offlclll ...1 It Seb..llln, In the
10.1 ",..reIBld.
Name F.'... .'.>. C; i',f,i........ ,',.
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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
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Genia. rY\aY~tQ.f)ot -Jf\+€.YY€~ {;Icolq~ LM- !)D
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.
70g
THE SEBASTIAN CEMETERY
CITY OF SEBASTIAN
SEBASTIAN, FLORIDA
OF THE SUM OF:
Dollars ($ J1JJ. ~ )
FROM:
on this 1# day of
following described Ceme
stated herein:
, 19U for the purchase of the
upon the terms and conditions as
Description of Property:
Cemet:ery Lot: (s) ~tJ ~ d2t) Block
Purchase PriCee J ~d ~
Terms and Condition of sale:
~~S(J7!o
This contract shall be binding upon both parties, the
purchaser, when approved by the owner of the property
described.
30<. Unit
Dollars (S 3t' tJ. ~
I
seller and the
above
I, or we, agree to purchase the above described property on the terms
and conditions stated in the foregoing instrument:
~~o-
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Q..
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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
abo~e ins=ent:. ~p?
City of SebaJSt:f..a.n
! /'
'Git/JI/uJuv e~~
Witness I
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.
City of Sebastian
POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
June 17, 1993
Eugene S. Roland
607 S. Easy street
Sebastian, Florida 32958
Dear Mr. Roland:
Enclosed is Cemetery Deed No. 1406 for Lots 19 & 20, Block 32,
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.
Very truly yours,
Cf0d~m.OdubA~
Kathry~M. O'Halloran
City Clerk
KMO:lml
enclosures
Ir";'lW>";~~,,",'''''';''~.''';";.':.'' ;;.:;, ,..,.'.ce.', . .,,,"';",,,.' ,...;....,.".;:..;.."""'_"'....,c,.:...-:";;~.""'""" -;... .. ., .
'I; STRUNK FUNERAL HOMES, P.A.
'[ CASH ADVANCE ACCOUNT - SEBASTIAN
i 916 - 17TH ST.
'r; VERO BEACH, FL 32960
'I PH. 561-562-2325
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2728
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DATE
12.14/02..
63-1205/670
PAY r.
b~J~~OF ~ ~ S~o-
CD"-IJ l~l~~~~
[I .DII1Il
ii .iii.iii iiii. ;;;~ ~~2::a~Orida 32960
if' bJdbm IUvor National BBDk
I FOR R...4....a.. LI ~ :... '+ , p" I k: a 2., l.o'l' , 9
Ifl 11100 2 ? 28111 I: 0 b ? 0 ~ 20 5 ? I:
tw ~ ,.. f:)% 00
I
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DOLLARS W ~~~':;,'''' il
II
~ {f""'--L./f/ M' !I
D.20~~~-~--~--~---J
I $ 1~S;.cOO
Name
Date
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 CopieslBid Specs.
001501 341910 LDC/Code of Ordinances
001501 362100 Community Center Rent
001501 362100 Yacht Club Rent
001501 362150 Non Taxable Rent
001501 343800 Cemetery Lots
601010343800 Cemetery Lots
LoVNiche , Block
001501 369400 Interment Fee
001501 369400 Weekend Service
680800 220681 Yacht Club Security Deposit
680800 220682 Community Center Security Deposit
680800 220683 Rivervlew Park Security Deposit
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
,1'.327
ctOfY
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Cash
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Amount Paid
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White - Dept. of Origin. Yellow - Finance · Pink - Appllcent
FLORIDA DEPARTMENT OF
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
A.
1. Name of
Deceased
(TYPE)
3.
Name of Medical
Certifier Mu
First Middle Last Date Month Day Year
of
Eugene Smith Roland Death Nov. 30 2002
City, Town or Location Name of (If neither, give street address)
Hosp. or
Roseland Ins!. Sebastian River Medical Center
Address Phone Number
2. Place of Death
County
I ndian River
Home
D The medical certification has been completed and signed.
application.
M.D.
Physician
Address
1623 N. Central Ave.
Sebastian, FL
937 Barefoot Blvd.
Barefoot Bay, FL
Fla. Lic. No.lReg. No.
772-664-4349
4.
mmad Siddi
Medical Examiner
Name of Funeral Home/r;;,.""ll5bf,lu:;al"
Establishment
Strunk Funeral
5. Check a.
Appropriate
Box
Phone No. (Area Code)
1228
772-589-1000
A completed certificate of death accompanies this
b.~
Shelia was contacted on 12/2/02
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Siddiqui will complete and sign the medical
certification of cause of death within 72 hours.
~rw",L 6;::,..,u:>cl-"
He/she verified that
, Medical Examiner, will complete and sign the
c. D
was contacted on
6. Funeral Director/
Ji
t'~--<?--~~
n of cause of death within 72 hours.
FE No.lReg. No.
1862
Date Signed
11 /30/02
B.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-02-1192
o A five (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.
ONo extension of time for filing the death certificate has been requested.
~;~lIClIVI'
Date
ISSUlild: 11 /30/02
Date Certificate
Due: 12/4/02
Subregistrar Signature
C.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -SEA
Approval Number:
Date
Medical Examiner, ' 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.
Method of Disposition:
&lBURIAL
DCREMATION
Signature of Sexton
or Person-in-Charge
DSTORAGE
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
/~ /7/oV
Date of Disposition
D.
DOTHER (Specify)
} ,('0 9 ,~k9)
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 County Health Department in the county where disposition occurred.
DH 326, B/97 (Obsoletes all previous editions)
(Stock Number: 5740-000-0326-2)
Distribution: VVhite: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar