HomeMy WebLinkAbout4-31-40wName
Unit
Block J�
Lot
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Date of Mark -out
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Date of Burial / �i4. f � � Time
Name of Funeral Fj4hie�� '
Authorized by
CERTIFICATE OF CREMATION
Name of Deceased: Dorothy C. Mardiat
Date of Death: 09/10/2017
This Certifies That The Deceased Named Above Was Cremated At
Space Coast Crematory, Melbourne FL
Date of Cremation: 09/22/2017 Time of Cremation: 0724
Cremation Number: 18751
C -Reference Number: 26240
Ce ified C,rematory Operator
Space Coast Crematory Is Owned & Operated By
Arrunen Family Cremation and funeral Care
Palm Bay - Melbourne - Rockledge - Ttusviffe
PO BoX1346, Melbourne FL 32902
STATE OF FLORIDA - BURIAUTRANSIT PERMIT - REPLICA
NAME OF DECEASED: Mardiat, Dorothy C.
PLACE OF DEATH - COUNTY
Brevard
NAME AND ADDRESS OF ESTABLISHMENT
Ammen Family Cremation And Funeral Care
950 Malabar Road SE
Palm Bay FL 32907
LICENSED DIRECTOR
Michelle A. Hinds
PLACE OF CREMATION
Space Coast Crematory
Melbourne, Florida
CREMATION APPROVAL ISSUED BY
Medical Examiner District #18
DATE OF DEATH: 09/10/2017
CITY, TOWN OR LOCATION FACILITY OR STREET ADDRESS, IF NOT A FACILITY
Palm Bay Palms Rehabilitation and Healthcare Center
ESTABLISHMENT LICENSE NUMBER: F041888
PHONE NUMBER: (321) 724-2224
NAME OF CEMETERY OR PLACE OF FINAL DISPOSITION;
DATE OF DISPOSITION:
FH ASSIGNED PERMIT NUMBER: F041888 26240 115817
DIRECTOR'S LICENSE NUMBER: F065075
DATE OF CREMATION: 09/22/2017
ME CREMATION APPROVAL NUMBER: 17-09-220
SIGNATURE OF SEXTON/OFFICIAL:
THE ORIGINAL PERMIT WAS ISSUED BY THE STATE OF FLORIDA; KEN JONES, STATE REGISTRAR. SHOULD A CEMETERY, CHURCH
OR OTHER AUTHORITY NEED A COPY OF THE ORIGINAL STATE ISSUED PERMIT, CONTACT AMMEN FAMILY CREMATION AND
FUNERAL CARE.
CITY OF SEBASTIAN 10929
ADMINISTRATIVE SERVICES RECEIPT
Name m d i,4,r ❑ Cash
Date 9'A7-;'7 ItCheck#b'9s'k_
0 Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001 218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees
rrol SCI - *34F62es qt
Llmrr .11 Nicks 4w
Total Pail
Initials
White - Dept. of Origin - Yellow - Admin. Svcs. • Pink -Applicant
~
"
WHY UL ~l'UUIUIUU
.emttery Itell.
"1619
NO.
THIS INDENTURE MADE 'I1IIa
3rd
day of
March
98
A. D.. Ill......,
between Ihe City of Sebastian, a municipal corporation exl.tlng under tbe law. of tbe State of Florida, a. Grantor and
............",...,.. ..,........ ....~t:h~. E ,. .~t'diat. .endI.Qr. .P.or.tp,y. .C... .Mar.dj..&t:......."............. .....,......
13225 U.S. 1, A-4 Golaith Road
....,............................. .Sebas.tian,.. Fl. .3295.6.,.,.......,...,....... .................",........"...,."...,...
of the County of .... ..~I).#f!I.l..~;i,y~J;'...................... ani State of ...... .f.~9.r::j.q~..................................,...
a. Grantee, WITNESSETH,
That the Grantor for and in consideration of the sum of $ ~.'.~9~ ~ 9~. .. , . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargaiD, sell, release, convey and confirm unto the Grantee ~~~~!=. .. heirs, legal representatives and assigns
the followinll property situated in Sebastian, Indian River County, Florida, to-wit:
N1Ches
All of ~ ~~&~~ Block, .:n. . . .. ,UNIT . It . . . . . . . . .. ,of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat
Book 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 mallltalned It aU timelln accordance with the rules and regulations, ordinances and resolution. 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 f'lIst 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 f'lrst above written.
...~",.mO!/d'~~..
? ,.,...,.-y. ~i;~ Clerk
CITY OF SEBASTIAN, FLORIDA
D,
.W~.W..l>~..............
Ma,or
r:::l!'t~d, Sealed und Delivered
'Y tt:'O:~l~~J\H: .H.. HH H.H. H.....
... ~-~!P~~4HHHHHH
~;-~~-;:nIDA
COUNTY OF INDIAN RIVER
I HEUEDY CERTIFY, That on this ~J;'sl.............,..,. .day
(QIitu ~tlll)
of ..,..~;r:::<;:h,..,.,.,.....................
......, I~,~."
bl'fore me personally appeared ,~~;I..~~.:t;.~~,.~m~~.....,.... ........................ and ~.~~.M!..Q.'.~U.(n:~r': ..' .,...
respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the la,,'. of the State of Florida to me known
10 be the indlv iduul. and officers described In and who executcd the forl'going cORveyance to
Arthur F. Mardiat and/or Dorothy C. Mardiat
.......................................................................................................................................
. . . . . . . . , . , , . . . , . , , . . , . . , . . . . . . . . . . . . . . . . . . . . . . . . . , . . , .. and severally acknowledged tbe execution thereof to be their free act and deed
os snch officers thereunto duly authorized; and that the Official seal of sold corporation I. duly affixed thereto, and tbe said conveyunce
Is the /let and deed of sold corporation.
WITNESS my signature and official seal at Seba.tlan, In the
last aforesaid.
.....'E".. LINDA M. GALLE31Y"'24
.~~. ~.. MY COMMISSION' CC "'
f.: '.i EXPIRES: June 18, 1998
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