HomeMy WebLinkAbout4-31-56wUnit
Block J 1
Lot
Date of Mark -out
Date of Burial % ` Time 419Av I'
Name of Funeral Home
Authorized by
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR �URIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBosTtAN
Nowa PIZe D
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) 388-8215 or 388.8214
Fax: (772) 589.5570
FUNERAL HOME:
ADDRESS:
PHONE #: 11
(Check One)
)PEN BURIAL LOT Lot Block Unit
_ OPEN CREMAINS LOT Lot Block Unit
..._,OPEN COLUMBARIUM NICHE Niche? W. Block—=Unit
W
BURIAL DATE AND SERVICE TIME: / 6 0 0
FOR DECEASED:
rvame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name W1 Signature Dale
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.
,or
Name 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 Ind that all fees have been paid
Cem ry Soklon Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
.A
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9969
arfim van lto
❑Cash
Date 1-11-16 [a Check # 110
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501362100 Taxable Rent -
001501362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 343805 002LEM Fae 5h -nn
Total Paid 50.00
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
oma
SEBASTIAN
HOME OF PELICAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
I, Stuart Norton, Grantee of City of Sebastian Cemetery Certificate #1724 by way of Jeanette Selig's
will, do hereby transfer my interest in the following: Unit 4, Block 31, Niche 56W of the Sebastian
Municipal Cemetery to:
Lorraine Rossmiller
7653 Niantic Avenue, Unit T3
Micco, FL 32976
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation."
I hereby certify that I have received no remuneration for this transfer. I request the consent of the City
of Sebastian.
uart Nortn
State of v { q {i vl { d
County of t' ��
Before me on this K� day of �i5, personally appeared Stuart Norton, known to me or who
produced �LI1 e -e U&PFig2.. as identification, who acknowledged tome that he/she/they executed the same
for the uses and pur ose erein set forth.
Wotarpublic Signatuni Printed Name:
My Commission x ' l I 14 Sa erwich
Notary Stamp: COmmonw a vginia
Notary Public
Commission No. 148337
My Commission Expires 116016
The City of Sebastian hereby consents to the transfer of burial rights:
By:/Z/�i^— ATTEST:
Joe�City M nager Sally A. May, MMC - City Clerk
App ed as to Form and Legal Sufficiency:
o ert A. Ginsburg, CityAttorney
ma
SEBASTIAN
HOME OF PELICAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
I, Mark Norton, beneficiary of one forth (1/4) interest in the City of Sebastian Cemetery Certificate
#1724 through Jeanette Selig's Last Will and Testament, dated February 9, 1996, do hereby transfer
my interest in the following: Unit 4, Block 31, Niche 56W of the Sebastian Municipal Cemetery to:
Lorraine Rossmiller
7653 Niantic Avenue, Unit T3
Micco, FL 32976
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation."
I hereby certify that I have received no remuneration for this transfer. I request the consent of the City
of Sebastian.
(ss.)
Mark Norton
State ofI
County of
i,m- j jt�
Witness
Before me, on this � day of Y nk1 D)S, personally appeared Mark Norton, known to me or who
produced0-Vi2m,&Arij6M1s fc&rneas identification, who acknowledged to me that he/she/they executed the same
for the uses and purposes herein set forth.
-NoPublic Signature
Printed Name: I lip"•
My Commission Ex '
Notary Stamp: RY'
PUBLIC y
cc REG is 7594455 = —
_ ; MY COMMISSION =
EXPIRFs C'
The City of Sebastian hereby consents to the transfer of burial right:
By: e ATTEST:
Joe Griffi , City Vanager Sally A.
Appr ed as to Form and Legal Sufficiency:
Robert A. Ginsburg, CitfAttorney
City
.m,
SEBASTIAN
HOME OF PELICAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
I, Michael Norton, beneficiary of one forth (1/4) interest in the City of Sebastian Cemetery Certificate
#1724 through Jeanette Selig's Last Will and Testament, dated February 9, 1996, do hereby transfer
my interest in the following: Unit 4, Block 31, Niche 56W of the Sebastian Municipal Cemetery to:
Lorraine Rossmiller
7653 Niantic Avenue, Unit T3
Micco, FL 32976
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation."
I hereby certify that I have received no remuneration for this transfer. I request the consent of the City
of Sebastian.
A"t."d / %, Inc (ss.)
Michael Norton
State of MC,
County of IZftIw
Before me, on this Aayy of MI:1 '�IFersonally appeared Michael Norton, known to me or who
produced identification, who acknowledged tome that he/she/they executed the same
for the uses and purposes herein set forth.
(-'Va,A+ln�en�
Notary Public Signature
POETY&W
NOTARY RAW
WAKE COWN.. NC
1101YOMOMMERM&210111
The City of Sebastian hereby consents to
By. 2
Joe Gri In; City Manager
Apprr add as to Form and Legal Sufficiency:
Robert A. Ginsburg, City A torney
Printed Name: 4 tJC� WC�
My Commission Expires:
Notary Stamp:
ATTEST: '" 1 " I
Sally A. Maio MMC - City Clerk
cay«
SEBASTL'W
HOME OF PELICAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
I, David Norton, beneficiary of one forth (1/4) interest in the City of Sebastian Cemetery Certificate
#1724 through Jeanette Selig's Last Will and Testament, dated February 9, 1996, do hereby transfer
my interest in the following: Unit 4, Block 31, Niche 56W of the Sebastian Municipal Cemetery to:
Lorraine Rossmiller
7653 Niantic Avenue, Unit T3
Micco, FL 32976
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation."
I hereby certify that I have received no remuneration for this transfer. I request the consent of the City
of Sebastian.
1 6;�( (ss.)
David Norton
State of (U�naSa hose
County of ec4Asl\. ,e
its
Before me, on this "day of -Pecc v , 3D Is, personally appeared David Norton, known to me or who
produced "DW tueo U, tfr�& ( as identification, who acknowledged to me that he/she/they executed the same
fUthheses and purposes herein set fo�6,,irMAA.
s
Notary Public Sign re Z Printed Name:
My Commission Expires: '3,,1k� �jg , r�n:3l
c Notary Stamp:
The City of Sebastian hereby consents to the transfer of burial rights: n _
��wj \ / /
By: /!�G ^-- ATTEST: v fp�l ,
Joe Griffin, City/ Tanager Sally A. Maio MMC - City Clerk
Approved astoForm and Legal Sufficiency:
Robert A. Ginsburg, City Aftorney
K1•t4 L1 Y4 Xrjr 4a Kxs4 acts.
Irme#Pr1ij Drrb NO.
12th April 2000
THIS INDENTURE MADE 71de ...................... day of ............................................. A. D., If.......
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
....................... ;.......................... J.eane.t.te..S.elig............................................................
557 SW Acacia Avenue
............................................. .... Sebas-tiani.. FL...3295.g...................................................
of the County of .. Indian..River ..................... ani State of ...... Flllr.i.da.....................................
as Grantee, WITNESSETHe
That the Grantor for and in consideration of the sum of $ L t 300: OO . . ...... . . . . . 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 .1?errr ... heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
Niches
All of 5 5 & 5 6 Bloom 31 W UNIT 4 , , of Sebastian municipal cemetery as per Plat Number 1 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 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 Clark and its corporate seal to be hereto affixed, the day and year first above written.
CITY OF SEBASTIAN, FLORIDA
Attes�aa4tl.)71 .../ LLfCX..... B7 ..VY.tA-Gj` !-. ayoW....................Clerk M
Signed, Sea
f9 u d Delivered
In the oft
c - ......... ............ (Ctg Seal)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
I HEREBY CERTIFY, That on this ....... 12th .......... day of ................ April........................... IR2000
before me personally appeared ......
, Walter . . .. W. Barnes .................. and Kathryn.M.,,,O,!HA119rap..
................
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 and officers described In and who executed the foregoing conveyance to
Jeanette Selig
.......................................................................................................................................
........................................................ and severally acknowledged the execution thereof to heir free act and deed
as such officers thereunto duly authorised; and that the Official seal of -said corporation Is duly x thereto, an the said conveyance
is the act and deed of said corporation.
WITNESS my signature and official seal at Sebastian, in the County io ian,. tvei/and Sta a of Florid , the day and year
last aforesaid.
LINDA M. GAMEY
r MY COMMISSION II CC 740478
EXPIRES: June 18, 2002 ary ublic a of Florida at L ge.
'' esmMd7lruNotary PubleUndenaerrr My co a pires;