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Home My WebLink About4-30-12 . :itll of -m~mrtrry Sttbu.atian . m r t~ 111.701 NO, THIS INDENTURE MADE TIaJa ....... ..15, th day of ......"..'.' . No.vemhe.r.. ............... A, D.. 19.99.., belween the City of Sebllstian, a municipal corporation existing undcr the laws of the Stale of Florida, lIS Grantor and ............................... .~:r;.!,? .r;J.'y:i,;r:~. .:e.I;~O.:(:.ows.k:i................, 202 Concha Drive . . . . . . . . . . . . , . . . . . . ..... . ... . . .. ,Se.ba s tian,. . .lIt . .3.2.9.58. . . . . . . . . . . . . . . . . . . of the County of .... ~.t:l.d.:i,~t:l.. .~;i, y~.:r;..,................. ani State of ......... ..f).q;r:;i.c;l.C',\................................ as Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of $ ,.1", 9.Q9.: ~9. . . . . . . , , . , . 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 .. , . . , . ., heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: AU of Lot(s)1. ~.~ ~.? ,Block, . . .~ 9. .. ,UNIT .. ~, . . . . . . . .. ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 6S of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; 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 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 hereatler adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements contained bt this instrument shall be covenants running with the land. In the event of the faiiure of the owner of any property situated within said cemetery to ob- serve and compiy 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 IlrSt 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 fust above written, CITY OF SEBASTIAN, FLORIDA Attest~A~/YJ... ()~rI..~.~ .........,~~(l... City Clerk .. .,{!)LlL~'~HHH Mayor I (J Signed, Sealed and Dcllvered In the Presence of. / k.Q(anLk::tHH...HH..... . ...1?,L.~.'~H..HH....HH.. (([lit\! ~eltJ) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEllEDY CERTIFY, That on this...... ..1.5 .th........ ,day of ......,.,..... .No.vemb.er......................, lil. 9.. , Chuck Neuberger Kathryn M Q'Halloran before me personally appellred ............................,........,.",.,."..., and .,.........'.... ~. . . . . . . . . . . . . . . . . . . . . . respectively Mayor and City Clerk of the City of Sebastian, a municipal corporlltlon under the laws of thc State of Florida to me known 10 be the Indlviduuls and officers descrIbed In and who executed the forc'going cORveyance to ........................ ......... ..... .~.:r;~ ..~,:!-:v;i,r.9-., ~r?:.Q.~p'i'J:~.1~;i,......,.....,............................,....... ,......... . . ' . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . , . . . . . . . . . .. and sevcrally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly author~ed; and that the Offlcil.1 seal of said corporation Is y a ed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at last aforesaid. r Unit FMtJ/(' l.- t( 3e> /J rZo zOt{;Jsk i se.. Name Block Lot /2- Ii 112-/97 Date of Mark-out I . I "I/.5-/7', Date of Burial " I ..s-v:e bN k ts. Name of Funeral Home Time 11/00 rl /J1 Authorized by Q,~ . -----._~.~------ -'~'-""---'--_.- '. 11/15/99 PaId by CEMETERY ReceIpt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '. 1 ,000. 00 LIst Pnce $ . . . . . . . . . . . . . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . NO. Net Paid $ ...l."O.OQ..QO... Monument permitted. . . . . . . . . . . . . . . . . . . . . . . 1'701 (Data above this line for CUy Record only) THE SEBASTIAN CEMETERY CITY OF SEBASTIAN~ FLORIDA OWLEDGED OF THE SUM OF: ($,/iV()r: for the purchase of the upon the terms and Description of Property: . r ". / cemetery Lot (~~ / L r / ~ Block,- ;;y) Uni t -<;- Purchase pri'f}.i; i~~ Dollars ($/tfztJ~ Terms 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 abo~e d~scribed property on the terms and conditions stated in the forego~ng l.Ilstrument: . '~' ~' " - -' I :/ I "", ,\~ · ?5\/'J~""k> The Ci ty of Sebastian agrees to sell the above the above named purchaser (s) on the terms and above instrument. d property to . l. s stated .Ln cne Witness \ " . . City of Sebastian 1225 Main Street 0 Sebastian, Florida 32958 Telephone (561) 589-53300 Fax (561) 589-5570 E-Mail: cityseb@iu.net November 19, 1999 Mrs. Elvira Brzozowski 202 Concha Drive Sebastian, FL 32958 Dear Mrs. Brzozowski: Enclosed is Cemetery Deed No.1701 for Lot 11 and 12, Block 30, Unit 4. Also enclosed is a fonn - Return for Transfers of Interest in 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, P. O. Box 1028, Vero Beach, Florida 32960 or you may call or call the Deparbnent of Revenue at (904) 488-9487 for more infonnation regarding the completion of this fonn. Weare enclosing two copies of each the receipt and ask that you sign and return to us the copies marked with an "X" and retain the other copy for your records. A stamped, self-addressed ' envelope is provided for your convenience. Sincerely, ~?:~{2!taUMA- City Clerk KOH:lrng Enclosures FLORIDA DEPARTMENT F SeOf Florida, Department of Health, Vital .sties AP!:'L1CA TION FOR BURIAL - TRANSIT PERMIT d J33(J !.I 1-/ A. 1. Name of Deceased (TYPE) First Middle - Last Month Day _ __ Year Sebastian Date of B rzozows ki , Sr. Death Name of (If neither, give street address) Hosp. or Inst. Nov. 11 1999 Frank 2. Place of Death County I ndian River 3. Name of Medical Certifier Noor Merchant, M. D. Medical Examiner Physician 4. Name of Funeral Home.llililc~t 0i~~1 Address Establishment 1623 N. Central Avenue Strunk Funeral Home Sebastian, - FI 1228 561-589-1000 5, Check a. D The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate appli~tion. Box City, Town or Location 202 Concha Drive Address 7744 Bay Street Sebastian, FI Phone Number 561-589-0879 Fla. Lie. No.lReg. No. Phone No. (Area Code) b. &J was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Merchant will complete and sign the medical certification of cause of death within 72 hours. Rachel 11/11/99 c, D was contacted on He/she verified that , Medical Examiner, will complete and sign the 6. Funeral Director/ Iii. v~l Bispllliii!r Date Signed. 11/11/99 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-99-0524 D A five (5) day extensIon of time for filing the death certificate (exclusive of weekends) has been requested and granted since th~ 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.', D No extension of time for filing the death certificate has been requested. ~;~tl &f Ot Subregistrar Signature Date _ ,Date Certifi~te Issued:~Due: II It \C\, 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: ~BURIAL DCREMATION SignalL:re of Sexton or Person-in-Charge CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery D. DSTORAGE J Date of Disposition 'touvm k / s--; /97 7 / / DOTHER (Specify) xi;~u: Il eI~L } 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. 8197 (Obsoletes all prevIous editions) (Stock Number' 5740-000-0326-2) Distnbution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar