HomeMy WebLinkAbout4-28-01 AvailableNameL' G5 �/f1Q c71t1! -! X /D_ ✓�
Unit `
Block
Lot I
Date of Mark -out 4-9— &
,a � l 5 �� �[JeiL� Time
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Name of Funeral Home : t t`
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CITY OF SEBASTIAN 10068
ADMINISTRATIVE SERVICES RECEIPT
Name RJA14C49)�j Cash
Date 1 4 Olnheck #7410
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
001001218010 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
DO I s-ct - 9 4z ?CAST o/c, -To , a0
Total Paibwrz
Security Dep Held - Amount $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. - Pink - Applicant
�mOF
SEAST"
HOME OF PELICAN ISLAND
CITY OF SEBASTIAN
Cemetery Certificate
THIS INDENTURE MADE this Ist day of April, 2016, between Jeanette Bartelson,
as Grantor whose address is 603 Dracena Drive, Barefoot Bay, FL 32976 and the City of
Sebastian, a municipal corporation existing under the law of the State of Florida of the
County of Indian River, State of Florida as Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $1,800.00 to be mailed
minus a 5% administrative fee, the receipt where of is herewith acknowledged, does by
this instrument grant, bargain, sell, release, convey and confirm unto the Grantee their
legal representatives and assigns the following property situated in the City of
Sebastian, Indian River County, Florida, to wit:
All of lots 1 & 2, block 28, unit 4, of the Sebastian Municipal Cemetery as
maintained on file in the records of the City Clerk.
To have and hold the same forever; in fee simple.
IN WITNESS WHEREOF, the said party of the first part has caused this instrument
to be executed in their name and witnessed the day and year first above written.
Witness: 1 1 W
STATE OF
COUNTY OF I YL 14-x1 ISI
By:
eanette Bartelson, Grantor
I HEREBY CERTIFY, that on this IT day Qf April, 2Q16, before me personally appeared
Jeanette Bartelson who produced ''L 10M iN as identification; and who
executed the foregoing conveyance to the City of Sebastian and severally acknowledged
the execution thereof to be her free act and deed as such an individual duly authorized.
G��1,��(✓� �1Lt,4liY1--�C��ItiL �
Nota
RICHELLE EMERSON -WINTER
'e' ' �: Notary Public - State of Florida
My Comm. Expires Sep it. 2018
,? „ . Commission 0 FF 130888
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) 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
XXXX OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
Lot-01—Block 28 Unit 4
Lot—Block—Unit
Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: DISINTERMENT ON TUESDAY, April 12, 2016 (ED 8:00 AM
FOR DECEASED:
Francis Robert Bartelson
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Jeanette Bartelson TeaviettP,13a*tO4o- v 4/6/2016
Name 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
cJ`unofhq CW. ,-M0hVin 4/6/2016
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:
Cemetery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
~tt~ Ut ~xuu~~~uu
p { A 1623
i ~ ~ 1 s ~ ~ ~ ~ ~ ~ NO.
THIS INDENTURE MADE Thls ...........12th..... day of ................May........................ A. ~., IB.98...,
between the City of Sebustien, a municipal corporation existing wader the laws of the State of Florida, oe Grantor and
.......................................JeaR~t.~~..$a~t~J:son.......................................................... .
603 Dracena Drive
..................................... ...Bare•foot..Bay.r . ~..329.7.6............. ......................................
of the County of ..Indian ,River .......................... an l state ar ......Florida
...........................................
ae Grantee, WITNESSETHe
That the Grantor for and in consideration of the sum of $ .......................... 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:
All of Lot(s)1F`~ , .. ,Block,?8 , , ... ,UNIT , , 4.......... , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 oC the public records in the office of the Clerk of the Cucuit Court of St. Lucie County of Florida; said land now lying and being
in Indian River County, Florida.
To have and to Hoid the same forever; provided that said property shag be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintalnod at ap times in acootdance with the rules and regulations, ordinances and teaolutiona oC rho City of Sebastian, Florida, hereto-
fore, now and hereafter adopted or provided for the government end operation of said cemetery. The conditions, restrictions and regnirementa 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 ce- ~tery to ob-
serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the dried 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 fast part has mused 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 : ............ ........................................
City Clerk
igned, led and Dclivere
In th Bence of: ~ ,
r -
/~.. G- .. .....................................
STATE OF FLORIDA
Wl'NTY OF INDIAN RIVER
CITY OF SEIIASTIAN, FLORIDA
IIy 7.. ~~~E~~':"~ .....................
Mayor
(Qlit~r ~e~l)
I IIE1tERY CERTIFY, That on this ..12th ................day of .................~~............................., 1~8..,
before me y appearedRllth Sullivan and Kathryn M. 0 Halloran
personall .................................................. .................!.....................
respectively Mayor and City Clerk of the City of Sebastian, n municipal corporation under the laws of the State of Florda to me known
to be the individuals and officers described In and who executed the foregoing coaveyunce to
Jeanette Bartelson
.......................................................................................................................................
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, and severally acknowledged the execution thereof to be their free act Dori deed
es such officers theremdo duly authorised; and that the Official seed of said corporation is duly xc thereto, and the sold conveyance
is the act and deed of said corporation. ~
WITNESS my signature and official seal at Sebastian, In the
lest nturesafd.
.~M;;ry~,c. LINDA M. GALLEY
MY COMMISSION / CC 97572
y.f• DIPIRES: June 10,1998
`%?`.o.'h~'~ Boded Thru Notsry PuhOc tlnderv~ntten
State~of Florida, the day end dear
f.. ... %~: u .' ... .................. .
ry F Fier 'tae lorida at Large.
My
•
TIE SEBASTIAN CEMETERY
CITY OF SEBASTIAN, FLORIDA
~SEIPT ~ S HERE 3.' CRNO GED TH S~jM OF:
l ~ ~, ; ~ ~ ~ ~~j~ c~%
/l~'lG ~ ~ Dollars ($ ~~~ / )
FROM: ---- (l Q e ~,~c.
on this _ f /-~' day of 1~9~_ for the purchase of the
following described Cemeter Lbt (s) ~~i3°1 upon the terms and
conditions as stated herein: ~
Description of Property:
~J
Cemetery Lots F Bloc ~~~
~ Uni t
~' ,
Purchase Pric
' ~ ' ~ ~~ ~ Do11 ars ($ ~~~
Terms and Condition of sale:
This contract sha11 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 se11 the above mentioned property to
the above named purchaser(s) o the to ms and onditions stated in the
above instrument. ~ ~ ~,
%C~ty of Se% astian
Witness
L~
O4~ °~
~ G
'~®,~ 4~
City of Sebastian
1225 MAIN STREi_T ~ SEBASTIAN, FLORIDA 3258
TELEPHONE (561) 589-5330 ~ FAX (561) 589-5570
May 21, 1998
Jeanette Bartelson
603 Dracena Dr
Bazefoot Bay, FL 32976
Deaz Mrs. Bartelson:
Enclosed is Cemetery Deed No.1623 for Lots 1 & 2, Block 28, Unit 4.
Also enclosed is a form -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. 0. Box
1028, Vero Beach, Florida 32960 or you may call (561) 567-8000 for more information.
We are enclosing two copies of the receipt 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.
Sincerely,
Kathryn M. O'Halloran, CMC/AAE
City Clerk
KOH:hng
Enclosures
i ,~->
Name
Unit
Block ~~`"
Lot {
/ 0
Date of Buria- ~~ ~~ Time ~~"-«'~;"~°'S,~°, ~~~~ ~~~~~
Name of Funeral Home
Authorized by -
Date of Mark-out
~.J .
~~ ~
~ ~~
s
Paid by CEMETERY Receipt No ................. Dated .......... .
1800.00 ................... No.
List Price $ ,, ,, , , , , , , , , , , , , Maximum No, Burial Spaces , .
Net Paid $ ..180: ~0 .............. .
• • • - • • • Monument permitted .............. . . ....... ~ 16
(Data above this line for City Record only)
~-, ~, a'
FLARIDA DFrwRTMFSlr OF State of FI a, Department of Health, Vital Statistics %~ ,,.1 <S
HEl ~T APPLICN FOR BURIAL -TRANSIT PERMIT ~ G~ ~~r'
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
Francis Robert Bartelson DEATH Feb. 2 1998
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Barefoot Bay Inst. 603 Dracena Drive
3. Name of Medical
Certifier
Shashin Desai, M. D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Home
5. Check
Appro-
priate
Box
Medical Examiner
Address
Phone Number
Physician 1600 W, Eau Gallie Blvd., Melbourne, FI 407-255-150
Address Fla. Lic. No./Reg. No. Phone Number (Area Code)
1623 North Central Ave.
Sebastian, FI 1228 561-589-1000
a ^ The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b~, Theresa was contacted on 2 /Z /98 within 72
hours after death. He/she verified that this death was from natural causes, that there was no accident
nor other external cause of death, and that Dr. Desai will complete
and sign the medical certification of cause of death.
c ^ was contacted on . He/she verified that
,Medical Examiner, will complete and sign the
medical certification.
6• Place of Sebastian Ceme y In state ce tery/ Removal
Final Disposition: cr ato -name/county: Indian Rlver from state Donation
~• Funeral Director/ ign re F.E. No./Reg. No. Date Signed
6i'~eet-Bie~e°er 18 6 2 2/ 2/ 9 8
B. BURIAL -TRANSIT PERMIT Permit No.1228-98-0063
Permission is hereby granted to dispose of this body.
^ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct
Disposer Report" will be filed with the Local Registrar of the County in which death occurred.
^ No extension of time for fili he death certificate requested.
~ Date Date Certific e /
Subregistrar Signature Issued: .~ q~ Due: ~` 7 S
C~ AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
Signature ,Medical Examiner Date
or
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
death is required for all cremations.
48 hours after
D CEMETERY OR CREMATORY
..
Methods of Disposition: Place of Disposition -~~-~-
gBURIAL ^ STORAGE Date of Disposition ~ - . l?~
^ CREMATION ^ OTHER (Specify)
Signature of Sexton )
or Person-in-Charge) ~ :_ G~~-.->i
i
This permit must be endorsed by the Secton 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, 10/96 (Replaces HRS Form 326 which may be used)
(Stack Number: 5740-000-0326-2) !-