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Home My WebLink About4-28-11Jj l y�. THIS INDENTURE a NO• September 98 day of .... ine under the laws of the Stale of Florida, as Grantnr and between the City of Robert H., and %or'r!tR�h. .. Paasc........ ... ............... 219 Cedar Street x ........ P...O.•.. BON :'R3 ". 32958 ............................. . . Sebastian, • • • • • • .. of the County of ... Indian• River ........................ an' 1 State of ......... , .Florida... • ..................... . as Grantee, WITNESSETH i to it in hand paid, the receipt whereof is herewith ac- That the Grantor for and in consideration of the sum of $ ....1, �0- Qr • • • ' ' ' ' m unto the Grantee knowledged, does by this instrument grant, bargain, sell, release, convey and confirY�lel.r .. , heirs, legal representatives and assigns the following property situated in Sebastian , Indian River County, Florida, to -wit: eof recorded in Pint 11 &12 UNIT ..... , of Sebastian municipal cemetery as per Plat Number 1 ther Allof Lot(s) ....... , Block, ........ , 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. Florida, hereto - To Have and to Hold the same forever; provided that said he rules and egulafions,sordin n es and resolutoons of the City of Sebastian, arr dead and spa be used, kept and maintained at all times in accordance with t fore, now and hereafter adopted or provide) for rho government n the event of the failure ofrtherowner of any conditions, roperty situated awithin requirements aid cemetery for ob in this instrument shall be covenants running with the land. 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 first part has "caused this instrument to be executed in its name and on its behalf by its Mayor and he fa attested by its City Clerk and its corporate seal to be hereto•aff. ecj;,the day and year first above written. CITY OF SE11A.STIAN, FLORIDA I NEIiEBY CERTIFY, Tool ull and .................... Ruth Sullivan ................... personally appeared • • • • . • • • • . ' ' ' ' . of . Scbastinn, a municipal corporation under the laws of the State of Florida to me known before me P Clerk of the City respectively Mayor end City ance o or Ruth A. Paasch • • ............. . to be the individuals and officers described in unadna/ executed tire. foregoing cuavi .. .......................... Robert H. ...•.••........ :n ^E execution thereof to be their free act and deed ,and severally ack duly affixed` thereto, and the said conveyance as such ,., thert the'O;fficiai soil of sa eunto duly authorized; and t the net and deed of said corporation• ver nd State f Florida, the day and year is WITNESS my signature and official seal :4t Sebastian, la t last aforesaid. - LINDA vM« — '.. • v ; :f'l:'.. . ..:: •'. . -f?*: • «:•.. �..,..'. °.c.. ,_�', ,'.?; h.: :•:"i; �y s .,.r yr .+' _ Name Unit Block Lot Date of Mark -out Date of Burialt*' r ' Time 4 /' Name of Funeral Hom Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE 4 5 2 O RECEIPT Name LA1AX—\Lf dash Date lGJ �Check #� No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bld Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots;' LoVNiche Block s�, Unit 001501 343805 Cemetery Fees C9 4 Total Paid T � 1� k als white - Dept, of Origin • Yellow - Finance • Pink • Applicant it FLORIDA DEPARTMENT OF HEA,LT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased Ruth Anna Paasch of Death May 26 2009 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 219 Cedar Street 3. Name of Medical Address Phone Number Certifier Nasir Rizwi, M. 13885 U.S. #1 # Sebastian, FL 772 - 589 -6844 Medical Examiner I I Physician 4. Name of Funeral Home /D*eeF-�l Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. runk Funeral Home 6 Crematory Sebastian, FL 1228 772 - 589 -1000 5. Check a. F� The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b Jennifer was contacted on 5/26/09 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Rizwi will complete and sign the medical certification of cause of death within 72 hours. c. El was contacted on He /she verified that Medical Examiner, will complete and sign the mec1icg?jrtifica)?on,#Fcause of death within 72 hours. 6. Funeral Director/ ign ur F.E. No. /Reg. No. Date Signed Der 44048 5/26/09 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit Nol 228 -09 -0246 ❑ 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. FIND extension of time for filing the death certificate has been requested. Registi "T-1 Date Date Certificate Subregistrar Signature rr\. Issued: 5/26/09 Due: 5/30/09 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Q 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. Me oci of Disposition: BURIAL CREMATION Signature of Sexton 1 or Person -in- Charge 1 STORAGE ROTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition 44 eT�s �- 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. Distribution: White. Cemetery or Crematory DH 326 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 5740- 000 - 0326 -2) Pink. Local Registrar R nW iS pops Sep 26 2008 2:45PM HP LRSERJET 3200 i FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY "Omf c+ f ELK&%ISLAND Fo, fnformatior contact: Kip Kelso - Cemefery Sexton Se 3stian M;inicipal Comefery (772) 589 -2545 I City Clerk's Uff ce ilicy FW,, 1225 Main Qfreet Sebastian, FL 32958 OJffc' (772) 398 -8215 or 388.8214 STRUNK FUG 6dff dW9TCAEMAMRY FJNERAL HOME 16.Z3 No. Central Ave. ADDRESS: PHONE #: (Crick One) iii OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COL'UMBARIUM NICHE BURIAL DATE AND SERVICE TIME 1[ » Block 28 Unit 4 7tBlock Unit iche Block Unit June .6, 2009 12 P.m. FOR DECEASED Ruth Anno Paasch INar"1e :DAME AND SIGNA71-j'R" OF LOT OW (� ust provide per documentaticrn of ER OR REPRESENTATIVE: wnerstiip Name r- Signature Date I I certify tr,at I have determined the awne ship of he above described sit Ihal all site fees and administrative fees have been paid and uthorize opening of same i NA�;1E AND SIGN JRE OF LICENSE? FUN R RE rvarne------------------------------------------------ t............. ig e .. Date ------•---•------------------------------- ---..... __ .. Cemetery Sexton, Certification: 1 certify that I have checked the oviners.riiP inforn:ition by viewing the owner's deed and confirming with Clerks office %ind that all fees have been paid 1,91 a lz,� Ce _terf Sex on We This form to be provided to Clerk's Off.c� by Sexton for permanert record upon comp ;et +on. p.I