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HomeMy WebLinkAbout1-36-16Certificate No. 2158 ~~ ~ ~~~ Certificate of Interment Rights - r. . IN ACCORDANCE with provisions- of the. Code ~of''Ordinances of the City of Sebastian, it is hereby certfieduthat carol Kendzierski ~ ~~ 8035 99th Avenue, Vero Beach, FL 32967 (name) (address) In and for consideration of the sum of $2,000.00 is entitled to full interment. rights in the Sebastian Municipal Cemetery for the following lot: Unit 1_Block_36_Lot_16 of the Sebastian .Municipal. Cemetery, as maintained on file in the records of the City Clerk for use in accordance., with the conditions., ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED~THIS 11th day of December, 2007. CITY F SE STIAN, FLORIDA ATT T: r~ ~- ~ inner ~ Sally .Maio, MMC anager City Clerk Gt1Y f~F ~~~ ~~ v ~~ -~ ~ HC?1V[~ ©F PELtGN ISUWE> City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Address ~~~ C3~~G~~ ~`L 3 Z9 ~ 7 .Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser Receipt is acknowledged in the sum of: ao tars ($ 02, D00, 0° ) on this. ~ ~~ day of ~~L'I')'~~~-Y" , 20 ~7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit ~_, Block ,~ (p ,Lot(s) (~ Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Opening & Closing ~ 5 V , ~~ W O H Circle One Vase and Ring for Niches (cost) OFFICE USE ONLY Interment Temporary Marker Preparation & Installation Signature of Purchaser The following documents were provided as Proof of Residency: I:\VVVV-DATA1Ms-Cemetery\RECEIPT.doc i and TOTAL $ ~ !15D, ~0 of Sebastian Disinterment Obituaries ~ Death Notices ~ Newspaper Obituaries ~ Online Obituaries ~ Newspaper D... Page 1 of 1 LOUISE B. MINTON Louise B. Minton, 88, died Dec. 6, 2007, at Atlantic Healthcare Center, Vero Beach. She was born in Toledo, Ohio, and lived in Roseland for 12 years, coming from Fellsmere. She worked as a clerk and operator for the Bell Telephone Co. for 23 years. She was a member of the First Baptist Church of Fellsmere. She was a member of the American Legion Auxiliary Post 189, Sebastian; a volunteer with the Sebastian River Medical Center Auxiliary; a member of Tops, Meals on wheels, and a volunteer at the Indian River County Public Library, Survivors include her daughters, Anita Rutter of Garland, Texas, Carol Kendzierski of Vero Beach; eight grandchildren; 21 great-grandchildren; and one great- great-grandchild. Memorial donations may be made to the VNA & Hospice Foundation, 1110 35th Lane, Vero Beach, FL 32960. SERVICES: Visitation will be from 6 to 8 p.m. Dec. 11 at the Strunk Funeral Home Sebastian. A funeral service will be at 2 p.m. Dec. 12 at the funeral home chapel with the Rev. Buddy Johns officiating. Burial will follow in Sebastian Cemetery, Sebastian. Published in the TC Palm on 12/8/2007. Today's TC Palm obituaries and death notices Questions about obituaries and death notices or Guest Books? Contact Legacy.com • Terms of use ~Q4~~rP~ ~y Lr~,x~~~.cam obituaries nationwide Back http://www.legacy.com/tcpalm/Obituaries.asp?Page=LifeStoryPrint&PersonID=9920... 12/10/2007 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY Ip~ AA~m~Y HOME OF PELICAN ISLAND 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 ADDRESS: 1623 North .Central Avenue, Sebastian, FL 32958 PHONE #: 772-589-1000 (Cheek One) _~,OPEN BURIAL LOT Lot ~~ Block ~ ~ Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: _o~.doY~~li N 1„Z~ 07 W FOR DECEASED: ,~p~ ~~,~. ~' ~,~,~D ~ Name ~ NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) 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 SIGNATUR F LICENSED FUNERAL E J ' Name Signat re Date -------------------------------------------------------------------------------------------- Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming ith Clerk's offi nd t tall fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Name Unit_ Block Lot ~ `~" ,, i';t. / f ~ Date of Mark-out / `. ~ f J • / , ~ ~ ~' ;~ Time ~ ~' ~ Date of Burial Name of Funeral Home ~ ' '~''' ~~~ Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE 3 9 5 0 RECEIPT i' 'Y° Y „,; ~, Name I~~ !~z, ~ C.~~ 6C.. ~ ^ Cash Date I + ' ~ '" V ~ ~jCheck#~ No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 CopieslBid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots ~ ~~ ~~ ~ ~ QQ • ~~ LoUNiche ~, Block ~~, Unit ~ '~11 0 ~ ~ ~ 001501 343805 Cemetery Fees V • Total Paid ~ ` 5n.olc~ Initials White - De . of Origin • Yellow -finance • Pink • Applicant FLORIDA DEPARTMENT OF HEALT A. State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of Louise B. Minton Death Dec. S 2007 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Atlantic Health Care Center 3. Name of Medical Address Phone Number certifier Gary Silverman, M.D. 1265 36th Street Medical Examiner Physician Vero Beach, FL 32960 772-567-6340 4. Name of Funeral Home/Dirae~t3isposal Address Fta. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 32958 1228 772-589-1000 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b, ~ Ashley was contacted on 12/6/07 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Silverman will complete and sign the medical certification of cause of death within 72 hours. c. ~ was contacted on He/she verified that Medical Examiner, Will complete and sign the med' I certi ti cause of death within 72 hours. 6. Funeral Director! Si at F.E. No./Reg. No. Date Signed Di~eet-i9isoe~er 44048. 12 /6 /07 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No.1228-07-0496 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. ~No extension of time for filing the death certificate has been requested. Rasietrar~r / Date Date Certificate Subregistrar Signature ~,Q,~~/),r ~ `~.~.a~~ Issued: 12 /6 /07 Due: 12 / 11 /07 Approval Number. Date Medical Examiner, ,gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must tie obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is required for ail cremations. D. Method of Disposition: BURIAL CREMATION Signature of Sexton or Person-in-Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition ; ~/j ~, ~© ~. ~r- / ` ~ / 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 ed'Aans) YelkrN: Funeral Director or Direct Disposer (Stock Number: 5740000.0326-2) Pink: Loeal Registrar ,~ r„M c. AUTHORIZATION for CREM~4TION, DISSECTION, or BURIAL-AT-SEA UNIT t~Uf~IBER "' BL~~GI~ L~T~h~ICHE 1 96 16 LQ T ~N I CH E ~ wn~r I Q ~~~up~nt[~] I ~ ~~~d Lask t~Jar~7e: ,~~ailable for ~ale_ Fir~:k: h~l: address: ~ik}~: 9kake~f'rov: ~ %ip: Pf7one: ( 7 _ Exk: FaJ: ( ~ - 99hJ: - - R e~~idenk: tJ okes: S old B ack ko Eiky G~16~7 995 - ~iky of ~ ebaskian Check #01 ~~~~ issued ko H ~Ip J ohn R obinson,l7 9 hJ epkune Courk, I ndialankicr FI ~. o ~'~. Dons ~,r ,.. _ _. _ ,. ~~ ~'ti ~~rsor~~l Info ~ Informant Gonk~ck~ Conkaok2 U~~er [~~efined Fi~l~ds r w~ner ~ miner: Available for 9 ale Edik t'J-il~ 111 ~'YIIZI~II~IiI N° 161 C~~ent~e~~e~~ ~r.e~ THIS INDENTURE MADE This ...26th. y of January A. D., 19.71.., ............ da ............. beta-een the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and mrs. Ruth C. Robinson P. 0. Box 161 (Josue St.) Roseland ....................................................................................................................................... of the County of ....Indian River and state of ......Florida . . ..... . ........... .................... as Grantee, WITNESSETH: Thnt the Grantor for and in consideration of the sum of $...**150.~~~* .... to it in hand paid, the receipt whereof {s herewith acknowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee.......... heirs, legal representatives and assigns the fol n property situated in Sebastian, Indian River County, Florida, to-wit: 61k. 36, Uni . A11 of Lotg..l~ . .1£j in ............. of Sebastian mumcl a er mbar 1 there- of recorded in Plat Bo , of the public records in the office pf the Clerk of the irc St. Lucie County of Florida. Q ~ ~~~ eel ~~~ To Have and to Hold the me forever; provide that said property shall used olel ively for the interment of the dead and shall be used, kept and maintain at a Imes m e r es and regulations, ordinances and resolutions of the City of Sebastian, Florida, heretofore, now and hereafter adopted or provided for the government and operation of said ceme- tery. 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 observe 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 be- half 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: .`J ~-``~~ ........../L ..:.":.. .... ...........~....... ~-i , Clerk i' Signed, Sealed and Deliv~~ in he Presence of: (~ C~2o / ~ CITY OF SEBASTIAN, FLORIDA ~~ ~ ~Pis~ B ~--~`-~ y ........................ .... ................ Mayor (t~~tg ~E~t) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ....28th day of ..........January 71 ............................, 1s...., before me personally appeared ....... C' S. Zimmer A. T. Jordan ........ ........................................ and ....................................... 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 mrs. Ruth Robinson •••• .................................................... and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly autborized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. Notary Public, State of Florida at Large. My commission expires: Notary ice, State cr4 Fioric9a at Large. My Commission Expires February 7, 1972, Bonded by Atha Insurance Agency, s^•~-a _. (dec. mr. L.K.R) Deed #161 ~ /%~~~%"~ ?aid by General Receipt No. ..ash .,,. Dated.. January..26,..1971,,,, mrs. Ruth C. Robinson P. 0. Box 161 (Josie St.) List Price 15 0.00 Maximum No. Burial s aces .... ~r >a .................. 1? 2....... Roseland, Fla. ~J ~/'~ discount $...... - ......... Total area in egnare Poet /' ~7 ................ V vet Paid $, , ,150.00 Monument Lots 1~ & 16 permitted ..................... Blk. 36 1 ~ (Data above this line for City Record only) ~. _ -_ ~~ ~ UNIT ~~ , BLOCK ~ ~ ,LOT ~~ • • r~ City of Sebastian 1225 MAIN STREET ~ SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 ~ FAX (407) 589-5570 M E M O TO: FROM: SUBJECT: DATE: Finance l~ Kathryn M. O'Halloran, City Clerk;~~ Repurchase of Cemetery Lot by City June 8, 1995 Please issue a check as follows: AMOUNT' $75.00 PAYABLE TO: John Robinson 116 Neptune Court Indialantic, Florida 32903 PURPOSE: Repurchase of Cemetery Lot 16, Block 36, Unit 1. SUBMIT TO: Linda Galley attachment \ws-form (lck-req) -; ~: .~; W' w F Q tf` Cr ~r w m Z Y C U C w~ U u Q O O LL Z g a m w z a m w w O } U • • rn M t~-i ~, o I` ;•. ~ ~ Q O ~ Z ~ p 0 O ~ ~ u. Z t0 Z ~ N Z ~ Q ~ 0 ~¢ ~m ~ Q Q a ~+ r fi ~ w z ~ + ~ O ~ L~ ~ ~ a G~ ,e ~ o ~.Ls > ~ ~ > ~ ` z - ~ o w ~ ~- Q z ~ V _ _ ~, r ~& ~ /y O m ~'/~ Mrl c N ~ ~ ~ y LL m a 7F: a ~ d (~ co ~ %~: ~'~ <~~ w Z ~ yr z c ~` ~7 ~ u ~ ~W ,a ,m,• ~ ~ ~ Z Z ~' ~-. ~ H ~ ~ ~"• L t.J ~ ~ U Q J Q ti. 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