Loading...
HomeMy WebLinkAbout4-28-17(ditig of Orhautian PZIiPPx �PP�� NO. THIS INDENTURE MADE This ......... 25-th ...... day of ..............January ..................... A. D., jm200Q between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Lorane Tomberg ............ ............................... .................................................. PX.... Box .85 ....................... . Wabasso, FL 32970 ... ........... I.......................... ................................... ............................... of the County of Indian. River ........................... an.l State of ..... IFI. Qxi da........................................ as Grantee, WITNESSETHi .750.00 .. to it in hand paid, the receipt whereof is herewith ac- That the Grantor for and in consideration of the sum of S ........................ sell, release, convey and confirm unto the Grantee her..... heirs, legal representatives and assigns knowledged, does by this instrument grant, the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 17.... , Block, A.... , 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, restriction tes and re uirements co to ob- in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property serve and comply with ouch 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 Clerk and its corporate seal to be hereto affixed, the day and year first above written. City ..... C City Clerk Signed a d and Delivered In t}, Pre nce of: i .....1 ........... ..�..................... CITY OF SEBASTIAN, FLORIDA '... .. ... ............ By .... .May! ((gitvr Meal) STATE OF FLORIDA COUNTY OF INDIAN RIVER .... �DDO I ilEl%EIIY CERTIFY, That on this ......... 25th........ .day of ................. ,JSLIUSL"y••••••••••. Chuck Neuber er and Kathryn . M, , 0! Halloran . • ..... . before me personally appeared .... .. ........... ...g......................porat ... under respectively ly Mayor Duals n cityi Clerk described of the Ci and webastian, a mu ail the itor- going�conveyanceetothe laws of the State of Florida to me known ..................... ............................... .. L. QrAlle.. Tol4berg ............................ ............................... and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is duly affixed tit , nd the said conveyance is the act and deed of said corporation. a Ste of Flo Ida, the day nd year WITNESS my signature and official seal at Sebastian, in the Count A I ;r last aforesaid. - UNDAM.OALLEY P. M11110N 0 CC 740478 0l 4. Eat�lAlB JuM J6.2002 My ytyyryP06k 1nden Public. State O/FiprMa at Large. Name Nr�'/ ° ,+rt$5,tt 4 111nzlo P 1. 4 — Unit Block Lot A& /7 Date of Mark -out I— S 00 Date of Burial C ') ' Time Name of Funeral Home ` Ccivnb n Authorized by Paid by CEMETERY Receipt No.... . Dated ...... 1� ?5/00 List Price $ ,750.00 ........... . Net Paid $ 750.00 Maximum No. Burial Spaces . ............... . Monument permitted ...................... . (Data above this line for City Record only) NO. x (jj The Sebastian Cemetery City of Sebastian, Florida is From: on thisZi� c described Cemetery Description of Property: Cemetery Lot Purchase in Terms and Condition of Sale: sum r: Dollars ($ U ) 'Loc-(- a�r%e Tom bP,r3 A . n dam. n� .. � n 2002 for the purchase of the following upon terms and conditions as stated herein: Block Unit AZ—Dollars ($ j 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 above described property on the terms and conditions stated in the foregoing instrument: 4aser P signature "-ri Purchaser signature The C' of Sebasti� "agrees to sell the above mentioned property to the above named nurcha�er(s) on the/terrrA and conditions stated in the above instrument. �' Witness Q � rR1GM City of Sebastian 1225 Main street 0 Sebastian, Florida 32958 Telephone (561) 589 -5330 0 Fax (561) 589 -5570 E -Mail: cityseb@iu.net January 28, 2000 Mrs. Lorane Tomberg P.O. Box 85 Wabasso, FL 32970 Dear Mrs. Tomberg: Enclosed is Cemetery Deed No. 1709 for Lot 17, 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 or call the Department of Revenue at (904) 488 -9487 for more information regarding the completion of this form. We are 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. Sin Orel ,� D• GZ��_,,-- ,� Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:lmg Enclosures 3. Name of Medical „Wu' ' bbl) bdb --4. Noel Palma, M.D.M.E. 26 Gun Club Road Certifier West Palm Beach, FL 33406 Medical Examiner Physician 4 Fla. Lic. No. /Reg. No. Phone No. (Area Code) . Name of Funeral Home /Direct Disposal Addr ��22,N.E. 4th St. Establishment Scobee - Combs - Bowden Funeral Home Boynton Beach FL 33435 1891 (561) 732 -81 75 5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b ❑ - 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... - 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 medical certification of cause of death within 72 hours. 6. Funeral Director/ Signature F.E. No. /Reg. No. Date Signed Direct Disposer a/, 1750 1/17/00 B BURIAL - TRANSIT PERMIT 1891 -00 -7 Permission is hereby granted to dispose of this body. Permit No. 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. Registrar or Date Date Certificate Issued: 1/17/00 Due: 1/19/00 Subregistrar Signature L Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. D CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Method of Dlsposltion: 01/1f 2000 BURIAL FISTORAGE Date of Disposition FICREMATION Signature of Sexton 1 or Person -in- Charge J} OTHER (Specify) / 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 Yellow: Funeral Director or Direct Disposer DH 326, 8/97 (Obsoletes all previous editions) pink: Local Registrar (Stock Number 5740.000- 0326 -2) TMENT Of Sta� ,,I Florida, Department of Health, Vital St�,,�, ics (T / 7 W LT *LICATION FOR BURIAL - TRANSIT PERM A. (TYPE) 1. Name of First -- - - Middle Last Date Month Day Year Deceased Melissa Kathleen Kimmel of Death January 14, 2000 2. Place of Death City, Town or Location Name of (If neither, give street address) County Palm Beach West Palm Beach Hosp. or 5903 Pointsettia Avenue Inst. 3. Name of Medical „Wu' ' bbl) bdb --4. Noel Palma, M.D.M.E. 26 Gun Club Road Certifier West Palm Beach, FL 33406 Medical Examiner Physician 4 Fla. Lic. No. /Reg. No. Phone No. (Area Code) . Name of Funeral Home /Direct Disposal Addr ��22,N.E. 4th St. Establishment Scobee - Combs - Bowden Funeral Home Boynton Beach FL 33435 1891 (561) 732 -81 75 5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b ❑ - 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... - 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 medical certification of cause of death within 72 hours. 6. Funeral Director/ Signature F.E. No. /Reg. No. Date Signed Direct Disposer a/, 1750 1/17/00 B BURIAL - TRANSIT PERMIT 1891 -00 -7 Permission is hereby granted to dispose of this body. Permit No. 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. Registrar or Date Date Certificate Issued: 1/17/00 Due: 1/19/00 Subregistrar Signature L Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. D CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Method of Dlsposltion: 01/1f 2000 BURIAL FISTORAGE Date of Disposition FICREMATION Signature of Sexton 1 or Person -in- Charge J} OTHER (Specify) / 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 Yellow: Funeral Director or Direct Disposer DH 326, 8/97 (Obsoletes all previous editions) pink: Local Registrar (Stock Number 5740.000- 0326 -2) Name Unit Block Lot Date of Mark -out 3 ! �z i //,3 Date of Burial /A 7— Time ei, �<'4 Name of Funeral Home Authorized by e C- ._ / •` KATHRYN BERRY Kathryn May "Kathy" Berry, 75, of Palm Beach Gardens, passed away March 16, 2013. She came to this area in 1973 from Pennsylvania. Kathryn had owned a motel, managed rental property and drove a school bus. She also was a foster mom for many children. She is survived by three daughters, Lori (Mark) Tomberg, Diane (T.R.) Hoffman, Charlene Tommeraas; seven grandchildren and six great - grandchildren. f Total Paid 50. o o Initials White - Dept. of Origin a Yellow - Finance • Pink . Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE 4363 RECEIPT Name b- &,rn b s Zb err `+ ❑ Cash Date 4-1-13 Of Check # 1 7 1 r No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche . Block , Unit 001501343805 Cemetery Fees /1�_ �� �i�-� '�� f Total Paid 50. o o Initials White - Dept. of Origin a Yellow - Finance • Pink . Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBAST_ "O"t ai r t"N ISLAND For information contact: Kip Kclso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 - 254 5 City Clerk's Office City Hall, 1, 225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -13214 Fax. (772) 589 -5570 FUNERAL HOME. ADDRESS. PHONE #_ (Che(;k One) OPEN BURIAL LOT Lot Block Unit OPEN CREMAINS LOT Lot __Block�Unit ---_OPEN COLUMBARIUM NICHE Niche_ Block Unit W BURIAL DATE AND SERVICE TIME: f ' �5 0 0,� FOR DECEASED: ivarTte NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE (Must provide proper documentatiori of ownership) Name Signature Date I certify that I have determined the ownership of tt above described site that all site fees and administrative fees have been paid and authorize opening of same NAIAE AND SIGNATURE OF LICENSED FUNERAL DIREC-i OH, Name W ZA. 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 <tnd that all fees have been pa!d Cemet ry Sextoon " ` / Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.