HomeMy WebLinkAbout1-40-04n a y CEMETERY Receipt No. . . . 4 � � . . . . . . . . . Date3 . . . . 5 / 13 / 8 5 . , . . . .
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Liat Pricx S . .600 : 00 . . . . . . . . Maximum No. Pwial Spaces . . . 4 . ... . . . . . . . .
Nat P;ud S ..600 . 00 ... .. . . . Monumant permittad . . . F1,a t .. . ... . . . . . . . . . ... 1 U �,t :J
Orville V. Co1e
Lots 1,2,3 & 4, t3lock 40, Unit 1 Addition 701 Wimbrow Dr.
(Datr �bove tLL Ilne tor Cfty R,ecord only) Sebastian, FZorida 32958
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�P�'tP�P�1,J ��'�� N�. ,: 1u��9
THIS INDENTUAE MADE 'li4 . . . . .13 th . . . . . . . . . . . dry ot . . . . . . . . Ma y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. D, lY. .85 .:
IYq�N'ECp lhe Clty of 3e6ustlan. a municlpal curporwtlon e:lrtlnr undcr the Irwe oi the 8tute of Flortda� e� C�rantor and
............. Orville V: Co1e...................................................................................................
............. ....
701 W.imbrow D.r.
. . . . . .. . . . . . . Seba� t.�,¢t�.. F�.QF�s?��... �z9.� $. . . . .. .. . ... . . . .. . .. . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . .. . . .. . . , . . . . .
a1 tba County ol ...Ind ian River ........................ �al 8tate ot .... FZa.c ida...................... ..................
Nq Grantae. WITN$8�
That the Gtaator for and in consideration of tha sum of $,, 6 00 ; 00 , . ,,,,,, to it in har►d paid, the rac�eipt wheceof is herawith so-
knuwledged. doea by this inutrument grant, bargain, eall, relartse, �nvey and conficm unto the Grsntee ,.f�1; ;... �►e�IB, legs►1 repreaentatives and aseigne
tha foUowing property �i�u:►ted in Sebastian, Indian River County, Florida, to-wit:
1 2 3,4 40 1 Addit.ion
All uf Lot(s) , : . .'. . . , Block, , , , .. . . . , UNIT . . . . . . . . . . . . . . of Sebxstian municapal �metery ae per Plat Numbez 1 thereof rewrded in Plat
Buok 2, at page 65 of the public recorda in the office of tha Clerk of the Circuit Court of St. Luue County of Florida; said land now lying and being
in Indiaa River County, Ftorida. '
To Have and to Hold the same forever; provided that said property shall Ue unnd eolely and exclusivaly for tl�o intermant of thn human dnud and shell
be used. kept and maintained at all times ln accordanca with tha rulea und regulationa, ordinunces and tesolutionx of tl►e City of Sabastiun, Florida, hecnto-
fo;e, nqw and hereafter adopted or providad fnr th�tr; government and operation of yuul c�metery. The wnditione, restrictions und rec�uiramdnts a>ntaue�d
in thix instxument ah:tll be c;ovenants runaing with the land. tn the event of the fuilure of the owner of any prope�rty aituated within suid cemetery to ob-
aerve und comply with auch rules, reguladons, resoluuons and ordinances and Uie conditions of' the dded of conveyance thereof then the title of such owner
in anci to eaid pTOperty shall torminate and the same ahall revert to thn City uf Sebastian, Fiorida.
IN WITNESS WHEREOF, The said party of the tust part has caused titis instrument to be executed in its name and on ita behrlf by its Mayor and
attestad by ita City Clerk and its corpocate aeal to be hareto �[fixed, the day and year fuat above written.
CITY UF ' I3AF7TIAN LORID�i
Attet .. rG.�-�L.d.'n.✓'...`r,-. !.V "'—' .� B7 .\ ..�. —
s ... ........� .......... .........................
Clty Qerl ` M o�
Eilgned, 9eeled und Dellveccd
In the Y'reoence o[�
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S"PATE OF FIAtCIDA
(�Iit� �sexl)
I
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Paid by CEMETERY Receipt No. . , .408 . . . . . , , , , Dated . . . , S / 13 /85 . . . . . . . . . . . . . . NO.
List Price S . ,600 :00 . . . . . . Maximum No. Pucial Spaces . . .4 . .. . . . .. . . . . f. !
600.00 Flat � y�%�"
Net Paid S . . . .. . . . . . . Monument permitted . . . . . . .. .. . . . . . . . . . . . . • Orv111 e V . Co1 e
Lots 1,2,3 & 4, BZock 40, Unit 1 Addition 701 Wimbrow Dr.
(Date sbove tbh Une !or Gty Iternrd un1Y)
Sebastian, Florida 32958
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Date of Mark-out �'`.j—�,,� � �
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�ate �f Burial_ � �� � � Time � ' � � ��� '�
Name of Funeral Home � � �" � ' '�� � �
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Authorized by ` ,
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COX-GIFFORD-SEAW(NDS FUNERAL HOME sur�r�us�' B�wK ��`�'$9
1960 20TH STREET V�RO SEACH. FL 32960
VERO BEACH, �L 32960 ��21���
2��%Z�QB
� PAY TO THE Cl of Sebastian I� *"155.00
� ORD�R OF ., �
�' One Hundr�d Fifty-Five and 00/100*********�`**************�`**�`*******�`*'�****'�****�'``****�OLLARS ��
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� . Cifiy of Sebastian
� 1225 Main St. , .
� Sebastia�, FL 32958
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE � 3 9 61
RECEIPT
Name w� �� � f�o rc� ❑ Cash
Date �'� � � � � t�Check# � ��
No. Amount Paid
001001208001 Sales Tax
001501322900 Garage Sales
001501341920 CopieslBid Specs.
001501341910 LDC/Code of Ordinances T
001501341930 Election Quali(ying Fees
601010 343800 Cemetery Lots
LoVNiche �, Block "T V . Unit 1L
001501343805 Cemetery Fees 15a � o�
TotalPaid l ��.�v
Initia s
ite — Dept. of Origin • Yellow — Finance • Pink • Applicant 5, ��
Gied-�'�
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Obituaries � Death Notices � l�Tewspaper Obit�aaries � Online Obitua.ries � Newspaper D... Page 1 of 1
ORVILLE VERNON COLE
Orville Vernon Cole, 84, died Feb. 1, 2008, at Sebastian River Medical Center. He born in
Norwood, Ohio, and moved to Sebastian in 1982 from Fairfield, Ohio. He retired from
Champion International Paper Co. as a beater engineer. He served with the Army Air
Forces during World War II. Survivors include his wife of 61 years, Pearl L. Cole; son,
Thomas Cole of Fort Pierce; and 2 grandchiidren. SERVICES: Visitation will be from 1 to 2
p.m. Feb. 5 at Seawinds Funeral Home, Sebastian. A service will be at 2 p.m. Feb. 5 at
the funeral home. Burial will follow in Sebastian Cemetery. A guest book may be signed
at Seawindsfh.com/obit.php.
Published in the TC Palm on 2/3/2008.
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FUNERAL
AODRESS:
PHONE #:
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
;ma
. SE�T�1
� ..: �
NOME OF PELKAN tSIAND
For information contact:
Kip Kelso - Cemefery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
O�ce (772) 388-8215 or 388-8214
Fax: (772) 589-5570
(Check One}
�OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
Lot Btock Unit
Lot Block Unit
Niche Block Unit
N S E W
FOR DECEASED: ORvt�«� V�R.�t o�J CD�C
Name
NAME AND SIGNATURE OF LOl' OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership) _
t'�AR �. �o�i� � � �io►� �'"�' �
Name ignature 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 sarne.
NAME AND SIGNATURE OF LICENSED FUNER DIRECTOR:
- �' �.o b t�.�1 G�---- � -a .. �'
S� rv� � G � � . �
Name ignature ` 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 11 fees have been paid:
�" b $ ,
Cemetery exto Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
1. Name of First
Deceased
ORVTLLE
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
2. Place of Death City, Town or Location
County
INDIAN RIVER SEBASTIAN
3. Name of Medical
Cert�er I�i. NASIR RIGWI, i�'iD
nMedical Examiner �
4. Name of Funeral Home/Direct Disposal
Establishment
SEA't�IN1�S FU EN12AI� �tOt�
5. Chedc a,
Appropriate
Box
b. �
Middle Last Date
VERNON COLE of
Death
Month Day Year
2/1/08
Name of (If neither, give street address)
Hosp. or
Inst. SEBASTIAN RIVER ��DICAL CENTER
13385 US 1 Phone Number
SEisASTIAN, FL 3295� 77�-5�9-6844
Address Fla. Lic. No./R No. Phone No. (Area Code)
735 FLEiYING ST �'
SEBASTIt�T9 �L 32958 2617 772-549-1933
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
was contaded on
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
and that will complete and sign the medical
cert'�fication of cause of death within 72 hours.
�' ❑ was contacted on He/she verified that
, Medical Examiner, wili complete and sign the
medical certifi tion of cause of death within 72 hours.
6. Funerai Diredod S' F.E. No./Reg. No. Date Signed
Dired Disposer FU 4412 6 2/ 4/ 08
B.
�' BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. ��°�61 %-0� 1
� A five (5) day extension of time for filing the death ceRificate (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 medicai certification of cause-of-death section of the death certificate within
72 hours.
�No extension of time for filing the de�th ce ' cate has been requested.
Registrar or Date Date Certificate
SubregistrarSignature Issued: 2/4/0� Due: 2f 1G%a5
�• AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: Date
Medica� Examiner, , gave authorization by telephone to
Funeral DirectoNDirect 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.
�• CEMETERY OR CREMATORY �
Method of Disposition: Place of Disposition s��,� � 6� 3✓ /" Lr!✓7�i1 �.� i,
�BURIAL
�CREMATION
Signature of Sexton �
or Person-in-Charge
�STORAGE
�OTHER (Specify)
Date of Disposition
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 counry where disposition occurred.
OH 326, e�s� �obao�as an aev�ow eda�ons>
(Stodc Numbsr; 5740-000.0326-2)
DisVibutan: White: Cemetary or Crematory
Yellow: Funeral Diredor or Direct Disposer
Pink: Local RepisVar
�`�u �� �4•