HomeMy WebLinkAbout4-28-28Name aht
Unit
Block
Lot �z8
Date of Mark -out / �' f -,r -
Date of Burial l / ` Time
Name of Fune
Authorized by
CITY OF SEBASTIAN 10409
ADMINISTRATIVE SERVICES RECEIPT
Name &RuWK WC1ArJ0 JCash
Date /_' °% 'p Check #-75A/❑'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
►so!.343 864- 4-16Lb
I)glr 4 81Kas LATA
Total Pai ��
Initials
Security Dep Held - Amount $ Check #
White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214 ctesta(a)cityofsebastian.org
FUNERAL HOME: Strunk Funeral Home and Cremator
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
XXXX OPEN BURIAL LOT Lot-28—Block 28 Unit 4 URN VAULT BEING BURIED Ao
OPEN CREMAINS LOT Lot—Block—Unit �
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: Friday, February 3, 2017 at 11:00 CHAPEL Service
FOR DECEASED: Ann Lou Luciano
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Lorraine Luciano LArrcil K.2 LuciAwo 1/26/2017
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:
William B. Whittaker, Jr.
Name
cWfiiaK,9 CwRittaiz , A
Signature
1126/2017
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 h ve been paid:
lzr-,7-h7
Cemetery exton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
For information contact:
Kip Kelso, Cemetery Sexton
Sebastian Municipal Cemetery
Phone: (772) 589-2545
r F
Fax: (772) 228-9927
V f
,1 p� 1
City Clerk's Office – Cathy Testa
1
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214 ctesta(a)cityofsebastian.org
FUNERAL HOME: Strunk Funeral Home and Cremator
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
XXXX OPEN BURIAL LOT Lot-28—Block 28 Unit 4 URN VAULT BEING BURIED Ao
OPEN CREMAINS LOT Lot—Block—Unit �
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: Friday, February 3, 2017 at 11:00 CHAPEL Service
FOR DECEASED: Ann Lou Luciano
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Lorraine Luciano LArrcil K.2 LuciAwo 1/26/2017
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:
William B. Whittaker, Jr.
Name
cWfiiaK,9 CwRittaiz , A
Signature
1126/2017
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 h ve been paid:
lzr-,7-h7
Cemetery exton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
wtV at or baottan
,,rmrtrrg D r r d
NO.
.1636
THIS INDENTURE MADE This ....... th........... day of ........ June ............................. A. D., 10 8....
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
Aau..L.P.v..Lurzi.4 q ............................... ...............................
9380 101st Ct
.............. ............................... Vero. - Reach,.. FL..3296.7......... ............. ...............................
of the County of Indian _.River,,,,,,,,,,,,,,,,,,,,,,, an-] State of Florida
as Grantee, WITNESSETHt
1 s 5 0 , , to it ' hand aid, the receipt whereof is herewith ac-
knowledged, $ does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , fl r ... heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s)? 7A 2§ , Block, ,?8. . . . , 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 Ivies 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, 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 ob-
serve and comply with iuch 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 Clerk
nee, Scaled uud Delivered
In a Presence oft
c � ....
.�- ..................
CITY OF SEBASTIAN, FLORIDA
DyI . ... ............................
Mayor
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
I IIEREDY CERTIFY, That on this ........ !Qth ......... day of ............. JunQ ........................ ....... , 1a.98
Ruth Sullivan Kathryn M. 0 Halloran
t
befure me personally appeared ........ 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
AnnLou Luciano ..............................................................
and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorized; and that the Official seal of said corporation is duly thereto, and be said conveyance
is the act and deed of said corporation.
WITNESS my signature and official seal at Sebastian, In the Co my o In Is Ri er nd State f lorlda, the day and year
last aforesaid.
LINDA M. GALLEY
._ MY COMMISSION II CC 740478
?s• EXPIRES: June 18, 2002 ota Pub l c, State o orlcla at Larg
1 o:. emdad Ibm Notary ftk undswrssn My cornmiss n e It
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
.ma
SEBASTIAN
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: 5 /.�°u�✓ /�
ADDRESS:
PHONE #:
(Chec One)
OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME
FOR DECEASED:
Name
Lot %Z43 Block 28 Unit
Lot Block Unit
Niche Block Unit
N S E�--- W
R
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
I )
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:
124 V,4
Name 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:
,�� Q. 440c--,�- 31t- V4
Ce tery exton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
04/13/2010 10:08 7725892583
1 1 f VL:LVVO 04.L.7
star Granite
P.O. Box 159
Elberton, GA 30634
'r:'1-8W241 7Z4112
F.- 706 - 283 -7043
Sold
To: SEBASTIAN CHAPEL
DAVID HINCEMAN
1623 NORTH CCN -RAL AVE,
SEBASTIAN FL 32958
Phone'.
772.589 -1000
Fax
772 - 582583
Ship Via
POOL T RUCK
Estimated Ship
Date
Terms
NET 30 DAYS
Freight
PREPAY
STRUNK FUNERAL HOME PAGE 01
%r mAi r .vv I r uu 1
Order Acknowledgement
Acknowledgement No 63412
Sales Order Date. 10129/09
Shp
To, STRUNK FUNERAL HOME
JUANITA
916 17TH ST.
VERO BEACH, FL 32960
Phone,
772 -466 -1 955
Fax.
Customer ID
4199
P.O. Number
LUCIANO
P.O. Date
10(29/09
SalesPerson TERRI REEL
QuentIt Item No. Color Demdotlon
1 MRKOKP STAR BLUE 2.0 X 1.0 X 0-4
PFT BRP
CARVE 8 LETTER PER D -722 MOD. PER ATTACHED
LETTER IN FROSTED PANEL, BLACK LITHO
REF. SUSAN ANN
SEND DRAWING FOR APPROVAL
u- y
A - �$
�G0..n 0
Order weight:
119.88
Pape, 1
GG rr
/vda�L7Af /'aK �Ovlee
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01/27/2017 08:25 7722287079 COS AIR BLDG PAGE 01/01
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
Phone. (772) 589-2545
Fax: (7 72) 228-9927
City Clerk's Office — Cathy Testa
City Nall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or388-8274 ctesta(Mcitvofsebastian, ora
FUNERAL HOME: Strunk Funeral Home and Cremator
ADDRESS: 1623 North Central Avenue Sebastian Florida, 32955
PHONE#: 772-589-1000
Check One
LC OPEN BURIAL, LOT Lot_28islock 28 Unit 4 `URN VAULT BEING BURIED
OPEN CREMAINS LOT LotBlockUnit
OPEN COLUMBARIUM NICHE Niche Block Unit
.N�S�E W
BURIAL DATE AND SERVICE TIME: Friday, Februa 3, 2017 at 11:00 CHAPEL Service
FOR DECEASED: Ann LP11 Luciatlo
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Lorraine Luciano Lorraiwe L uccpv� 1/26/2017
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:
William B. Whittaker Jr. 'nf[IQiaM Li' o4JRittaken, JA.
Name Signature Date1�/261017
Date
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owns deed and confirming with Clerk's
office and that all fees h ve been paid: y
Cem tery exton Dafen % J/
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
r�
01/27/2017 15:02 16415 P.001/001
FUNERAL DIRECTOR'S R94UEST TO CI
P
TIA
SESA5eT
L CEMET ft
R BURIAL OPENING IN SEBASTIAN MU I
For information contact:
Kip Kelso, Cemetery SOX1
••
Sebastian Municipal Comet ry
S'
phone; (172)589.2545
-
PDX.- (772) 228-9921
GCity
Clark's Cifte - Cathy 7 sk
11
City Hall. 1225 Main Stree
Sabastian,F! 92958
Oflice(772J386.8215 Or 36114214 otosra(o1'r
ebas)an .or
FUNERAL HO E:
5tr k F ner Ho a an Cr at
ADDRESS; 1623
orth Central Avenue. Sebastian. Florida. 32958
PHONE#: 77 5
9- 000
�7d.
xx�PN U
IAL LOT Lot�28-819ck 28 n
a 'URN VAUL
BEING SURIEO pd+
�
_ �opEN R
MAINS LOT LotT,,.Block
Unil
ppEN 0
UMBARIUM NICHE Niche BI c
unit
BURIAL DATE
D SERVICE TIME Frida , Febrtta 3, 2017 d
5:00 CHAPF
Service
FOR DECEAS Q
Ann 1 Wqjano
Url
Name
NAME AND SI
TURF of LOT OWNER OR RFPRESFNTATIVE.
(Must provide P e
r documentation of ownership)
rUnIgta Le'
Name
Signature
atp
I certify that I h vq
determined the ownership at the above described
that all Site fees
Rnq administrative
fees have been paid
and authorize opening of same,
NAME AND SI NATURE
OF LICENSED FUNERAL DIRECTOR:
WilliamB. Wlitaker,jr.
c}JQRiar<$,
Ut.
28 11
Name
11.001
01/27/2017 14:09
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2289927
OOFF:REDIAL ALL FAIL
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
r1 �i Phone: (772) 589-2545
Fax: (772) 228-9927
V
City Clerk's Office - Cathy Testa
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388.8215 or 388.8214 ctesta(dicityofsebastian.ora
FUNERAL HOME: Strunk Funeral Home and Cremato
ADDRESS: 1623 North Central Avenue, Sebastian, Florida. 32958
PHONEM 772-589-1000
(Check One)
XX:y OPEN BURIAL LOT Lot-28—Block 28 Unit 4 URN VAULT BEING BURIED.
_OPEN CREMAINS LOT
_OPEN COLUMBARIUM NICHE
Lot—Block—Unit
Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: Friday, February 3, 2017 at 11:00 CHAPEL Service
FOR DECEASED: _ Ann Lou Luciano
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Lorraine Luciano Lorrai.Kt LuctaKo 1/26/2017
Name Signature Date
I certify that 1 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:
William B. Whittaker, Jr. CwiitticixR CAttalm, Ja. 1/26/2017
Name 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.
CASH ADVANCE ACCOUNT - SEBASTIAN
1623 N. CENTRAL AVE.
SEBASTIAN, FL 32958
One Hundred Fifty and 00/100
FAY
TO THE City of Sebastian
ORDER
OF'
1228-17022 Luciano
0/C fee
II'00759211• 1:06 700 6 7 7 51: L01963611•
01/26/2017
AMOUNT
$ 150.00 8
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