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Home My WebLink About4-28-30Name 'e, XLI, . AA- S ! ,(`�� ,� A Unit Block Lot 30 Date of Mark -out r Date of Burial ) �3 / Time DO oV Do) Name of Funeral Home �li/�� lr �D Z Authorized by " Ruby Sibayan 1946-2017 Ruby "Marlene" Sibayan, 70, of Indian Harbour Beach, passed away on May 17, 2017. She was born on July 30, 1946 in Vero Beach, FL to the late Neil and Ella Cain. Marlene was a faithful member of the Church of Christ in Cocoa. Marlene retired from Acopian Technical as a manufacturing supervisor after 30 years of service. She enjoyed reading, crosswords, and in her active years, bowling. Most of all she cherished her grandchildren. Marlene is survived by her beloved husband of 46 years; Cecilio Sibayan, children; Wendy Littleton, Trina Massie (Dustin), and Cello Sibayan (Jessica), grandchildren; Rebecca Littleton, Rachel and Dylan Massie, and Mick, Cecelio, and Kima Sibayan, and brother; J.W. Cain. She was predeceased by her brother Neil "Butch" Cain. State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT I4FALTH DATE PRINTED: May 30, 2017 TRACKING NUMBER: 2017081733 1. DECEDENT INFORMATION Name of Deceased Date of Death RUBY MARLENE SIBAYAN May 17, 2017 Place of Death • County City, Town or Location Name of facility, or street address If not a facility BREVARD MELBOURNE HOLMES REGIONAL MEDICAL CENTER Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number BEACH FUNERAL HOMES B CREMATION SERVICES - EAST F052125 F052125 (321)777-4640 1689 S PATRICK DRIVE INDIAN HARBOUR BEACH, FLORIDA, 32937 Funeral Director/Direct Disposer Fla. Lic. NodReg. No. CHRISTOPHER D. VIEIRA F048223 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of Vital Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2017-8052125-5099 �— Date Issued: May 18, 2017 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District Approval Number: 4. CEMETERY OR CREMATORY Place of Disposition: SEBASTIAN CEMETERY r�yy Method of Disposition: BURIAL Date of Disposition: 3 O �Z— EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so. DH 326E, 10112 64V-1.011, Florida Administrative Code CRY Cf SE ;ig-_ - - - -- � I HOME OF PELICAN ISLAND Certificate No. 2539 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: James W. Cain 2000 SW 5th Drive Okeechobee, FL 34974 In and for consideration of the sum of $4,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 28, Lots 29 & 30 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 18th day of May, 2017. CITY OF SEBASTIAN, FLORIDA 47 f — Joseph F. Griffin City Manager ATTEST: 13aenette Williams, -MING City Clerk _ CRYch� SEAT" HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone May 31, 2017 Mr. James Cain 2000 SW 5�h Drive Okeechobee, FL 34974 RE: Interment Rights to Unit 4, Block 28, Lots 29 & 30, Sebastian Municipal Cemetery. Dear Mr. Cain Enclosed is City of Sebastian Certificate 2539 entitling you to full interment rights in Unit 4, Block 28, Lots 29 & 30 the name of James W. Cain. If you have any questions, please contact our office at 388-8209. Sincerely, ,> kL- Cathy Testa Records Clerk Enclosure CITY OF SEBASTIAN 10448 ADMINISTRATIVE SERVICES RECEIPT / Name l.tANJ UCash Date -I $ • 1 VCheck # O 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 `� not4sol - 3�38os 01c "(�� 0-01010 - S+ -!)y oa Lois - . L/19W Total Paid Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant 3v 4ru Fv 0-"4-d.- kc s a.; d O'k , -Gr N -W I 0 (Ah JYk , 512511-7,(511 �% r •-C•. iV aryt>F S u P" A63 9 HOME OF PELICAN ISLAND 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) A000 S�4Y. S46 �IA- FK, h�-� , F. 34 -?74- ,....... R,3--7(, 3- 3/84 Area Code & Phone umber KU -6A sI kc-14-Gt n Name & Residence Addreds of Intended Receipt is acknowledged in the sum of: F;Lk R �f Ai\ L4 Other Than Purchaser OFFICE USE ONLY Dollars ($ 44DOO . oo ) on this (9 day of 20j_7_for the purchase of the following described Cemetery Lot(s) and/or Niche(s). 2-1 ,� D Z�{ Unit Block, Lot(s) fi , 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 - $20) Opening & Closing Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser I:\W W-DATA\Ms-Cemetery\RECEIPT.doc Interment 41 0, 00 /W O H Circ One Disinterment TOTAL$ / SD . Ob City of Sebasti The following documents were provided as Proof of Residency: t!1•tI~ lit ~PUFIIIiLIlIlI ~~em~e#~e~~ ~~~e~ 98 THIS INDENTURE MADE TWa ......3rd........... daY et ..December ............................... A. D„ 15....... bet~ceen Ilse City of Sebastian, a municipal corporation a:leting under the laws of the State of Florida, as Grantor and ............................. Roaaria . andlar. Marisa . InsAlera...................................................... . 448 Seagrass Avenue ...................................Sebastian, ..FL..329.58 ..................................................................... . of the County of ..Indian ,Ri.yer .......................... .n~ State of ...... ~'.~f~X}.~ ...................................... I u Grantee, WITNE38ETHs 1 O~ DO That the Grantor for and in conaideratlon of the sum of S . i ....:................... to it in hand paid, the receipt whereof la herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Crantea their. , helm, legal represe:ttativea and assigtra the following property situated !n Sebastian, Irtdian River County, Florida, tsrwlt: All of Lot(s)?9&3O. ~ g1orJE; 8..... . ~ UNIT , , ~-, , , , , , , , , , , of Sebastian munidpal cemetery as per Plat Number 1 thereof recorded in Pht Book 2, at page 65 of the public records in the office of the Clark of the Circuit Court of St. Lode County of Florida; saki land now lying and being in Indian River County, Florida To Have and to Hoki the same forever; provided that said property shall ba.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, ordlnanoea and resolutions of the Clty of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditioons, reatri~uated witkdr4s~aled cemetey to ob- in this instrument shall ba covenants ruttning with the land. In the event of the fallure of the owner of any p pe Y serve and comply with such rules, regulations, resolutions and ordinanaa and the conditions of the debd 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 3ebaatian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this Ittatrument 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 OF SEIIABTIAN, FLORIDA Attests ~ ~f %~+.c.-"'~ ~'rf+-^ ........... . City Clerk Signed, and Delivered ` In the r c ors .~w....~G~`~ ................... By ~ ~ . .................... ,.. ..... Mayor STATE OF FLORIDA CUUNTY OF INDIAN RIVER December ....day at .....,.. .................................... I~S.., I }lEIIEIIY CERTIFY, That on this , , 3rd, , , , , , , , , , , , , , Ruth Sullivan ana Kathryn M. O'Halloran ....................................... before use personally appeared ................... ................ reeprctively Mayor end City Clerk of the City of Sebastian, a municilsnl corporation under the laws of the State of Florida to me known to be Ilse individuula us,d officers descrllxd In and who execut~hl rise forrguing co.veyunea to Rosario ,and/or, Marisa, ,Insoles ................................................... .............................................. ... •,,,,,,,,,,,,,,, and severally acknowledged the execution thereof to be their tree act and deed ss suck officers tlsereunto duly authorised= and that the Official seal of said corp~ratlon ~ y affixed tharcto, and the said conveyance is the act and dead of said corporation. ' h d end yea- NO. (Glitg o4eaf) '-'1664 WITNESS my signature and official seal at Sebastian, In the last aforesaid. ~-~~ LINDA M. =7 MY COMMISSION 40415 EXPIRES: June 18, Bondse Thns floury Puese UrMsaaasss My Public, State of Florida, t e .y r~. I~~