The URL can be used to link to this page

Home My WebLink About4-28-35Name Gt/'A\ Unit Block_ Lot.. Date of Mark -out 3. ' > Date of Burial J �(/ a ZI L Time 3 Name of Funeral Home J �Rl�ltit`- Authorized by WAYNE DOUGLAS BOOTH Mr. Wayne Douglas Booth, 49, died April 9, 2013 at Sebastian River Medical Center in Sebastian. Mr. Booth was born May 3, 1963 in Bay Shore, Long Island, New York and lived in Sebastian for 24 years coming from Pompano Beach, FL. He was a veteran of the US Navy having served on the aircraft carrier USS Independence. He was employed by T Kat Services for 10 years as a Painter. He was a graduate of Deerfield Beach High School. He was survived by his wife of 31 years, Vicki Booth of Sebastian; son, Timothy Booth of Sebastian; parents, Jonathan A. & Judith Booth of Gadsden, Alabama; brother, Kenneth A. Booth of Archdale, North Carolina; mother -in- law, Barbara Coon of Hudson, FL. He was preceded in death by his brother, Jonathan "Jackie" A. Booth, Jr. and father -in -law, Thomas Coon. (ai#u of jirhaltian }� 1629 ,j r ut P i * r r� D r e h NO. '' THIS INDENTURE MADE Thls ...................... day of ....... June ............................... A. D., 19.8..., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ....... . ............................. Jmathan .A.. and /or..Judith. B— Bioo. th................. ............................... 333 Joy Haven Dr ........... ..........................Sebas tian;.. FL ..329 58 ..................................... ............................... . of the County of ... Indi.ari, Ri.v1? ' ........................ ■n:l State of Florida ............. ............................... as Grantee, WITNESSETHt That the Grantor for and In consideration of the sum of $ , ,1� 500.00 .. . . ...... . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee hiS. , , , , heirs, legal representatives and assigns the following p3 repty4 rutted, Sebastian, Indian River County, Florida, to -wit: All of Lot(s)YY..... . , Block, 28 .. , , , , UNIT 4, .......... .. f Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in the offlce 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, 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 such rules, regulations, resolutions and ordinances and the conditions of the dried 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. Attests .. ......... ......... ............................... City Clerk Sign , Sea d and Delivered In e P nce oft STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By Mayor (49itu 5eul) I HEREBY CERTIFY, That on this W ...................day of ........ ....June...................... ....... 1998 , before me personally appeared ....,.Ruth Si4 ivari dKathr MI 0 Halloran an .... respectively Mayor and City Clerk of the City of Sebastian, a municlltol corporation under the laws of the State of Florida to me known to be the htdividuuls and officers described in and who executed the" foregoing conveyance to Johnathan A. and /or Judith B. Booth ........................................................................................................ ............................... ......................... ............................... and severally acknowledged the executlo thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is d affixe thereto, and the said conveyance Is the act and deed of said corporation. WITNESS any signature and official seal at Sebastian, In the unty f Ian Iv and State Z�p o� rida, the day and year last aforesaid. / �/ ' UMI(M. (iN.LEY MY COMM Mi CC 376721 �Gtdubflc, .... .. .. • • ........... . EliPil#S: Jun 9 1�� 9 at Florida at Lar 7tsu tbhry PubMe Iscdetw IMn a ea r CITY OF SEBASTIAN CITY CLERK'S OFFICE 4368 RECEIPT Name �'�n /� �T ✓1 Date No. 001001 208001 Sales Tax 001501 322900 Garage Sales ❑ Cash � Check # // � ��;; Amount Paid 001501 341920 Copies /Bid Specs. _ 001501 341910 LDCICode of Ordinances _ 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots _ LoVNiche �, Blockk, Unit 001501 343805 Cemetery Fees _ _plc 5�0 "/j WJL;�'� Total Paid 150.00 UU Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5!T!! -i HOW OF PELICAN ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Maur Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax_ (772) 589 -5570 ETM111K FUNERAL HOME & CREM]tff(D.71Y FUNERAL HOME: 1671 No- mantra! Ava ADDRESS: SES hS i IAN, FL 3291`3 PHONE #: ( h eit One) OPEN BURIAL LOT Lot 35 Block 2-2 Unit OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: FOR DECEASED: Name C6�- NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Name S=ove Da :e I certify that I have determined the ownership described site, that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DI EC Name ,j Da e 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 th all fees have been paid: Ceme ery xt n Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion, State of Florida, Department of Health, Bureau of Vital Statistics T BURIAL TRANSIT PERMIT DATE PRINTED: April 9, 2013 TRACKING NUMBER: 2013054352 1. DECEDENT INFORMATION Name of Deceased Date of Death WAYNE DOUGLAS BOOTH April 9, 2013 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER SEBASTIAN SEBASTIAN RIVER MEDICAL CENTER Name and Address of Funeral Home /Direct Disposal Establishment Fla. Lic. No. /Reg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589 -1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director /Direct Disposer Fla. Lic. No. /Reg. No. GARY D. EVANS F065074 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: 2013- FO41870 -5067 Q G Date Issued: April 9, 2013 Meade Grigg, 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 , I Method of Disposition: BURIAL Date of Disposition: 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, 10/12 64V- 1.011, Florida Administrative Code