The URL can be used to link to this page

Home My WebLink About4-27-01MICHAEL DOUGLAS June 24, 1955 - April 19, 2014 Mr. Michael Douglas, 58, died April 19, 2014 at Sebastian River Medical Center in Sebastian. He was born in Maquoketa, Iowa and lived in Micco coming from Mineral Point, Wisconsin in 1987. Mr. Douglas was a dairy farmer in Wisconsin prior to moving to Florida. He was owner of River Grove Enterprise Construction, Inc. and a partner in River Grove Enterprises, Inc., River Grove Mobile Home Village, Micco Bay Carwash and Barefoot Mini - Storage. He loved spending time with his grandchildren, working with his sons, was an avid hunter and loved the outdoors. Survivors include his wife, Sandra Douglas; sons, Ryan Douglas (Patricia) and Duke Douglas all of Micco; mother, Bonnie Elizabeth Douglas; grandchildren, Madeline, Connor, Sebastien and Beau; sisters, Kathy Clasen of Malabar and Connie Douglas- Linnell and brother, Steven Douglas, both of Grant /Valkaria. He was preceded in death by his daughter, Mandy Douglas and father, Charles (Bud) Douglas. Name Block Lot Date of Mark -out - 1 / { Ci Date of Burial ,�lrt Time ' a Name of Funeral Home Authorized by 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 (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: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE #: 772- 589 -1000 {Check One) x OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: Michael Douglas Name Lot 1 Block 27 Unit 4 Lot Block Unit Niche Block Unit N S E W Saturday, April 26, 2014 2:00 PM CHAPEL SERVICE NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper docume tion of ownership) 4 nI Name ig ature Dat 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: Tim rvin I WA �l1►n Name Signature V Dat Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office a t all fees have been paid: Cemetery Se )p& J 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 BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: April 23, 2014 TRACKING NUMBER: 2014059265 1. DECEDENT INFORMATION Name of Deceased Date of Death MICHAEL DOUGLAS April 19, 2014 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. NoJReg. 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. TIMOTHY W. MARVIN F022789 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: 2014- FO41870 -5063 G�� r Date Issued: April 21, 2014 J 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 Sf 1 ► �� T 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 CITY OF SEBASTIAN CITY CLERK'S OFFICE /, p C C RECEIPT 4 U U U 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copieald Specs. 001501 341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots ❑ Cash / 2'Check # 700J Amount Paid LOUNIche . Block . Unit �,,�y- 001501 343805 Cemetery F DQ /� c2j5D 00 61 to - 4- 09Q,e Total Pald Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant QMV of Orha tian firmettry U r r b *NO. rilJ19a7 15th September 97 THIS INDENTURE MADE Tkls ............... I...... day of .............. ............................... A. D., 19....... between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Bonnie E. and /or Charles A. Douglas ........ ......................8440..U., S.:.. HWy.. 1.......................................... ...I........................... Micco, Florida 32976 ........................................ ............................................ ..... ............... I...................... of the County of Indian, River .................. and State of Florida as Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of $ 1 8OO OO ..... , ... 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 ,the 1 r heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: AB of Lot(s)1, &. ,? , Block, . 2 %.... , UNIT ..4, .... , , .. , , of Sebastian municipal cemetery as per Plat Number I 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, 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 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 OF SEBASTIAN, FLORIDA Attests .... By !!V• .......... h City Clerk Mayor Signed, Sealed and Delivered In the Presence aft Cc ... ' i... . . . .. ..................... Yeav Anti) �.. . ............. STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ....... 15.0 ........... day of .......... Se. pl emb .ex .......................... to. 9.7, before rare personally appeared . Walter W. Barnes .. and Kathryn . . . ..M.. ... 0 ..Halloran . . . . .. .......... ... ............................. ...................... respectively Mayor end 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 Bonnie E. and /or Charles A. Douglas ........................................................................................................ ............................... ........................ ............................... 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 thereto, and the said conveyance Is the act and deed of said corporation. WITNESS any signature and official seal at Sebastian, in the unty ndlan'River a tate f Florida, the day and year Iast LINDA M.11MIff W COMMISSION 100 375724 » M. ekm orm: Juno is, INS .040ION / CC _ ... ... ... I ....... .... ............... .... ............ . go" 7w "Many pulaftLv4w iMa 'RES7 June 18, IM Note Public St o Florida at Large. ."eoayNOundrnalYrs My co lesion expires Lin a M. Galley IJ i' 6t i� b b � a R � V •V O • O n ' o :gyp • vi z x 0 � � a z to � w , r 1-�o H- O ct ct 0 W PSI r N V 2'� N ,Y a 0 . 0 9f�n THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA THE SUM OF: FROM. ' on this day o 19 followin described Ceme y /Vaiah conditions as stated herein: ars ($ for the purchase of the upon the terms and Description of Property: Cemetery Lot (s i Block Unit Purchase Pr' e:� Dollars 1 7M Terms and Condition of sale: 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: The City of Sebastian agrees t sell the above named purchaser(s) o the above instrument. Ci y o itness astian ationed property to ditions stated in the • SA �a y 4F OF PELICAN \SAP City of Sebastian 1225 MAIN STREET 13 SEBASTIAN, FLORIDA 32958 TELEPHONE (561) 589 -5330 0 FAX (561) 589 -5570 September 17, 1997 Bonnie E. And/or Charles A. Douglas 8440 U.S. Hwy 1 Micco, FL 32976 Dear Mr. & Mrs. Douglas: Enclosed is Cemetery Deed No. 1599 for Lots I & 2, Block 27, 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. We are enclosing two copies of Receipt No. 955 and ask that you sign and return to us the copy marked with an' ' and retain the other copy for your records. A stamped, self - addressed envelope is provided for your convenience. Sincerely �• D •��Z.�GG4K d'� Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:Img Enclosures r