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Home My WebLink About4-27-06Y Titiv of #rhastian 1611 1!Ipmettry JoPPb NO. THIS INDENTURE MADE Thin .......25t1? ...... day of ...... November ........................... A. D., 1e.9,7.., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ............... ......................... Thomas Fornash Te............................. ......... ............................... 229 Midvale rr .............. ............................... Sebastian,..FL.32958 ................ ..... ....... ............................... of the County of ...... Indian. River ... . ...... . ... . .. . . . . an l State of Florida ............... ............................... as Grantee, WITNESSETHs 500.00 That the Grantor for and in consideration of the sum of $ .......................... to It ' ,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 property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 6, , . , . , , Block, , 2% , , , , , 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 Rivet 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 Attu /57 ... '..1.:..�'L "• `i`"�.... By W .:`' ......... City Clerk Mayor Signed, Scaled and Delivered In H resencc oft �/7 � n iTliL"o.... ..4r1 .i. ........................... (Qlitg SCN)) .............. . S ATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 25th November ...... ..............................1 Ig97., ........................day of .............. Walter W. Barnes Kathryn M. O'Halloran before nre personally appeared ............................ ............................... and ........ ..........1.................... 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 descrllxxd In and who executed the foregoing conveyance to Thomas Fornash ................................................................................................... ............................... 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 affi�4, t�rreto, and the sold conveyance is the net and deed of said corporation. l Gam(/ WITNESS my signature and official seal at Sebastian, in the my o lon Itiv nd State of _Florida, the day and year last aforesaid. LINDA M. GALLEY W COMMISSION / CC Jf ; •_ i� - ..... .................... EVINES: Jum 18, 1M Notary Public, t t t Florida at Larg . ?„ 8ottdM Twu Nsauy Pubk thdnralbn My co 18810 )Tres s Linda . Ga ley Name L-L s Unit Block Lot Date of Mark -out Date of Burial r do Name of Funeral Home 4 Authorized by Paid by CEMETERY Receipt No. 96••• •••••••' Dated ............ 500.00 Maximum No. Burial Spaces ................ . List Price $ .. .... ........ 1 '� 1 JL .500.OQ Monument permitted .............. • * * * * • . Net Paid $ • " " " (Data stave this line for City Record only) R DA DPPART1v1PNr OF �wO State of Florida, Department of Health, Vital Statistics APPLICA&I FOR BURIAL — TRANSIT PERMIT 46 3 ,27 A. (Type or Print) 10 98 -00009 �! 1 Name of First Middle Last DATE Month Day Year Deceased OF Anne Marie Fornash DEATH November 07, 1997 2. Place of Death County Indian River 0. Name or Medical Certifier Jerry Pierone, M.D_ City, Town or Location 4. Name of Funeral Home/ Direct Disposer Cox— Gifford Funeral Home Vero Beach Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial Hospital J Medical Examiner 2045 15th AvenuedTn7) 562 -8447 Phone Number dPPhysiician Vero Beach, Florida 32960 A 1AV Goth Street Fla. Lic. No. /Reg. No. Phone Number (Area Code) Vero Beach FL 32960 1423 (407) 562 -2365 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b Gerald Pierone, MD was contacted on 11/07/97 within 72 hours after death. He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that he will complete and sign the medical certification of cause of death. c ❑ was contacted on . He /she verified that Medical Examiner, will complete and sign the medical certification. 6. Place of Instate cemetery/ Removal Final Disposition: Sebastian, Flo crematory - name /count : Indian River Y from state Donation 7. Funeral Director/ Si r !�/l F.E. No. /Reg. No. Date Signed Direct Disposer _�0( !'L -2 G/ V / / — /h —s > B. BURIAL — TRANSIT PERMIT 1423 — 247 -97 Permission is hereby granted to dispose of this body. Permit No. ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. No extension of time forr(c)b" fi�' g e cleat rtifiicate.requeste Registrar or 09 Date 11/10/97 Date Certificate Subregistrar Signature l.z Issued: Due. C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA Signature Medical Examiner Date or Medical Examiner, gave authorization by telephone to _ Funeral Director /Direct 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. D. CEMETERY OR CREMATORY Sebastian City Cemetery Methods of Disposition: C�:BURIAL ❑ CREMATION Signature of Sexton ) or Person-in-Charge) ❑ STORAGE ❑ OTHER (Specify) Place of Disposition Date of Disposition 11/11/09 This permit must be endorsed by the Secton 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 County where disposition occurred. DH 326. 10/96 (Replaces HRS Form 326 which may be used) (Stock Number: 5740- 000 - 0326 -2) THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA REC IPT IS B AC OWLEDGED OF THE SUM OF: '/- 67 Dollars FROM: on this CX day of �/ ^� , 1 for the purchase of the following described C eery Lot upon the terms and conditions as state herein: Description of Property: *' Cemetery Lot Bloc / Unit Purchase Price: Z� Dollars 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 to the above named purchaser(s) on above instrument. 1 the above mentioned property to to d ndi ions stated in the Witness an C . • City of Sebastian 1225 MAIN STREET a SEBASTIAN, FLORIDA 32958 TELEPHONE (561) 589 -5330 o FAX (561) 589 -5570 December 1, 1997 Thomas Fornash 229 Midvale Ten Sebastian, FL 32958 Dear Mr. Fornash: Enclosed is Cemetery Deed No. 1611 for Lots 6, 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. O. Box 1028, Vero Beach, Florida 32960. We are enclosing two copies of Receipt No. 966 and ask that you sign and return to us the copy marked with an 'W' and retain the other copy for your records. A stamped, self - addressed envelope is provided for your convenience. Sincerely, >n- 0 06�y� 4eft- Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:lmg Enclosures