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Home My WebLink About4-27-09vulgj 111 3®Pllllliltull *Pmrt rrg B .f r b. NO. 1616 98 THIS INDENTURE MADE Thla .........6th......... day of .......... y .............................. A. D., 19......, between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ........................................ ................................................ ............................... 160 Harris Drive ......... ............................... Sebmtian,..FL .32958 ............... ............................... I .................. of the County of . Indian River ,, , ,,, , , , ,, , , , , an] State of ....Florida as Grantee, WITNESSETHh That the Grantor for and in consideration of the sum of $ ... 1 ?.0.00 ...' .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 tr..... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(syq. & 10 , 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. 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 d affix thereto, and the said conveyance Is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, In the -last aforesaid. � � 3 MY COMMISSION I CC 4 r EXPIRES: June 18, ION Bel Thru Notary Public lfidersrtlbrs Linda) M. Florida, the day and year Ys. cowl . .. .................. . lorldi at I.arg� CITY OF SEBASTIAN, FLORIDA Attest: By W.!!....................... ............ .............'........�e` City Clerk Mayor Si nrd, waled and Delivered� th resence .. .... -.... // • . .. ................ (civr p cal) . /44-- .......................... STATE OF FLORIDA COUNTY OF INDIAN RIVER I ]HEREBY CERTIFY, That on this ....fth ................day p of ........... My..... ............................... Sullivan Kathryn M. O'Halloran before me personally appeared ,.,Ruth .................. ............................... 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 Duhaflie ............................................... �. �.......................................... ............................... 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 d affix thereto, and the said conveyance Is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, In the -last aforesaid. � � 3 MY COMMISSION I CC 4 r EXPIRES: June 18, ION Bel Thru Notary Public lfidersrtlbrs Linda) M. Florida, the day and year Ys. cowl . .. .................. . lorldi at I.arg� Name M k Unit k Block Lot Date of Mark -out /: 4! -a Date of Burial F ' !1 Time Name of Funeral Home, Authorized by '- "bu , mf- V Lc Paid by CEMETERY Receipt No ................. Dated .............................. List Price $ ....11 000 :�.... Maximum No. Burial Spaces ................. Net Paid $ ....1 , 000 ;00. , , Monument permitted ....................... (Data above this line for City Record only) NO. 1616 Paid by CEMETERY Receipt No ................. Dated .............................. List Price $ ....11 000 :�.... Maximum No. Burial Spaces ................. Net Paid $ ....1 , 000 ;00. , , Monument permitted ....................... (Data above this line for City Record only) NO. 1616 3. Name of Medical Certifier John Suen, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Check Appro- priate Box 6. Place of Sebastian Final Disposition: 7. Funeral Director/ Direiai Dicpccoc a ❑ The medical ce this application. Medical Examiner )q Physician 87 Roy Address 1623 N. Central Sebastian, FI Address Phone Number it Palm Blvd., Vero Beach FI 561 - 770 -488E Ave. I Fla. Lic. No. /Reg. No. Phone Number (Area Code) 1228 I 561- 589 -1000 completed and signed. A completed certificate of death accompanies b ❑ Lisa was contacted on 1/14/9H 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 Dr. Suen will complete and sign the medical certification of cause of death. c ❑ medical certification. Cemetery , j]ln state cemetery/ LC.J.r,ramafnry - n2mw4 was contacted on . He /she verified that , Medical Examiner, will complete and sign the Indian River F.E. No. /Reg. No. 1862 Removal from state n Donation Date Signed 1/14/98 B. BURIAL — TRANSIT PERMIT Permit No. Permission is hereby granted to dispose of this body. 1228 -98 -0029 ❑ 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 for filing the death certificate requested. Re*_4r911`6� Date /� /9 Date Certific Subregistrar Signature Issued: Due: / 9Y 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 Methods of Disposition: Piacp of M.-,nn.itinn .5r_1W# a Gr r_ ._✓ l -d1�Ir t f- 59 BURIAL ❑ STORAGE Date of Disposition r 1-7 ❑ CREMATION ❑ OTHER (Specify) �'- Signature of Sexton ) or Person -in- Charge) 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. OH 326. 10196 (Replaces HRS Form 326 which may be used) !Stock Number: 5740- 000 - 0326 -2) H IDA �)�jop State of F da, Department of Health, Vital Statistics FOR BURIA L APPLIC!N — TRANSIT PERMIT �( A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Albert Ward Duhame DEATH Jan. 14 1998 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Integrated Health Services of Vero Bch 3. Name of Medical Certifier John Suen, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Check Appro- priate Box 6. Place of Sebastian Final Disposition: 7. Funeral Director/ Direiai Dicpccoc a ❑ The medical ce this application. Medical Examiner )q Physician 87 Roy Address 1623 N. Central Sebastian, FI Address Phone Number it Palm Blvd., Vero Beach FI 561 - 770 -488E Ave. I Fla. Lic. No. /Reg. No. Phone Number (Area Code) 1228 I 561- 589 -1000 completed and signed. A completed certificate of death accompanies b ❑ Lisa was contacted on 1/14/9H 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 Dr. Suen will complete and sign the medical certification of cause of death. c ❑ medical certification. Cemetery , j]ln state cemetery/ LC.J.r,ramafnry - n2mw4 was contacted on . He /she verified that , Medical Examiner, will complete and sign the Indian River F.E. No. /Reg. No. 1862 Removal from state n Donation Date Signed 1/14/98 B. BURIAL — TRANSIT PERMIT Permit No. Permission is hereby granted to dispose of this body. 1228 -98 -0029 ❑ 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 for filing the death certificate requested. Re*_4r911`6� Date /� /9 Date Certific Subregistrar Signature Issued: Due: / 9Y 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 Methods of Disposition: Piacp of M.-,nn.itinn .5r_1W# a Gr r_ ._✓ l -d1�Ir t f- 59 BURIAL ❑ STORAGE Date of Disposition r 1-7 ❑ CREMATION ❑ OTHER (Specify) �'- Signature of Sexton ) or Person -in- Charge) 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. OH 326. 10196 (Replaces HRS Form 326 which may be used) !Stock Number: 5740- 000 - 0326 -2) THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA 3Y ACKNOWLEDGED OF THE SUM OF: FROM: on this day of( following described Cemet ry _. conditions as stated herein: Dollars Lot _. 19LZ for the purchase of the ()/ upon the terms and Description of Property: Cemetery Lot (ts) 0 Block c-97 Unit Purchase Pric 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 sell the above me tioned property to the above named purchaser(s) on he t rms and nditions stated in the above instrument. WiG�As//O ?� • - a — Witness May21, 1998 Mary Duhame 160 Harris Dr Sebastian, FL 32958 Dear Mrs. Duhame: • ♦ Y O a, Q 5�� City of Sebastian 1225 MAIN STREET a SEBASTIAN, FLORIDA 32958 TELEPHONE (561) 589 -5330 a FAX (561) 589 -5 -570 Enclosed is Cemetery Deed No. 1616 for Lots 9 & 10, 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 the receipt and ask that you sign and return to us the copy marked with an . "X" and retain the other copy for your records. A stamped, self - addressed envelope is provided for your convenience. Sincerely, Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:1mg Enclosures