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Home My WebLink About4-14-09 t1~i#~ of ~rl~tts#ittn V' ~ ~ ~ l ~ ~ ~ ~ ~ ~ ~ NO. i 1UVO THIS INDENTURE MADE Thin ....?$th............ day of ..........ALI~USt ........................ A. D.,~..2~C2 between ilre City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .................................~..E.9N..G.O.~tR~i..~.. AND/..OR..TII~RES~..NSW.ALL......................................... 1362 SCHROLL STREET .................................S~BASTIAN.~...E.LORI•DA• •32.9.58.......................................................... of the County of ....INDIAN..RIVER .................•,. an] stnte ot .....FL.OR,~DA,•,•„..,,,.....•...••.......•,•....• as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ ... ~ ~ ~ • ~ ~ , , , , , , 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 , , , , , , , , , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) . , 9. , . , ,Block, .14 , , , , ,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 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. ;~ -._ Attest: ..' ...... ...................................... Clty Clerk Signed, Sealed and Delivered in the Presence of: STATE OF FLORIDA COCrNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By . ~~ .aJ~. ~ . `!Y:~ ................ . Mayor ((~c#g ~e~1) I HEREBY CERTIFY, That on this ....?$t~ ..............day or .......Aug.uS~.................................,x>i~st..2p02 before me personally appeared ....Wal.te>::..W.••Ba•r•ne•~ ..... .. .. ..:.... .. .... and ...S.a.l~.3?..P~....Ma.iO............. respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals and officers described in and who executed the foregoing conveyance to Leon Correll and/or Theresa Newell ....................................................................................................................................... ........................................................ and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized; and that the Official soul of said corporation is duly affixed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal ai 3ebasiian, in the County of Indian River and State of Florida, the day and dear last aforesaid. 1~:Y'.bN4.,, H. JOANNESANDBERG ('.~ ,( ~G7~.-~.-.......L//J.Zi:;~r!'~- ~~•' := MY COMMISSION # DD 088532 Nota ublic, State of Fiorlda at Larg~ ;~;:; EXPIRES: April 3Q 2006 My mmissIon expires r YYYYYY %~'Rf~ •i~~`' Bonded Thru NWery Public Underwriters 1 Cf1Y t~F ~y ~-. ~.~ -r~ J l,; ~e,k ,~ HC3ME t}~ PELiC~1tV 15LAND September 3, 2002 Leon Correll and/or Theresa Newell 1362 Schroll Street Sebastian, Florida 32958 Dear Mr. Correel & Ms. Newell: Enclosed is City of Sebastian Deed number 1860 for Cemetery lot 9, Block 14, Unit 4. Also enclosed is a copy of your receipt. If you have any questions, please contact our office. SAM:js enclosure ~~ ~~ ~~~~s, ~~~~~~ Receipt is acknowledged in the sum of: 1 /`o0/t;~.~ ,~'J,i r ,~1;~~~C.(,i'' Qi2C~ ~~` ~~ ~'_~`~ Dollars ($ 7~0.. G'~' From: ~-e ~!%? ~0 ~' ~e ~ ~ ~~~~ ~° r 77~ e ~,. e s c %Ue vv e 11 /~3(~ S~l~~oll Sheet on this~~` day of ~~ us t 20 U ~.~- for the purchase of the following described Cemetery Lot(s)/Niche~s) upon the terms and conditions as stated hexein: Deseriptaon of Property: Cemetery Lot(s)/Niche(s) g Bloclc /~ ~ Unit P(,~C? Purchase Price: ~ ` JL-12 ,~i1,t,(.~-rl,L~,`L~ ~cr` ~~ Dollars ($ 7o ~ ,. c~ o ) 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: Pur aser signature _ _ __ Purchaser signature The City of Sebastian agrees to sell the above mentioned property to the above named purchases (s) on the terms and conditions stated in the above instrument. ~~,- ~ ty of Sebastian fitness FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY :~. S~~T~N HOME OE PEEKAN ISLAND For information contact: Kip Kelso -Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Ott<ce City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax: (772) 589-5570 FUNERAL HOME: S l3W~tl~QS f u~r~~~r ~ ~''~'~ ADDRESS: 7~S I~"tE./hl~,v S s1~ PHONE #: ~? 2-' $~ y' 15 3`3 (Ghee e) A OPEN BURIAL LOT Lot r• Block ,~ OPEN CREMAINS LOT Lot Block OPEN COLUMBARIUM NICHE Niche Block N S BURIAL DATE AND SERVICE TIME: FOR DECEASED: ~ ~A, Name Unit '~ Unit Unit E W NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (~t provide proper documentation of ownership) Name Signature Date I certify that I have de mined the ownership of the above described site, that all site fees and administrative fe ave been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL RECTOR: Name Signature ~ Date Cemetery Sexton Certification: I certify that 1 have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Ceme e Se ton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. °' ~ X 8 8 0 8 8 8 5 8 8 8 8 ~ d 8 g 8 cdfr, ~ o _ `mob" ~ ~ 0 0 0 ~ g 10 A N N N ~ ~ pW ~ ~ T~t f ~ pT pm ~ ~ ~Npp N pOp ~ W N S ( O O O O O O -+ ~"'~ N ` S 0 0 s 2' 3 ~ ~ C ~ 3 3 ~ ~ ~ ~ 3 ~ ~ ~ m ~ w m z 3 -' ~ ~ n N N ~ ^S^ ~ C~ N ~ N O ~' C CJ 7 ~ S N N ~ C7 C ~ -1 O N x ~ N fD ~ z (D H N ~ Z7 ~ n N ~. ~ N ~ N n ('~ 7 • N 7 N C l7 N fD ~ ,~.. 7 f d ti N ~ ~ c Z Cn ~ ~ -. . ^ ~ 7 ~ ~prO m ^~ T ~ . v i ~ ~ - ao ~ m H mxW v ~ ~Oa ~ ~ ~ i ~~ 4 - ^ ~ m Z • _~ ~ - ^ ° s o 6j ~ d e ~ ~ a i~ ~ ~ ^. O ~ 0 ~ ~ ~ `7 Q ~ LEON CORRELL & THERESA NEWELL Paid by CEMETERY Receipt No... ~ 9 6 9 . .. , , ,Dated ....8 ~ ? 8 ~ ~ 2 ............... NO. List Price $ .. ~ 0 Q ..0 Q ...... Maximum No. Burial Spaces ................ . Net Paid $ .. ~ 0 ~ : ~ ~ .... Monument permitted ...................... . (Data above this line for City Rticord only) !' ~;~ ~J Name ~ F ~~ r~ r~ K. Unit Block ~ :~ 1860 LOT 9, BLOCK 14, UNIT 4 a /^~i Lot 7 - Date of Mark-out ~~ ~~` ~ / ~' ,.. Date of Burial ~ 5~'~%= !''-~ ~~ Time `'" ~-' ~ Name of Funeral Home ~ ~ ~ ~ ` i° ~ -~ Authorized by , FLORIDA DEPARTMENT OF HEALT A. (TYPE) a. 1. Name of First Middle Last Date Month Day Year Deceased of LEON RICHARD CORRELL Death 5/26/08 2. Place of Death City, Town or Location Name of (If neither, give street address) ty Hos or NDIAN RIVER SEBASTIAN Instp 1362 SCROLL ST 3. Name of Medical Address Phone Number Certifier TALIB HUSSAIN, MD 7768 BAY ST Medical Examiner g Physician SEBASTIAN, FL 32958 772-589-7177 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 735 FLEMING ST SEAWINDS FUNERAL H011E SEBAATIAN, FL 32958 2617 772-589-1933 5. Check Appropriate Box medical of cause of deathwithin 72 hours. He/she verified that Medical Examiner, will complete and sign the 6. Funeral Director/ S' tore F.E. No./Reg. No. Date Signed Direct Disposer ,~~ _ _ FO 44126 5 / 27 / 08 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 08-2617-100 five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. ~No extension of time for filing th death rt' cate has been requested. Registrar or Date Date Certificate Subregistrar Signature Issued5 / 27 / U8 Due: 6 / 3 / 08 c Approval Number: Date 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. Awaiting period of 48 hours after death is required for all cremations. D. Method of Disposition: BURIAL STORAGE CREMATION Signature of Sexton or Person-in-Charge State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT The medical cert~cation has been completed and signed. A completed certificate of death accompanies this application. b. ^ was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. c, ~ was contacted on OTHER (Specify) f This permit must be endorsed by the Sexton 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. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA CEMETERY OR CREMATORY Place of Disposition ~ ,E ~ ~ t ~, -# ~,/ ( ,~ ~ f~ ~ ~ 1~ ~/ - Date of Disposition ~~3 a /O Distribution: white: Cemetery or Crematory DH 326, 8/97 (Obaoletes ell previous ed'Aions) Yellow: Funeral Dnedor or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar ~,,~~ `~ ~ CITY OF SEBASTIAN CITY CLERK'S OFFICE 410 4 RECEIPT Name VV /` ~ Ca ~ -f {o rod ^ Cash ~u r1~ Check# ~ ~D ~ ~~~~ ~ - Date , ~ No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 CopieslBid Specs. 001501 341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees // ~~, e ~ W r r 601010 343800 Cemetery Lots ` ~ LoUNiche ~_., Bl~k ~. Unit ~ 001501343805 Cemetery Fees -~f- W-~-- - Total Paid f ~0 ndiats White -Dept. of Origin • Mellow -Finance • Pink -Applicant