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Home My WebLink About4-25-191 w 5/24/96 Lots 1 Paid by CEMETERY Receipt No.... Dated Block List Price $ 1,x•00 Maximum No. Burial Spaces Unit 4 Net Paid $ 1, �O Monument permitted (Data above this line for City Record only) NO. 1;64U (City of Orbtts#ittn Teme#erj Deed NO. 15410 THIS INDENTURE MADE This day day of May A.0, 1096 betwern the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Anne Dobbins 33301129th'Stret Sebatsian, Florida 32958 • of the County of Indain River an I State of Florida se Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ 1 t 000.00 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 her heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 19 &2q Block, 25 , 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! 71 C2--C Signet aled and Delivered In t• Bence o City Clerk 'STATE OF FLORIDA CITY OF SEBASTIAN, FLORIDA By c;::;0- c.e...c -apt- Mayor ((Eitp $enl) COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 24th day of May , 1996., before me personally appeared Louise R. Cartwright and Kathryn M. O'Halloran respectively Mayor and City ('Ierk 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 Anne Dobbins and severally acknowledged the execution thereof to be their free act and deed es such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the net and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the Cou ty of Indian River State of Florida, the day and year last aforesaid. LINDA M. GALLEY MY COMMISSION R CC 875724 EXPIRES: hale 18.1998 Ranbd MN Wary Pstas Undon :1m Not. ry Public, St of Florida a Large. My omrniee in dress e . r Linda M. Galley �ob��t117.S Lot 1 Date of Mark -out 1 1(9-1 L t 1 Date of Burial CJ"C) ) 1' ` Time a • 0b ? % ii Name of Funeral Home ) G Authorized by 509£P£ 109100 8 8 8 8 8 8 (A A A N pW 00 �O tO <D 8 O 8 § ao N Cn saaueuPJ0 io aPoOlal 0 N d W C� W 0 0 0 CA) ANNE HARRISON DOBBINS Born: July 16, 1915 Death: September 24, 2011 Mrs. Anne Harrison Dobbins, 96, died September 24, 2011 at VNA Hospice House, Vero Beach. She was born in Detroit, Michigan and lived in Sebastian for 38 years coming from Miami, Florida. Survivors include her son, Jay Dobbins of Dallas, Texas; daughter, Holly Beth Wolack of Sebastian; 6 grandchildren and 5 great - grandchildren. She was preceded in death by her husband, James Henry Dobbins in 1996. A. FLORIDA DEPARTMENT OF HEALT (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Deceased Anne Harrison Dobbins Date Month Day Year of September 24, 2011 Death 2. Place of Death City, Town or Location County Indian River Vero Beach Name of (If neither, give street address) Hosp. or VNA Hospice House Inst. 3. Name of Medical Certifier Richard T. Penly M.D. Address 1265 36th Street Vero Beach, Horida 32960 Phone Number (772) 567 -6340 El Medical Examiner Physician 4. Name of Funeral Home /Direct Disposal Establishment Strunk Funeral Home and Crematory Address 1623 North Central Avenue Sebastian, Florida 32958 Fla. Lic. No. /Reg. No. F041870 Phone No. (Area Code) (772) 589 -1000 5. Check Appropriate Box a. p c. ❑ The medical certification has been completed and signed. A completed certificate of death accompanies this application. was contacted on 1 12L0' 1 I He /she verified that thi de th w s f om 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. was contacted on medical certification of cause of death within 72 hours. He /she verified that , Medical Examiner, will complete and sign the 6. Funeral Director/ fliosoWNopeeer Sig .tu F.E. No. /Reg. No. q ( gate�Sig; ed F042972 q `2(� i 1 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -11 -426 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. 0 No extension of time foffiling t - death certificate has been requested. •rlegictrur or 'A ,t.�� Date Date Certificate Subregistrar Signature V (Jv-1_/ Issued: 9/24/2011 Due: 9/29/2011 c. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method f Disposition: URIAL STORAGE CREMATION DOTHE Signature of Sexton /../Z. or Person -in- Charge } �_.—: Place of Disposition Date of Disposition 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. DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740-000-0326-2) Distribution: White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY HOME OF PELICAN store 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 Lot 19 Block 25 Unit 4 OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 9/28/ 2011 at 2 :30 p.m. FOR DECEASED: Anne Harrison Dobbins Name NAME AND SIGNATURE OF LOT OWNER OR REPRES TATIVE: (Must provide proper documentation of ownership) JOMPS Dobbins Name Signature ate 1) 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 FUN Glenn A. Strunk Name Si • . ture Cemetery Sexton Certification: certify that I have checked the ownership information by viewing the owner's deed and confirming with C = • s Mice and that all fees have been paid: /1 Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. !HE SEBASTIAN CEM RY CITY OF SEBASTIAN, FLORIDA EIPT IS . REBY ACKNOWLEDGED OF THE SUM OF: FROM: J Dollars ($/(4.16, ) "&li) ,7,t_gt 4, iP 2ARIAL,...t.t _,,:d-_1. , _ It A • on this ■Ip day of fie...-... , 19 diP for the purchase of the following described Ceme - y L4t(s) /Nialietst- upon the terms and conditions as stated here n: Description of Property: Cemetery Lot(s)/ Purchase Pric Terms and Condition of sale: Block Unit Dollars ($/ This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and condi ons stated in the above instrument. Ci• of Seba • I • • City of Sebastian 1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589 -5330 0 FAX (407) 589 -5570 May 29, 1996 Anne Dobbins 7330 129th Street Sebastian, Florida 32958 Dear Mrs. Dobbins: Enclosed is Cemetery Deed No.1540 for Lots 19 and 20, Block 25, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, P. 0. Box 1028, Vero Beach, Florida 32960. We are enclosing two copies of Receipt No. 894 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self - addressed envelope is provided for your convenience. Sincerely, )77. 9'iji&4 Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:lmg Enclosures t EIPT IS FROM: git-IE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA REBY ACKNOWLEDGED OF THE SUM OF: L.ik AIL /. &If) on this ■Ip day of117 following described Ceme 1 y L4 conditions as stated here n: Description of Property: Cemetery Lot(s)/ Purchase Pric Dollars (.4" ) • , 19( for the purchase of the t (s) /41c #e -(--}- upon the terms and Terms and Condition of sale: Block C.7v Unit Dollars ($/ #5. �) 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: 4t----1,e ,44,71. The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and condi 'ons stated in the above instrument. Ci • of Seba a, .52 - `541/2,1 -2 <3,x IL15 /9 ods1d Sh', %/' 1 ed 6/96 -261 _Tan'elhb)/ QiYk Paid by CEMETERY Receipt No 894 Dated 5/24/96 Lots 19 & 20 List Price $ 1,000.00 Block 25 Maximum No Burial Spaces Uhi.t 4 Net Paid $ 1 000 00 Monument permitted (Data above this line for City Record only) NO. 1640