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Home My WebLink About4-24-13Unit Block Lot �3 Date of Mark -out Date of Burial /• Time 'SOX'c9go 5 Name of Funeral Home /O�r ; 4 — Authorized by ./" 10/19/2015 13:02 7722287079 COS AIR BLDG PAGE 02/03 FUNERAL DIRECTOR'S REQUEST TO CITY OF SE12ASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEBAST tMme a reuCw isu.ND 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 FUNERAL HOME: ADDRESS: PHONE#: »L- 3 2 3 3' (Check ne) OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: Name Lot _i'� Block Unit Lot Block Unit Niche Block Unit N_S_E_W NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) , Name Signature Date 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 FU A ECTOR: c. LOA -,- Name tO i,- Name Signature Date Cemetery Sexton Certification: I certify that 1 have checked the ownership information by viewing the owner's deed and confrminc with Clerk's office and at all fees have been paid: �� CemqAery Sextbri 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 pl�ll�li•�I BURIAL TRANSIT PERMIT fHFdITH DATE PRINTED: October 21, 2015 TRACKING NUMBER: 2015157756 1. DECEDENT INFORMATION Name of Deceased Date of Death BARBARA A CARPENTER October 19, 2015 Place of Death - County City, Town or Location Name of facility, or street address if not a facility INDIAN RIVER VERO BEACH INDIAN RIVER MEDICAL CENTER Name and Address of Funeral HomelDirect Disposal Establishment Fla. Lie. No.1Reg. No. Phone Number THOMAS S LOWTHER FUNERAL HOME F041584 F041584 (772) 778-3233 1655 277H ST - VEROBEACH, FLORIDA, 32960 Funeral Director/Direct Disposer Fla. Lie. No.1Reg. No. RYAN LOWTHER F076689 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: 2015-e -5207 �— Date Issued: Octoberr 19, 19, 2 2015 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 MUNICIPAL CEMTERY 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 T7� '86 (AT Of 4Z 4 51� HOME OF PELICAN ISLAND Certificate No. 2074 CIS` OF STIA Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: John Carpenter S Seashore Lane, Vero Beach, Fl 32960 (name) (address) in and for consideration of the sum of $1,900.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit 4_ Block 24 Lot(s)Niche(s)_13 & 14 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 24 n day of March 2006. Cny OF SEBASTIAN, FLORIDA A T: 7, *Mimer S ly Maio, MMC ger City Clerk aly OF HOME OF PELIW, M&ND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be proved at time of purcbam N Address 77,,? - Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: on this day of 20p,, for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit , Block , Lot(s)/294/Z _Niche(s) for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: S'oa Corner Markers (set of 4 - $20) Opening &Closing � �V� O H Circle One Vase and Ring for Niches (cost) Interment Disinterment $�97s-aa-aa Signature of Purchaser of Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEIPT.doc a 0 o_I I:, CO COT o S S S S S o OD OC� t0 t0 CO pp S O O O O O A A t M;; '0 CA Q � m g m m CA) THOMAS S. LOWTHER 6704 FUNERAL HOME AND CREMATORY 1655 27TH STREET FT. PIERCE. FLORIDA 33151 VERO BEACH, FL 32960 NUMBER 6702 (772)778-3233 63-8419/2670 03/23/06 1,975.00 DATE AMOUNT **Nineteen Hundred Seventy-five And 00/100 Dollars********F***************'"*''***'t**"'"'*"�"'�*'"*****'"'�** PAY TO THE ORDER City of Sebastian OF carpenter cem. prop. 000670411' is 267084 L99i: 2 60000 1 5 1 5 3 9011' MY Of 44 al F HOME OF FILA ISLAND 1225 Main Street, Sebastian, Fl 32958 Telephone (772) 589-5330 — Fax (772) 589-5570 March 24, 2006 John Carpenter 5 Seashore Lane Vero Beach, Fl 32960 Dear Mr. Carpenter: Enclosed is City of Sebastian Certificate 2074 entitling you to full interment rights in Cemetery Lots 13 & 14, Block 24, Unit 4. Also enclosed is a copy of the receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. S�ncerely, Sally aio, MMC City Clerk SAM:ar enclosure CITY OF SEBASTIAN CHECK RE VEST Accounting Use Only Input Date 3/10/2004 Fiscal Period Document # Entered By Document Amount # of Lines Total HC Hash To Be Completed By Department Due Date 3/12/2004 Single Check Y Vendor Number. IN TC Document Reference Organization Code Object Code Project Code Amount 601010 534959 $17400.00 Number of Lines Amount $1,400.00 Description Buy back of 2 cemetery lots (Unit 4, Block 24, Lots 13 & 14) purchased July 26, 2002. Original deed received in Clerk's Office on 3/10/04 (cop attached) ISSUE CHECK TO NAME Kevin J. Pawner ADDRESS 487 Bywood Avenue CITY Sebastian , STATE FL ZIP 32958 Check Drawr By APPROVED BY DATE L5/O BUDGET APPROVAL (534000 AND 535450 ONLY) MAIL ATTACHED DOCUMENTATION (Except for remit slips, requesting department should attach a copy of documentation along with the original) Please make a copy of check for Clerk files. Thanks, Ann 0 (situ of offiastialt X1852 *COPY (1rutettr ' Berb NO. THIS INDENTURE MADE This .......2.61H........ day of ........,JUS Y .............................. A. D.,)W .... ZQD2 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .................................. L WELCH, JR,. AND/OR KEVIN J. _PAUKNER .......................... 487 BYWOOD AVENUE, SEBASTIAN, FLORIDA 32958 ...................................................................................................................................... of the County of .....INDIAN RIVER FLORIDA ..................... ani State of .................................................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ .1. ! 4 Q Q -.0 Q ............ 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) 13 & 14, Block, 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 iuch rules, regulations, resolutions and ordinances and the conditions of the dried 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 fust above written. Attest:..... ......... ........... City Clerk Signed, Sealed and Delivered in the Presence of: ............. ............ STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA ByVI W. ............... Mayor ((ffitv deal) I HEREBY CERTIFY, That on this ..... Z6.TH............ day of .....JULY........................................X11..2.QO2 before me personally appeared ..... WAL TER, , W, BAR NE..S . and .. $AU Y_ . A,.. MA I Q, . ........................ ........... respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals and officers described in and who executed the foregoing conveyance to JOHNL. WELCH, JR. AND/OR KEVIN J. .PAUKNER ......................... and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. LL=i0v 1H. JOANNE SANDBERGMY COMMISSION#DD 089532 "" """"""""""EXPIRES: Apol A 2006 Notary ublie, State of Florida atOwdedThmMdarywbficunderwrftm My commission expires: - .. The Sebastian Cemetery Cit' of Sebastian, Florida Receipt is acknowledged in the sum of: Dollars ($ From: on this y of 204 ' for the purchase of the following described Cemetery Lots) ) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)/Niche(s) Blod-, Unit Purchase Price: Zinr,��.r 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: ; L� chaser signature tjl Purchaser siglqature The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. ity of Sebastian Witness 001501 341920 Copies/Bid Specs. i 001501 341910 LDC/Code of Ordinances 001501362100 Community Center Rent 001501362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 601010 343800 Cemetery Lots Lot/Niche . " - � Block 001501 369400 Interment Fee 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 68M 220683 Riverview ParkSecurity deposit 9 t I TOM Paid IVoldto— DW. of Oripin • Yellow - Finan • Pick •, Applicant