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Certificate No. 2074
CITY Of SEBASTIAN
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, F1 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 °d day of March 2006.
CITY OF S ASTIAN, FLORIDA A T:
Minner
Manager
.ly Maio, MMC
City Clerk
..
Name
Unit
Block
Lot
Date of Mark-out �-Z A
Date of Burial Time
Name of Funeral Kom
FLORIDA DEPARTMENT OF
HEALT State of Florida, Department of Health, Vital Statistics •
APPLICATION FOR BURIAL - TRANSIT PERMIT
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
Forest Abbott Carpenter Death March 21 2006
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Vero Beach Inst. Indian River Memorial Hospital
3. Name of Medical Address Phone Number
Certifier George A. Mitchell, D.O. 1000 36th Street, Vero Beach, Florida 32960 (772) 567 -4311
F-Imedical Examiner X physician
4. Name of Funeral Home /Direct Disposal Address Fla. Lic. No. /Reg. No. Phone No. (Area Code)
Establishment 1655 27th Street
Thomas S. Lowther Funeral Home Vero Beach, Florida 32960 2559 (772) 778 -3233
5. Check a. The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. E George A. Mitchell, D.O. was contacted on 3/22/2006
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 within 72 hours.
C. was contacted on He /she verified that
Medical Examiner, will complete and sign the
medical certification of cause of death within 72 hours.
6. Funeral Director/ Signature F.E. No. /Reg, No. Date Signed
Direct Disposer _ 2588 March 22, 2006
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 2559 -06 -076
® A 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.
nNo extension of time for filing the death certificate has been „requested.
Registrar or /17 / I Date Date Certificate
V 411-
Subregistrar Signature LL:* 7r, CI �--°—~� --.. issued: March 22, 2006 Dye: April 7, 2006
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 of Disposition: Place of Disposition Sebastian Cemetery
r9 BURIAL FISTORAGE Date of Disposition March 24, 2006
CREMATION
Signature of Sexton
or Person -in- Charge
OTHER (Specify)
) - 'e�� a '7
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
Within 10 days to the local County Health Department in the county where disposition occurred.
DH 326, 8197 (obsoletes all previous editions) Distribution: White: Cemetery or Crematory
(Stock Number. 5740. 0040326 -2) ) Pink: Funeral
oca Reg Director «or Dived Disposer
®� w
CITY OF SEBASTIAN
CHECK REQUEST
Accounting Use Only
Input Date 3/10/2004 Fiscal Period
Document # Entered By
Document Amount # of Lines Total HC Hash
Due Date
To Be Completed By Department
3/12/2004 Single Check Y Vendor Number
LN
TC
Document
Reference
Organization
Code
Object
Code
Project
Code
Amount
601010
534959
$17400.00
Description
Number of Lines Amount $1,400.00
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 (copy attached)
ISSUE CHECK TO
NAME
Kevin J. Paulkner
ADDRESS
487 Bywood Avenue
CITY
Sebastian,,---) STATE FL ZIP 32958
Check Drawr By /
APPROVED BY -
DATE -.3 /0
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
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�i.►' r ut r t.r r y D e r b NO.
THIS INDENTURE MADE Tkis .......26TH........ day of ........ JUL Y .............................. A. D.,XA .... ?.Q02
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
................................. JOHN..L WELCH,..JR._.AND, /OR..KEVIN. J,.... PAUKNER ..........................
487 BYWOOD AVENUE, SEBASTIAN, FLORIDA 32958
...................................................................................................... ...............................
of the County of .....INDIAN RIVER anal State of FLORIDA
as Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $ .1, n 4 Q Q -.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 ......... heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
All of Lot(s) 1.3 & L 4, Block, ..? 4 ... , 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 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: . . . . . . . . .....................................
IS . . . .
City Clerk
Signed, Sealed and Delivered
in the Presence of:
YK.......... .
..........
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
By ..v;Cn.11.i. ...............
Mayor
(Citg deal)
I HEREBY CERTIFY, That on this ..... 261H ............ day of ..... JULY ................ ....................... .XN..2QO2
before me personally appeared ..... WALTER W BARNES ............. . . . ......... and .. $AL.L Y.. A . MAI Q, .............
respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known
to be the individuals and officers described in and who executed the foregoing conveyance to
JOHN L. WELCH, JR. AND /OR KEVIN J. PAUKNER
......................... ............................... and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance
is the act and deed of said corporation.
WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year
last aforesaid.
H. JOANNE SANDBERG
AMY COMMISSION # DD 089532
. EXPIRES: 6130, 2006 Notary ublic, State of Florida at
8wded Thru Noy" PWbc undmnm:ers My commission expires s
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CITY OF SEBASTIAN f 1 ; (�
CITY CLERK'S OFFICE 0 t J
RECEIPT
!�
Name �jl G`if ^ "9 x,-0,!5re 0 Cash
Date Check #_2Z _
AmountPaid
001001208001
Sales Tax
001501 322900
Garage Sales
001501 341920
Copies/Bid Specs.
001501 341910
LDC /Code of Ordinances
001501362100
Community Center Rent
001501362100
Yacht Club Rent
001501 362150
Non Taxable Rent
001501343800
Cemetery Lots
601010 343800
Cemetery Lots
Lot/Niche �XF—t&Block_, Unit
W 001501 369400
Interment Fee
m 001501 369400
Weekend Service
° 680800 220681
Yacht Club Security Deposit
680800 220682
Community Center Security Deposit
680800 220683
Riverview Park Security Deposit
co
N
Total Paid 1,AZ
Initials
White — Dept, of Origin a Yellow — Finance a Pink • Applicent
1�6
The Sebastian Cemetery
City of Sebastian, Florida
Receipt is acknowledged in the sum of:
Y=
From: r-J o #ilk �f�� Cf/ '9'tJ�`
Dollars ($
3:52 Z5" E
on this day of 20 for the purchase of the following
described Cemetery Lot(s) ) upon the terms and conditions as stated herein:
Description of Property:
Cemetery Lot(s)/Niche(s) Block Unit
Purchase Price: � 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:
Iq Oft
6gThaser signature
Q,c� Cti
Purchaser si ature
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.
n
�07-ity of Sebastian Witness
(lit, of #rhastittn
y}� A ; � 018 52
S NO.
THIS INDENTURE MADE Thla ....... 2.6TH........ day of ........ JUL X .............................. A. D,yJ .... 2Q02
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
.................................. JOHN..L._, WELCH,..JR. AND /OR KEVIN. J,. . PAUKNER ..........................
487 BYWOOD AVENUE, SEBASTIAN, FLORIDA 32958
............................................. ............................................ ............... I............................
of the County of .....INDIAN RIVER and State of FLORIDA
.......................... ........................ ...............................
as Grantee, WITNESSETHe
That the Grantor for and in consideration of the sum of $ , 1 s 4Q 0 -.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 , , , . , , , . , heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to -wit:
All of Lot(s) 1,3A 14, Block, .. ?A .. , , 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: .� . .........................
City Clerk
Signed, Sealed and Delivered
In the Presence of:
...........
. ..........
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA
By ..V1J. Ilk. 4 . �J.. A .............. .
Mayor
((ility 'sgxl)
I HEREBY CERTIFY, That on this .....Z6.TH ............ day of ..... JULY ............... .........................XJ§..2Q 02
before me personally appeared ..... WAL TER„ W ., BARNES ...... and .. $AL.L X.. A t„ MAI Q, , , , , , , , , , , , , ,
respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known
to be the individuals and officers described in and who executed the foregoing conveyance to
JOHN L_...WELCH,. JR. AND /OR KEVIN..J... PAUKNER
....... ..... ...
......................... ............................... and severally acknowledged the execution thereof to be their free act and deed
as such officers thereunto duly authorized; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance
is the act and deed of said corporation.
WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year
Inst nfareRaid.
H. ' Y Py = MY COMMISSION # DD 089532 I�' -� . .... ... ....................
*° �- Notary ublic, State of Fiorida at L
pf t aondaddThru a� n U2� ars My commission expires:
July 30, 2002
John L. Welch, Jr. and
Kevin J. Paukner
487 Bywood Avenue
Sebastian, Florida 32958
Dear Mr. Welch & Mr. Paukner:
Enclosed is City of Sebastian Deed number 1852 for cemetery lots 13 & 14, block 24, unit 4.
Also enclosed is a copy of your receipt.
If you have any questions, please contact our office.
Sin tefeDy 4
CS y . Maio MC
City Clerk
SAM:js
enclosure
The Sebastian Cemetery
City of Sebastian, Florida
Receipt is acknowledged in the sum of.
Dollars ($ / iD`t� -d0 )
From: ,�/ C��i� - G�/ L Cf/ r,7,� . Ab lDf' c G /i�;
IS 7
7-Mt)-
on this day of 20 for the purchase of the following
descri bed Cemetery Lots) ) upon the terms and conditions as stated herein:
Description of Property.
Cemetery Lot(s)/Niche(s) --Block "2�/ Unit
Purchase Price:
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:
chaser signature
Purchaser si ature
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.
n
zty of Sebastian
Witness