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HomeMy WebLinkAbout4-23-35FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: John Young, Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 Jveranauda.citvofs ebastian. orq City Clerk's Office - Cathy Testa City Hall, 1225 Main Street, Sebastian, FL 32958 Office (772) 388-9215 or 388-8214 ctesta(d.citvofsebastian.ora FUNERAL HOME: Strunk Funeral Homes & Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE* 772-589-1000 (Check One) X OPEN BURIAL LOT Lot 35 Block 23 Unit 4 OPEN CREMAINS LOT Lot Block Unit OPEN COLUMBARIUM NICHE Niche Block Unit BURIAL DATE AND SERVICE TIME: Wednesday, February26, 2025 at 11am DECEASED NAME. Ora Junella Hassert Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) John M. Whalev _IohwM. whaled Name Signature 5 Flores Drive, Palmetto, Florida, 3422134221 1 certify that 1 have determined the ownership of the above describe to that all fees have been paid and authorize opening of same. / NAME AND SIGNATURE OF LICENSED FUNERAL DIR R: Mary Koochak _ Name Signatur February 20, 2025 Date site fees and administrative Date February 20, 2025 Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. j e"qE- Y2- Dt2--iu VR kkUTS 7 I loC�t (JC - trunk Funeral Homes & Crematory Cash Advance Account - Vero 916 17th Street Vero Beach FL 32960 PH. 772-562-2325 PAY One Hundred Fifty and 00/100 10 THE ORDEROF City of Sebastian 007200 i . n�.s 63-14241670 571 Beechland Boulevard Vero Beach, FL 32963 DATE AMOUNT 02/20/2025 150.00 W n F1228-25080 Hassert City of Sebastian O/C With Srvc - AUiHCRR[U 61GNAIDRE 61007 200o i:06 70 l4 2461: 10 L000 24 24iin CITY OF SEBASTIAN 16296 DEPARTMENT RECEIPT CFIINA�N1C'E �f�y Name � ` r 4 °j^,•� _j Cash Date Zl ZI I �v2� ''I Check N , 2OO J Credit Amount Paid 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001 208001 Sales Tax 450010 369900 Airport Badge 450010 362521 AP Shade Hangar Rent 450001 208045 Airport Sales Tax 001501 347557 Community Center Revenue 001501 341920 General Fund Copies 001501 354100 Code Enforcement Fines 001001 220030 PD Shop with a Cop 001001 220033 PD COPE 001001 220032 PD Cadets 010043 535270 PD Uniforms 601010 343800 Cemetery Lot Sales 001501 343805 Cemetery Fees 5C('✓1 C(i �.00 480010 341920 Bldg Dept Copies uVtifI- I+ , KDL'v,;�^Z7J. L63 a� �T K I Y I Total Paid 10,010 Initials • White - Dept. of Origin Yellow - Finance Dpt. • Pink - Applicant State of Florida, Department of Health, Bureau of Vital Statistics —' — BURIAL TRANSIT PERMIT HEALTH DATE PRINTED: February 21, 2025 TRACKING NUMBER: 2025037644 1. DECEDENT INFORMATION Name of Deceased Data of Death ORA JUNELLA HASSERT February 19, 2025 Place of Death -County City, Town or Location Name of facility, or street address if not a facility BREVARD PALM BAY LIFE CARE CENTER OF PALM BAY Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. NodReg. No. Phone Number STRUNK FUNERAL HOME- SEBASTIAN F041870 F041870 (772) 589-1000 1623 N CENTRAL AVE SEBASTIAN, FLORIDA, 32958 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No. Medical Verification Statement Tammy at the certifying physician's office, was contacted on 02/20/2025 by the funeral director listed above; he/she indicated that CHARLES EUGENE POTTS, certifying physician, will complete and sign the medical certification of cause of death within 72 hours. 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: 2025-FO41870-5027 �— Date Issued: February 20, 2025 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: Method of Disposition: 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 y~ ~if~ ~~ ~'P.~MB~tMIt ~Gi~ ~ ia~ ~ ~ ~ ~ ~ ~ ~ ~ ~ NO. THIS INDENTURE MADE TLL ......12.C1i......... day of ......... J~~-.y ............................. A. D.~..~r.QQl between tl-c City of Sebastian, a municipal corporation existing under the laws'of the State of Florida, as Grantor and ......................................... ~a~me>~ . E:... ~r...June.~..~ a ..Las se~>;.t............................ ............... 1732 Sunrise Lane .........................................Sebastiany.. •~'lor•ida• •32958.............. ................................. of the County of ...Indian,,Rver,,,,,,,,,,,,,,,,,,,,, anI State of ......~~-.9X7,C~~..................................... as Grantee, WITNE88ETHe That the Grantor for and in consideration of the sum of S 1 a.QQQ e QQ ............. to it in hand paid, the receipt whereof is herewith ao- 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) ~,~ Ss,~ ~ ,Block, . 2 3.... ,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 asxordance 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 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 fast 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. CITY OF SEBASTIAN, FLORIDA City Clerk ~gned, sled and Delivered in th esence ofs ., ~..__ TATS OF FLORIDA CO[1NTY OF INDIAN RIVER Mayor ((drtg ~fexl) I HEREBY CERTIFY, That on this .....~~~k'1............day of ........~1].~.X ......................... ........, ~C..2,~~1 before me personally appeared .......W$.~t~~..W.....~axlle.s ........................ and ..Sa11~.A...Ma1A.............. respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the individuals and officers described in and who executed the foregoing conveyance to ............................................James..,.. R~..,I~il~~-.~•r~..~~.s>~~xt............................................ ........................................................ and severally acknowledged the execution thereof to be their free act and deed as such officers tl-ereunto duly authorised; and that the Official seal of said corporation is duly affixed thereto, and the said Conveyance is the act and deed of said rnrporstIoa. WITNESS my signature and official seal at 9ebsstlan, In the County of Indian River and State of Florida, the day and year last aforesaid. ";. H.JOANNE SANDBERG ~ ~j~~ ...... . .. . . .................... _ : ;r_ MY COMMISSION # CC 725842 No Public, State of Florida at EXPIRES: App 30, x(12 M commission expires s jk Bonded Thru NolEtry Pu6BC Undenr8sers ._ ~ DIY Ci Ss~ H©M~ OF PEL~CA~N ISLAND July 16, 2001 James E. or Junella Hassert 1732 Sunrise Lane Sebastian, Florida 32958 Dear Mr. & Mrs. Hassert: Enclosed is City of Sebastian Cemetery Deed No. 01806 for Cemetery Lots 35 & 36, Block 23, Unit 4. Also enclosed is a copy ofyour receipt. If you have any questions, please contact our office. Sinc y, ~~ Sally A. M ' MC City Clerk -.t The Sebastian Ce~ne~e~ry City ®f Sebastian, Florida Receipt is aclrnowledged in the sum of: Dollars ($ /, ~d . /lam ) From: ~~' S ~, ~'~ ~J~/~,C~/~ ,z`z`,~~~~?`' ~on .this /o~~ day of 20.0 / for the purchase of the following dcscdbed Cemetery Lot(s) ctye(~' upon the teens and conditions as stated herein: D~.scription of Properly: Cemetery Lot(s)~che(s) ~~h ~~~_ Block ~~~ Unit Puichase Price: ~ ~~~~~ Dollars .($ /;~ .~ ) Terms and Condition of Sale: This contraet.shah 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 teams and conditions stated in the foregoing instrument: Pur s tore Purchaser signature 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 'ty of Sebastian Witness ~ .,~ ±~ ~. CITY t>F SEt~ASTIAN ` CITY CLERK'S: OFFICE RECEIPT Y.,.i Name ~f ~ ~.~ ~., ^ Cash Date_ ~ f^ f~n '_ rr1',,1r ~Chaclt /_ ,~~- f- . - - { 001001208001 Sales Tax 001501322900 Garage Sales - 001501341920 CopieslBid Specs. 001501341910 LDClCode of Ordnances . 001501362100• Cammunigr Center Rent . . 001501062100 Yacht Club Rent 001501362150 Non Taxable Rent a 001501343800 Cemetery Lols ~ ~ "/? ,~~ ;4 601010 343800 Cemetery Lots ~/Ar. rf y lotMiche. * 1 Block ~°v'„~, Unit ~ J 001501369400. Interment Fee 001501369400 Weekend Service 680800220681 Yacht Club Security Deposit 680800 220682 Community Center•$ecurity Deposit 680800220683 Riverview Park Security Depoeii ~ r; / f y;~ ''~f~ ToWPald 1~~~'~y',~.~% .: >` Initials WNtr- ~. ~ ~!'N~n •: fellow - finance • Plnk -Applicant HASSERT, JAMES E. OR JUNELLA 1732 SUNRISE LANE SEBASTIAN, FLORIDA ~~3'29~58 LOTS 35 & 36, block 23, UNIT 4 DEED ~~ 01806 G~ G . ~~ ..~uLUed'pCe-~3~' 7-d7O/ Paid by CEMETERY Receipt No.... Q $ 9 9 , , . , ~ ... Dated .....7. x,12 (2 QQ 1. . 1 000.00 .......... No. List Price $ ... ; .. Maximum No. Burial spaces ............ LOTS 3 5 & 3 6 , $ L O G K 2 3 NetPaid$ ...1,000:,00 ""' , UNIT 4 .. Monument permitted ....................... (+ 1 e (Data above tt~fe line for City Record only) r