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HomeMy WebLinkAbout4-22-07HELYN F. WOJTAN August 1, 1928 - February 18, 2016 Helyn F. Wojtan, 87, of Clermont, FL passed away February 18, 2016 at Edgewater at Waterman in Mount Dora, FL. Helyn is survived by her son, Denis T. Wojtan, of Clermont, FL; two grandsons, Denis V. Wojtan of North Carolina and John W. Wojtan of Fort Lauderdale; two great-grandchildren and one great -great grandchild. �tt�1 itf �P�tMSftMIt (� y » ♦ 01842 NO. THIS INDENTURE MADE Ills ....8TH ............. day of .........APRIL...... I..................... A. D., W 2002 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ................................................. HELYN.OX WOJTAN P.O. B78098.9........................................................... .................................................SEBASTIAN.,. FLORIDA. 329.78........................................... of the County of ......INDIAN . RIVER... , , , .... , anti State of ....... FLORIDA .............................................. as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $„1 x.900 '00... * ..., . . . , to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm uo the Grantee .. , ..... , heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Allof Lot(s) , Tt 8 . , Block, .. 2? , , , UNIT ,,, ,, , , , , , , , , of Sebastian municipal cemetery as per Plat Number i 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. ..... >....... (/`.j./.. ......... City Clerk Signed, Sealed and Delivered In the Presence of: STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By......... Mayor (ctg �sral) I HEREBY CERTIFY, That on this ...$th................day of ......April..................................... W 2002 before me personally appeared .....Walter W. Barnes Sall A. Maio and.........y ............................ 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 ............................................. Helyn..WQj.tan................................................................ ...... ..............:................................... 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 c�i.� .Cil/ k ? MY COMMISSION # CC 725842 Notary , Gblic, State of Florida at Larg . EXPIRES: Apri130, 2002 My co lesion explret t 2Q' * h,. Bonded Thru Notary Public Underwriters April 22, 2002 Helen Wojtan P.O. Box 780989 Sebastian, Florida 32958 Dear Mrs. Wojtan: Enclosed is City of Sebastian Cemetery Deed No. 01842 for Cemetery Lots 7 and 8, Block 22, Unit 4. Also enclosed is a copy of your receipt. If you have any questions, please contact our office. ce ly, ally A. "o, CMC City tler SAM:js enclosures fraf C\1 © ce N c © a J 0 69 I O i y .a 4W- f7� a Ln O O ru I Z � O d Q N m Ln Wy O 0 CD M .. Z0�N O LL _ ICV Ncl- Q- o WQ - m- ZW a)O= —? m = v rr d W Z � nQ) e Ln Z > aC ru = 0 8a5, ru Ic b Ail Os _ N S O H it V II� o Ili A „ z ° �IIN WW = (L0 °o tJ LL ve unviawyaNaapO X.11 ® 111/Id1111. CITY OF SEBASTIAN �' CITY CLERK'S OFFICE •) 'j RECEIPT Name />iA�"s / <0�'��.2� ❑ Cash Date �� Check#, Amount Pa 001001208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501 362100 Community Center Rent 001501362100 Yacht Club Rent 001501362`150 Non Taxable Rent 001501 343800 Cemetery Lots 601010 343800 Cemetery Lots Lol/Niche #—I Block �_, Unit 001501 369400 Interment Fee 001501 369400 Weekend Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 680800 220683 Riverview Park Security Deposit Total Pald Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant WOJTAN,.HELYN DEED #01842 P.O. BO$ 780989 SEBASTIAN, FLORIDA 32978 LOTS,7 & 8, BLOCK 22, UNIT 4 JAN W. WOJTAN INTERRED IN LOT 8 ON 4/5/2002 4 a 0 H H z Cit w ' N N I O z O U o PCI 1� H w H00 O 3 ul � x O p: N: o 00: y "" 10 al z ' ad 4 a 0 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY Nom( d PILKAN KLMO 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 411fce (772) 388-8215 or 3888214 Fax: (772) 589.5570 FUNERAL HOME:�,� �� f %t�' ZZ - ADDRESS: 10 dy1r- PHONE #: (Check One) . X QPEN BURIAL LOT Lot ��_Block Unit _OPEN CREMAINS LOT Lot ___Block 'Unit PEN COLUMOARIUM NICHE Niche Block'- Unit W BURIAL DATE AND SERVICE TIME: b %� FOR DECEASED:F Na4. el NAME AND SIGNATURE OF LOT OWNER OR REPRES TA IV : (Must provide proper documentation of ownership) Name ign Date I certify that I have determined the ownership o/Khe ab ve described site that all site fees and administrative fees hake been paid and authorize open of same NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR. /0, Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office Lind that all fees have been paid -ix40 4?- /6-�L l Cem ry xton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. 110 State of Florida, Department of Health, Bureau of Vital Statistics BURIAL TRANSIT PERMIT DATE PRINTED: February 23, 2016 TRACKING NUMBER: 2016028167 1. DECEDENT INFORMATION Name of Deceased Date of Death HELYN F WOJTAN February 19, 2016 Place of Death - County City, Town or Location Name of facility, or street address if not a facility LAKE MOUNT DORA EDGEWATER AT WATERMAN VILLAGE Name and Address of Funeral Home/Direct Disposal Establishment Fla. Lic. No./Reg. No. Phone Number BREWER & SONS FUNERAL HOME - CLERMONT F040703 F040703 (352) 688-4991 1018 WEST AVE CLERMONT, FLORIDA, 34711 Funeral Director/Direct Disposer Fla. Lic. No./Reg. No. TAMMY M. TOLBERT F020443 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: 2016-Fo40703-5021 ��y'------ Date Issued: February 19, 2016 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 CEMETERY 2 Method of Disposition: BURIAL Date of Disposition: Zc3 r!6 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 Name Unit_ Block Lot Date of Mark -out 2, �`�� , %. , 4A Date of Burial -1. � 14, Time a S[n Name of Funeral H e El.c �t� � --- Authorized by , CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT 9985 Name r�wer & Sons Fune-bash 2/24/16 Date W Check # � n�3 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501 362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 343805 o/C 150.00 U4, B22, L7 Total Paid 150.00 I iti White - Dept. of Origin • Yellow - Finance • Pink - Applicant