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Home My WebLink About4-22-12Name —K i C. Unit Lot Date of Mark -out 0 Date of Burial -- -j Li ---__ Time Name of Funeral Home A Authorized by RUDOLPH, MARTHA 1507 SPINNAKER LANE SEBASTIAN, FLORIDA 32958 DEED #1781 LOT 12, block 22, UNIT 4 Richard E. Rudolph interred 3/10/01 CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name D Cash 0 No. U 11�51t/ ) Amourd Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC/Code of Ordinances 001501 362100 Community Center Rent 001501 062100 Yacht Club Rent 001501 362150 Non Taxable Renl 001501 343800 Cemetery Lots 601010343800 Cemetery Lots Lot/Niche , Block , Unit 001501 369400 Interment Fee 001501369400 Weekend Service 680800 220681 Yachl Club Security Deposit 680800220682 Community Center Security Deposit 680800 220683 Riverview Park Security Deposit Total Paid Initials White — Dept. of Origin • Yellow — Finance • Pink - Applicant 150 ^{ S (iV�rvY1�s IGw 1v0�na,. 3a9S$ P (�)'..& F.. R,,d..LJ, LL' -J .max.. 41 (3111 aa,, koT I2 MUNK 1623 N3N "UNERAL HOME o, Central Avenue SEBASTIAN FL 32958 (561) 589.1000 Tito of #Phastiun Temptrry Deed NO. THIS INDENTURE MADE ThL ..... Uth.......... day of ...... Ma. rch .............................. A. D.,=..20.01 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ............. ............................... Martha Ru doleh. ............................... 1507 Spinnaker Lane .............................................. S. ebast. ian,... Flor. ida.. 3. 295 58 ... ............................................ of the County of ...Indian , River ..................... anal State of ....'. S?. ic"...................................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ . 5 P o, . 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 Lots) . AL. , Block, . 2 ? , , , , UNIT ....4.. , ..... , 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 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 first above written. Attest: .! ! : ........................ City Clerk VnedSeal/ed Delivered f:L� STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By . I�I.UU�!� ............... Mayor ((llity 'Sta1) I HEREBY CERTIFY, That on this ....12th. _ .... _ ... „ _day of ........ March .... ............................... XK ..2,001 before me personally appeared ...Walter W. Barnes ............................. and ..Sa�ay.�.... $a, L2.............. 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 cowveyance to .......................... .........................Martha Rudolph............................ ............................... ........................................................ 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 SANQI3ERG 1/ i. ;.: ..= MY COMMISSION # CC 725842 Not/mmission lic, State of Florida at Larg EXPIRES: April 30, 2002 My expires: �lpf�ty;' Bonded Thru Notary Pubfic underwriters Paid by CEMETERY Receipt No. ..............Dated ... Max c h..12 List Price $ ... . 5 9 9 . Q • ... Maximum No. Burial Spaces . . Vet Paid $ ..... Q Q r .Q Q . ............. . Monument permitted ...................... . s 9 i i • e O a � C � O, (Data above this line for City Record only) Martha Rudolph Lot 12, Block 22, Unit 4 NO. o m < c O c m Q p' n m ib CL `2 (n> 'n r r Z -� c of � x C.) z y O �gv _ a_ ❑ A X00 0 =N A m F Sta*Florida, Department of Health, Vital S *ics y APPLICATION FOR BURIAL - TRANSIT PERMIT A !TYPE\ 1. Name of First Middle Last Date Month Day Year Deceased of Richard E. Rudolph Death March 5 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Sebastian Inst. 1507 Spinnaker Lane 3. Name of Medical Address Phone Number Certifier Frederick Week , M.D. 1460 36th Street Vero Beach, FL 561 - 561 -7777 Medical Examiner Physician 4. Name of Funeral Home /3fte -Bispttsal' Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian, FL 1228 561- 589 -1000 5. Check a. U The medical cernricanon nas Deen compieteo ana signea. A completeo cerancate of oeam accomparnes irns Appropriate application. Box b. Megan was contacted on 3/5/01 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Weeks 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 edi ication ,Af c#tWof death within 72 hours. 6. Funeral Director/ gnatur e F.E. No. /Reg. No. Date Signed 1862 3/5/01 Lli.un+ rlicnncwr _ � , B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -01 -0121 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. �i No extension of time for filing the death certificate has been requested. ftReglist a a Date Date Certificate Subregistrar Signature Issued: p Due: 311t, l O 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. Method of Disposition: BURIAL CREMATION Signature of Sexton or Person -in- Charge STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery 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. Distribution: while: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow Funeral Director or Direct Disposer (Stock Number: 5740. 00(3- 0326.2) Pink: Local Registrar MY OF SEBASTIAN MD 1225 IvNEPf • $°U§QWN!%A 32958 TELEPHONE: (561) 589 -5330 • FAX (561) 589 -5570 March 15, 2001 Martha Rudolph 1507 Spinnaker Lane Sebastian, Florida 32958 Dear Ms. Rudolph: Enclosed is Cemetery Deed number 1781 for Lot No. 12, Block 22, Unit 4 Also enclosed is a form - Return for Transfers of Interest in Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court, when and if you have the deed recorded. A copy of the receipt is enclosed for your records. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, 2000 16th Avenue, Vero Beach, Florida 32960. If you have any questions, please contact our office. S' ref 4W—_ y . Maio MC City Cler SAM/j s Enclosures An Equal Opportunity Employer" Celebrating Our 75th Anniversary The Sebastian Cemetery City of Sebastian, Florida Receipt is acknowledged in the sum of: Dollars ($ From: i on this %r day of �_� 20_LZ for the purchase of the following described Cemetery Lot(s)INich (s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)/Niche(s) /07 Block A9 Unit _�/- Purchase Price: /� Q Dollars.($ 's-ee. /% y ) 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: 1, or we, agree to purchase the above described property on the terms. and conditions stated in the foregoing instrument: Purchaser signature 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. City of Sebastian Witness