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Home My WebLink About4-21-27Name 1I 1 1�Y1 Gt / �cep rh i Unit Y Block — — I Lot --)-- —7 Date of Mark -out Date of Burial v ~' �2_ 7 i Name of Furneral Home Sec, a i Authorized by 6c,� t Y e r-n c)�I n� Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery . Contact Information: City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta0witvofsebastian.org Funeral Home:�UnWl40me - I L90 n I �' Address: S ��Se , I Phone: (�Ti J 1 5eq y Vi 66 O&L (q54) � Ili Cell (Che Open Burial Lot Open Cremains Lot Open Columbarium;Niche Burial Date and Service Time: . 0o ory) IWCN-Cl Deceased Name: a�syh Unit `-1 Unit Unit Block Block Block hidcc -K A is G Name and Signature of Lot Owner or Representative: (Must provide proper documentation of ownership) Print Name Signature Date Address Phone Number I certify that I have determined the ownership of the above -described site that all site fees and administrative fees have been paid and authorized opening of same. Name and Signature of Licensed Funeral Director: Print Name Signature Date I certify that I have checked the ownership information by viewing the owner's deed and confmni ng with Clerk's Office and that all fees have been paid: Cemetery Certification: 2 C�nete Date ry This form is to be provided to Clerk's Office for permanent record upon completion. 11 CITY OF SEBASTIAN 17052 FINANCE DEPARTMENT RECEIPT Name�� nonCfA5=IC5J ❑ Cash ''�� (nw d,� WCheck ll� rDatte -1 TC% ; �1R t' ❑ Credit , -'r�,, n 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 601010 343800 Cemetery Lot Sales �-� 001501 343805 Cemetery Fees> 480010 341920 Bldg Dept Copies PD Shop with a Cop PD COPE PD Cadets PD SRT e� Total Paid Initials White - Dept. of Origin • Yellow - Finance Dpt. - Pink -Applicant Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: City Clerk's Office Cathy Testa City Hall, 1225 Main .Street Sebastian, FL 32958 Phone (772) 388-8209 ctestaQcitvofsebastian.ona Funeral Home: e 1�tj��r�l (d Yeej Address:—r �6)jaCAC ii stbaiicn R 82.q�j -� T 5� Phone: � qW (�Tjj)21q4V � uN4 Cell (C]LeA 'ehd ) Open Burial Lot Unit4_ Block Lotj 9 + �� Open Cremains Lot Unit Block Lot El Open Columbarium Niche Unit Block Niche_ Gr j � P)QC ed . � Burial Date and Service Time: n m hi'� n `J Une 2� %(12 Deceased Name: 1141,ch(icl , s. lY l alar isc Name and Signature of Lot Owner or Representative: (Must provide proper documentation of ownership) Print Name Signature Date Address Phone Number I certify that I have determined the ownership of the above -described site that all site fees and administrative fees have been paid and authorized opening of same. Name and Signature of Licensed Funeral Director: Tor6 Print Name j Signature Date 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 Certification: Cemetery Date This form is to be provided to Clerk's Office for permanent record upon completion. I� or itu of £►rbastittn TP11tPfPX1� BPP• NO. THIS INDENTURE MADE This .... ?.$.th........... day of ..... DIP. VeMb .P,.r .......................... A. D., W..200O between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Brenda Rosian ........................................................................................................ ............................... 686 Layport Drive, Sebastian, Florida 32958 ...................................................................................................... ............................... of the County of ..Indian River ...................... ani State of ... Florida........ ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ l r 5 99 -.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: 25,26 All of Lot(s) .2.7.. .. , block, .2j ..... 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 rust above written. s r_edand °..� C ...... .......... City Clerk � ..... . .......... . .......... b ....................... STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By W. • • rJVIS.:" ............... Mayor (0fig deal) I HEREBY CERTIFY, That on this ........ 28th ......... day of ......... November ..... ........................mr -20DO before me personally appeared ,. Walter W. Barnes ........... and . Sal.ly..A...Maio ............... 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 Brenda Rosian .............................................. ......................................................................................... ........................................................ 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 r MY COMMISSION # CC 725842 ' ' . ' ' ' ' ' ' ' ' . ' Not Publle, State of Florida at La EXPIRES: Apr+130, 2002 �'��, _ Bonded Thru Notary Public underwriters My mmission expires: