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Home My WebLink About4-21-30(aiitu of Orhafit"n Prmptrry a je r b NO. THIS INDENTURE MADE Tlsls ......29.th......... day of .......September A. D,gX. 2Q00 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ................... ............................... Charles A. and Alice M. Werner 1249 W. Oleander Circle ....................................... ...... Ba r e f.o,o t ..Bay,...Fl o r.i.da . 32-976 ................................... of the County of ........ 1p.d. ala.Ravex ................ an-.1 State of ...... F. 1. orida..................................... as Grantee, WITNESSETHt That the Grantor for and in consideration of the sum of $ , ;1, s .. Q . ............. 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) . 2t9.4 3 9Block, . 21, , , , , 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: rk��' CITY OF SEBASTIAN, FLORIDA X d, Se d and Delivered P lice of• STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ......29th ...........day of By . V.V. OJ Y)...V �!. CAS!`!? ,! ............ . Mayor (cty �sgal) ......S.eptember .............................9M . 2,000 before me personally appeared .... Walt.er..W...Barnes ....: ..................... and Kathryn..M...Q'.Halloran.. 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 .................. ......................Charles A .. �......Alice....... Werner.............. ............................... er ...................................... 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 BANDBERf ... ..... ............ :x. MY COMMISSION # CC 725842 Nots ublic, State of Florida at Lar EXPIRES: April 30, 2002 My c fission expires s ;o of Bonded ThN Notary Pubk Undernd:ers �9 �, aB., 3e. 6._ i��/ 6 y Unit Block Lot -Z_ �. -It� - —:) 1-) 14, Date OT Mark-ou Date of Burial----- Name of Funeral Ho 77 Authorized by Z 0 0 -a C> T CD M rlM !R M M C-) CO) :5 CO) --4 0 • MZ =r o a vii 0 S FLORIDA DEPARTMENT OF HEALT A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT 1. Name of First Middle Last Date Month Day Year Deceased of Alice Marie Werner Death April 20 2009 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay Inst. Palm Bay Hospital 3. Name of Medical Address Phone Number Certifier Ashish 0J a, M. I 5305 Babcock Street MMedical Examiner thysician Palm Bay, FL 321 - 676 -9009 4. Name of Funeral Home /Wee l9ispftl Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) 1623 N. Central Ave. Establishment trunk Funeral Home >; Cremato Sebastian, FL 1228 772- 589 -1000 5. Check a. U The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. Darlene was contacted on 4/21/09 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr- Ojha 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 ificaf n of se of death within 72 hours. 6. Funeral Director/ gn tre F.E. No. /Reg. No. Date Signed D; rA icp�ei i 44048 4/21/09 B. I BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-09-0190 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. [:]No extension of time for filing the death certificate has been requested. R*84810 ere Date Date Certificate Subregistrar Signature T (� , Issued: 4/21/09 Dye: 4/26/09 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 BURIAL OCREMATION Signature of Sexton or Person -in- Charge ❑STORAGE FIOTHER (Specify) 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: White: Cemetery or Crematory DH 326, 6/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740 -000 -0326 -2) Pink: Local Registrar ,fty-,, i. P-r- Sep 26 2008 2:45PM HP LRSERJE:T 3200 FUNERAL DIRECT FOR BURIAL OPENI FJNERAL HOME: ADDRESS: PHONE #: Se R'S REQUEST TO CITY OF SEBASTIAN G IN SEBASTIAN MUNICIPAL CEMETERY g �BasrtlgN WAI V PILIGV. ISLAND For inforrnatior contact: > Kelso - Cemetery Sexton )3stian Municipal Cemetery (772) 589 -2545 I City Clerk's Uffice ity 1 -1al,, 1225 Main 8frast i Sebastian, FL 32958 0/!ic (772) 388 -8215 or 388 -8214 Fax: (772) 589.5570 STRUNK FUNERAL HOME & CREMATORY 1671 Nn rant.-.1 A.— Fl. 32958 (Che k One) ✓✓ OPEN BURIAL LOT LI l ` 30 Block 21 Unit 4 OPEN CREMAINS LOT L�t_Block Unit OPEN COLUMBARIUM NICHE Nuche Block Unit - I W BURIAL DATE AND SERV!Ci; TIME: 14/28/09 2:00 P.M. F OR DECEASED: Alice Marie Verner Ivarle �_ :JANE AND SIGNAT;.; OF LOT OW ER OR REPR VTATIU ( "Aust rovide proper cumentation of wners le Name Signature Date I certify tnat I have determined the owne ship of the above described site That all site fees and adrninislrative fees have been paid and Outhorize opening of sam NAME AND SIGNATJ OF LICENSES FUNER IR rvarne-------------- ------------------------ - - - - {- -- fiignat re. .._..__.......__...------ - - - -•----------------- DatA.__ ... Cemetery Sexton, Certification: I certify that l have checked the oviners ip inforn;�3tion by viewing the owner's deed and confirming with Clerk's office and that all fees have een paid Cemetery Sexton, Date This fora to be provided to Clerk's OfLc by Sexton for perrnanert record upon compietion. P. 1