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Home My WebLink About4-21-34CITY OF SEBASTIAN CITY CLERICS OFFICE RECEIPT No. / / 20 001001 205001 Sales Tax 001501322900 Garage Sales 001501341920 CopleslBld Specs. 001501341910 LDC/Code of Ordinances 001501 341930 Election OuallIft Fees 601010 343500 Cemetery Lab LoUNIche Block Unit 001501343805 Ce��me'tte, Few .Git iL�$'pRI 3416 ack>N� Amount Paid i Total Paid en? Initials White- Dept. of Origin 0 Te low—Finance • Pink • Applicant Francis E. Erickson, Vero Beach Francis E. Erickson, 76, died.Oct. 8, 2005, at Indian River Memorial Hos- pitalin Vero Beach. He was born in Provi- dence, R.I.; and lived in Vero Beach since 2000, coming from Micco. He was a machine operator. at Gorham Manufacturing`. He served in the Navy dur- ing World War Il. He was a member of St. Luke Catholic Church, Bare- foot Bay. Survivor is a sister, Claire LaPorte of Warwick', R.I. He was preceded in death .by his wife, Evelyn Erickson. SERVICES: Visitation will be from 9:30 to.10:30 a.m. Oct. 17 at the Strunk Funeral - Home, Sebastian. A Mass of Christian Burial will follow at it a.m. at St. Luke Catho- lie Church. Burial will be in Sebastian Cemetery, Sebas- tian, with full military hon- ors conducted by American Legion Post 189, Veterans of Foreign Wars Post 10210, PLAV Post 210, all of Sebas- tian. Name FRAAl CI Ei FRId<50fy 0J ib/ 5' &q ) Unit l Block) Date of Mark -out (a-13-65, Date of Burial Name of Fune Authorized by ��_' 17 _—P.S'. rime WJO 19A(5T (J7- LUko .� TitV of Orhastian T r m p t i r g D r r is NO. THIS INDENTURE MADE This ....11TH........... day of ..... DECEMBER A. D, W..2QOO between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and FRANCIS EVELYN „ERICKSON C(O.RENE VAN DE VOORDE, 3663 15TH AVENUE ATTORNEY' A.T ''L'AW " " "' ................. ..........................VERO. BEACJJ.,..F.L.ORID.A.. 329. 6Q ... ............................................ of the County of ............ I....... an-1 State of ....F.L.Q I�� ........ ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ �, .5 QQ.•. Q.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)3 3434 , Block, . 3j.... , 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: .. ....... C ` ...................... City Clerk Si ed, S led and Deliver i the esence oL f: r .......... .. . STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By W.. to .............. Mayor ((gitg Meat) I HEREBY CERTIFY, That on this .....11TH. ..., day of . .......DECEMBER 114N,.Z000 before me personally appeared ..... :.W.AL TER . W.... .BARNES ........................ and SALT Y..A ... MAI.O............... . 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 cuxveyance to ................... I ..................... FRANCIS.,& EVELYN„ ERICKSON.................................................. •••.•..•.•••••••••••••••• •••••...• ...................... 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 net and deed 'of sail'_-, corporation. DFLORIELT 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 Francis E. Erickson Death Oct. 8 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Memorial. Hospital 3. Name of Medical Address Phone Number Certifier Pedro Alonso, M. P.O. Box 5349 Medical Examiner Physician Vero Beach, FL 32960 772- 567 -4311 4. Name of Funeral Home/DireeO.Diap"W Address Fla. Lic. No. /Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Ave. Strunk Funeral Home Sebastian,! FL 32958 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 6. Funeral Director/ B. b. [i Dr. Alonso was contacted on 10/14105 He/she verged that this death was from natural causes, that there was no accident nor other external cause of death, and that he will complete and sign the medical certification of cause of death within 72 hours. C. r was contacted on He/she verged that Medical Examiner, will complete and sign the death within 72 hours. an BURIAL - TRANSIT PERMIT Date Signed Permission is hereby granted to dispose of this body. Permit No. 1228- 05-0423 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. Revistrarbr— Date Date Certificate SubregistrarSignature 4v i'k e..�..� Issued: 10/8/05 Dye: 10113/05 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 S cibastian - Ceiyaery . dBLIRIAL DSTORAGE Date of Disposition C �/ 7 A'5 OCREMATION ROTHER (Specify) Signature of Sexton or Person -in- Charge 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. DH 326, 6/97 Obsoletea all Distribution: White: Cemetery or Crematory ( previous editions) Yellow: Funeral Director w Diced Disposer (Stock Number. 5740-000. 0326 -2) Pink: Local Registrar XWY"