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Home My WebLink About4-21-35ti Titg of #rhas#ian if NO. THIS INDENTURE MADE Mils .....10th .......... day of ..January. A. D.,X14..20Q1 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and William H. Melton ........................................................... ............................... 1541 Emerson Lane .................................... S.ebast.ian,...Flor.ida • •3. 2958 ............................ ........................ of the County of ...Indian . River ..................... and State of ........ Fl orida.... ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ , 5 OO . 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 5 . , Block, ...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: �` _..��/�� ....................... . City Clerk 9i ed, Seal and Del2rcd i the Pr nee of: .� ..... ................. .......... ......... STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By .�' .Q.. Y.�! . '�" .............. . Mayor (Citg �$ex1) I HEREBY CERTIFY, That on this ......... 10t.h........day of ...... January ... .............................., }i K2.O,01 Sall A. before me personally appeared ..... Walter W. Barnes ....................... ............................... and ........ .X.............. 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 William H. Melton .............................................. ......................................................................................... ......................... ............................... 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. Al H. JOANNE SMDBERG ........... 4. ;,__ MY COMMISSION # CC 725842 Not ublic, State of Florida at Large. EXPIRES: April 30, 2002 My mmisslon expires: nX Hooded That Notary Pubft UWamtheta n ZR ►WMDWZA W. A Unit Block _ iR »'% Lot Date of Mark -out 0/ Date of Burial Time i ou . Name of Funeral Home __5 i- C'/ 6' Authorized by MELTON, WILLIAM H. _.20/ DEED #1771 1541 EMERSON LANE SEBASTIAN, FLORIDA 32958 LOT 35, BLOCK 21, UNIT 4 Paid by CEMETERY Receipt No........... 10 200 1 ......Dated 1 ........... . List Price $ 5 QQ •,Q Q ..... . . . .......... . • • Maximum No. Burial Spaces. . Net Paid $ 5 00:.00 .............. . ' ' ' ' • • Monument permitted ...................... . (Data above this line for City Record only) William H. Melton NO. Lot35, Block 21, Unit �41 � I e-" i \ ƒ~ I . 0 f ») a. \�4 i` INVOICE TO: William M. Melton 1541 Emerson Lane Sebastian, Florida 32958 FROM: Sally A. Maio, City Clerk City of Sebastian DATE: October 24, 2001 Charges for opening/closing grave for Saturday service on October 20, 2001: $125.00 Paid 50.00 Balance Due $ 75.00 Please make check payable to City of Sebastian and mail to: Thank you. City of Sebastian 1225 Main Street Sebastian, Florida Attention: City Clerk's Office F0 gr QSem CA $ g mz ff D A DEPARTMENT OF EALT n rrvDG1 State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT � 3s tea/ L/y 1. Name of First Middle Last Date Month Day Year Deceased of Dorothy Irene Melton Death Oct. 13 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Sebastian River Medical Center 3. Name of Medical Address Phone Number Certifier Seth Baker, D. 7955 83rd Avenue Medical Examiner 6hysician Sebastian, FL 561- 388 -4606 4. Name of Funeral Home /Direct- Bispeset --+ 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 certittcation has been compietea ano signea. A completea certmcate or seam accompanies mis Appropriate application. Box b. Donna was contacted on 10/15/01 He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Baker 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 Adicalpertific,PW of cause of death within 72 hours. 6. Funeral Director/ Si re F.E. No. /Reg. No. Date Signed 1862 10/13/01 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -01 -0500 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. l Date Date Certifi ate Subregistrar Signature Issued: 1 0 `L 'S' O 1 Due: ( a 11\0% C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA E 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 FICREMATION Signature of Sexton 1 or Person -in- Charge J? STORAGE OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition /o /°R D/ O 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, 6197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number. 5740-0000326.2) Pink: Local Registrar C January 12, 2001 William H. Melton 1541 Emerson Lane Sebastian, Florida 32958 Dear Mr. Melton: MY OF SE�'iA111 HOME OF FEUCIAN ISLAND • Enclosed is Cemetery Deed number 1771 for Lot 35, Block 21, 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. S cer Sally A. M ' , CMC City Clerk SAM/j s Enclosures Ike Sebastian Cemetty City of Sebastian, Florida Receipt is acknowledged in the sum of: Dollars ($ 5ZM, L%e ) on this day of • M • • 1 • I k1l i • • 1 • • • • • Description of Property: Cemetery Lot(s)/Niche(s) &5_ Block v2 / Unit Purchase Price: Dollars .($ 5?,z� , od ) 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: I, 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