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Home My WebLink About4-20-26Name--/Y,E / Unit Block Lot .Z Date of Mark -out Date of Burial eLl/f Time /ls�—� Name of Funeral Hope 5 Authorized by CITY OF SEBASTIAN 10737 ADMINISTRATIVE SERVICES RECEIPT Name RLw Y_ ❑ Cash Date I19 1 T Check # ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees ooy bi 33905 OTC, UNrr lK.oaa Lffr A6 C 4 be Total Pail -taw Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office -- Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a)citVofsebastian.org FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE* 772-589-1000 (Check One) XX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI Lot 26 Block 20 Unit 4 Lot -Block -Unit Niche Block Unit N S E W 8/11/2017 @11:00am FOR DECEASED: Nettie Louise Camoaena Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Nicholas C. Campagna Ntohol,as c. Cawactowa Name Signature Date 8/8/17 933 Brookgreen Place, Lawrenceville, Georgia, 30043 1 certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: William B. Whittaker, Jr. Name WW49 x V. WAMA&t, h. Signature 8/8/17 Date Cemetery Sexton Certification: 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 Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. 08/08/2017 10:56AM 7727788934 STRUNK FUNERAL HOME PAGE 01 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, .Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office — Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or388-8214 ctesta(a).cityofsebastian.orp FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONEA 772-589-1000 (Check One) XX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIM Lot 26 Block 20 Unit 4 Lot—Block—Unit Niche Block Unit N S E W 8/11/2017 @11:00am FOR DECEASED: Nettie Louise Campagna Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Nicholas C Camoaana N%ahol,as o. amjQa0vo Name Signature Date 8/8/17 933 Brookgreen Place, Lawrenceville, Georgia, 30043 1 certify that I have determined the ownership of the above described site that all site fees and administrative fees have been,paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: William B. Whittaker, Jr. wm4w V, Zf/AM", /4• 8/8/17 Name Signature Date Cemetery Sexton Certification: 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: ee Li ie Ceme ry S don Date This form to be' :provided to Clerk's Office by Sexton for permanent record upon completion. Tits of Orhastian THIS INDENTURE MADE Tbb ......23rd......... day of ...... June.. .. ............................. A. D,XA..ZPQ0 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .... ............................... Nettie.. QamPagna.......................................... ............................... ..... 601„ Mulberry Street, Sebastian, „Flori.da 32958 of the County of ..... Indian ..Ri.v:er ................... and State of ....Fla rids....... ............................... as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of $ .1 J90. % QQ ............. 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) ..2 5., 2 *oak, . z Q. , , , , UNIT ... ......... , 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. Atte ! . �L... ........ Cltv Clerk CITY OF SEBASTIAN, FLORIDA By 7/ 6G .. . W tY'.. �! .............. Mayor 09ity opal) COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ...... OU ............. day of ........................... before me personally appeared . A ^. ............................ and /�y.. respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the Iaws State of th of Florida to me known to be the individuals and officers described In and who executed the foregoing conveyance to ... ............................ ............................... ......................... ............................... and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; 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 alanature and official seal at Snhaatian. In the County of Indian Rivrr and State of Finr:da- the day and v.a.