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Home My WebLink About4-19-07�tt�J pf �P.�ttSftitri (��m�#P�� e�e� No. {'��=� 1'HIS 1NDENTURE MADE TWr ........12tY1 ..... day or .............. January,.................. e. n., �S�.Q.QQ betN•rcn Il�e City of Sebactlan, a municipsl corporstlon e:iating undcr the laws of the 9tate of Florlda, oe Grantor and ...................:�J!!ti'w►!`�%......Scott Gates ... . . . ......... . ............................................................. �� 7b� �S�.W. $arjoer Street . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . � e.ba s z i.an.,. . .F.L . . 3� 2.95 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or �h� County ,r Indian River Florida ..................................... .�l sfoce or ...................................................... � Granteq WITNES9ETH� 1��.�� That the Grantor for and in consideration of the sum of S ..... ....... .. ... ......... to it y'�hand paid, ttie receipt whereof is herewith ac- knowkdged, does by this instrument grant, bacgain, sell, releax, convey and conCum unto thc Grantee . nl g,,, heirs, legal representatives and assigns the following property situated in Sebastlan, Indian River County, Florlda, to-wit: All of Lat(s) �& a. .., Block, ...19 .., UNIT ,, 4. ......... , of Sebastian municipal cemetery sa per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in tha offica of tha Clerk of the Circuit Court of St. Lucie County of Flocida; sald land now lying and being in Indien River County, Flodda. To Have and to Hold the same forover; provided that said property sluil 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 rulea and rogulationa, ordlnances and resolutions of tha City of Sebastiun, Floridn, hereto- fore, now and henafter �Jopted or provldal for the governtnenL and oporation of �aid cematary. Tho condltlone, reatrfctlone and requlrements containad in thif inetrument thall be covenant� tunnfnd wltlt the Lnd. In tho evant of the Calluro o[ tha ovmer ot any property Ntuatad wlthin eeid txmetary to ob- aerve and comply wlth auch rules, regulatlons, rewlutione and ordlnances and the condition� of the debd of conveyance thereof then the title of such owner in and to said property ahall terminate and tha mme ahall revert to the Clty of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the fuat part hsa caused this inatrument to ba executed in its nama end on its behalf by lts Mayor and atteated by its City Clerk and its corporate aeal to be hereto affixed, tha day and year Cust abova wdtten. ��.�.��G�4,-r... ..... .. � City Clcri Ced uncl Dcilv red �nce ol: ..G"/.....'.. ....... . ...... . ........ �..�%. ��1`4.-.c.xx ..�.,� � . . . . . . . . . . . . . . . . . . CITY OI+' SEI3ABT7AN, FLORIDA D, . . (.��J.�..<�,�r�- . . . .. . . ..... .. . Mn�ur �QItY� p PAI� STATE OF FI.ORIDA COUNTY UF INDIAN R1VER I HEIiEBY CERTIFY� Thst on th�e ........12th.........�ey „r ......... JanuarY ............................... 104�r.Q�� Chuck Neuberger Kathryn M. 0 Halloran beture me pet�onally appeared ........................................................... snd ....................................... reepcctively Mayor and Clty Clerk of the City ot 3ebestfnn, u municlpul corporntion unAer the luws of thc 9tnte ot Florida to me known to bc the lud{viduule un� utficers deccrlixYl In und who executcd the torrguing cuwveyunee ta Scott Gates ......... .............................................................................................................................. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, and severully acknowlndged the executlon thereof to be thefr tree act nnc] deed as such officers t6erruntu duly authorised; and thnt the Officinl ecnl of seid corporntion Is duly uffl;�tu, and the seld conveyunce is the nct unJ deed of eald eorporaUon. / WITNESS my siBnatnn snd otflclsl oeal at 8ebaetisn, ln the lest afuresatd. �� LINDA M. GMLEY MY COMIAISSION 0 CC 740478 EXPIRES:June 18,2002 ea�d�d TI� �ae.r RAk th�d..nla� My State ,6f Florjda, the dey end �ea: .�. ..--- . .................... .................. Florldo at I.arge. Name Unit_ Block Lot /� Date of Mark-out �/ 6/ � ' �" Date of Burial � �� Time Name of Funeral Home ��' " � �� Authorized by ��'L��- -'` `� — , , .� � ? � � o �� O � m 7 . � = f I � � d m v � : � 0 v = m d °. O. � � � � ! � S 0 �"' W � rn g 0 0 0 0 o Z c �, �;, �, o cn o ° ° � o o° w W W j' A A N O O W � N � O � 0 O O � c Z � �� T 6� c� r S f7 ��Tpp or O� Z � O � �N(yp1 � cyD 1 �. T N � O � � N p.-�.� � � O y O � � x � y � �; a � y � � � N � W y � \ � c � � �• ❑ � n� I ^ � d Id � � T x � � � � � 0 O � � a 2 ��°, .� � _� � �� r'O m m T m�m ~ � N T � 'rt mz ) HENRY FUGATE Born: December 4th, 1925 Passed Away: March 10th, 2012 0 03/12/2012 14:03 7722287079 FUN�RAL WOME COS AIR BLDG FU�tERAL DIR�CTOR'S R�QUEST TQ CITY �F SEBASTIAN FOR BURIAL �PENING IN S�B.ASTIAN MIJNICIPAI. CEMET��Y �, nn kOMF OF FELICJdY ISNND . For inf4tmation c�ntact: Kip Ke/so - Cemetery Sextan Sebastfan Municfpal Ceme%ry (772) 5$9-2546 Ci�y Clork's Office Clfy Hall, 1,22b Main Sfreet Sebastian, FL 3,�958 4ffice (772) 388-8215 ar ��8-8214 Fax: (T72) 589-5570 Northside Chapel Funeral Directors ApD�2�SS: 12050 Crabapple Road Roswell, GA 30075 p��N� �, 770-645-1414 (Check Qne) OPEN BURIA�, �,4�' � __ ✓ OPEN CREMAINS �(�T OP�N COLUMBARIUM NiCH� BUR(AL DATE /1ND SERVIC� T1ME: �ot _. ,� Block Unit � l,ot � Block _ f�, Unit __ �f Niche Biock Unit �N S E W �.� � � - - -- PAGE 01/01 FOR DEC�AS�D: _... � j�I �, n r��u c� a�, Name �- , .. „ , NAME ANp SIGNATURE OF LOT OWNER OR R�PRESEN�'AT1V�: (Must provide proper do�umentatidn of ownership} L�� ` � �,��i� Nam� Signa ure Date I c�rkify that 1 have determined the ownership of the �bove described site, that ail site fees and administrative fees h�ve been paid and �uthoriz�: opening of same, NAME ANC� SIGNATUR� OF �,ICENSED FUN�RAL DIR�CTOR: `p!/�c �. ,t ,(� �..� v y cl �iv� C�, �-c.� � :� �' l �-i' � c�/ Z Name Signatur I�ate Cemetery Sexkon Certificatian: ~ ^^^�------��-�T---------~.^��--------r-� I ceriify th�t 1 hav� checked �kh� ownership information by viewing the owner's de�d and aonfirming with Glerk's ofFice an khat all fees have b�en paid: /G i� • Ceme ry �xton p� This fpt-i�n to be provided to Clerk's OfFiee by Sexton for permanent record upon corr�plEtion. Name of Deceased Georgia Department of Human Resources Vital Records Service PERMIT FOR THE DISPOSITION OF HUMAN REMAINS Date of Death 1 i�1��?� � a Ftif��i�� 2. 3�1.�� 2 Place of Death (Hospital or Street No.) OR Interment (Cemetery) City, Town or Location of Death OR Interment Cc �.�.��5 �� l.�rs� �i.�s��.�. , 4. 5. 6. Name of Certifying Physician, Coroner or Medical Examiner (Not Used For DisintermenVReinterment) 7. ��. �4��.��a �(3��L3�a Funeral Home Name and Address �� 9. �.2£�5� �_ t�'im�� i)� 12{).�°st�i.�s ��. 3i�0�S - - - - -- ---- - - -- _ . . . 1_�.327 PERMIT NUMBER Fetal Death� No � 3. Yes ❑ vnty of Death OR interment ��1 t�a�. Certifier's Address (Not Used For DisintermenUReinterment) 5i31I ��.l�T�� i� �� .�t0$� 8. ,��'��A� G1� ��;�a� Funeral Home Lic. No. 10. �� Method of Disposition � OR Date of Disposition OR Reinterment DisintermenU ❑ ;-°3, �'°"�� L: 1 1. Cremation ❑ Donation ❑ Other ❑ Removal From State Reinterment 12. Name and Address of Disposition OR Reinterment Site Location of Disposition OR Reinterment Site (County, City or State) ��'d�,.�'i'PIA� '��' �3�i.4�`� 13. s. 21 �I(s�'�� 3.�2�� .�,,vr� 14. �.�� !F'� a = � 31-10-20.(a) The funeral director or person acting as such, or other person who first assumes custody of a dead body or fetus shall obtain a disposition permit prior to cremation or removal from the state of the body or fetus. A disposition permit may be required within the state by local authorities. Local Vital Records Registrar - Signature ,• � l�sae ,A�1 A, 1 a �e ef��.� Sexton (or Person in Charge) - Signature �. , Form 39 (Re . 8-91 � " �' t:' - � Date Signed 16. �a-I:�-°r:�i � Date Signed is. 3�G//� y �� 1� 1 ��1H[�1�1�1E 1 �1[�1E1� FUNERAL DIRECTORS and CREMATORY Certificate of Cremation The undersigned Funeral Director of the duly licensed crematory certifies that the remains of Henry I Fugate have been cremated on March 10, 2012 at Northside Chapel Funeral Directors and Crematory, case # 06712 licensed by the Georgia State Board of Funeral Service and located in the City of Roswell, State of Georgia. Furthermore, the undersigned certifies that the remains of Henry I Fugate were cremated in accordance with the Laws and Rules and Regulations of the Board. The undersigned Funeral Director also certifies that the following was delivered to the crematory by WAYNE B. BOYD a person duly authorized to care for the remains of the deceased. Name of the Deceased: Henry 1 Fugate Social Security Number: 404-24-8097 Date of Death: March 10, 2012 __ Serial Number of any Prosthesis removed from the Deceased (if any):. Type of Prosthesis: Finally, the undersigned certifies that he/she is the Funeral Director of the crematory in charge of the final disposition and that the vessel contains substantially the remains of the deceased identified in accordance with O.C.G.A.§ 43-18-8(a)(1). Furthermore, the undersigned certifies that the remains are being released to: LINDA DRAGONETTE , a person legally authorized to accept the remains. Sworn (or affirmed) before me, The 10 day of ��g Notary �• ` 2012 (/' V L GsiEi . / V J � Signature of Funeral Director WAYNE B. BOYD Print Name My Commission expires: REXT. GRi�'Zk.E 4339 N�aty Pubkc, Fulbn CouMY� Ge�g� License Number My Commiss�n E�i��6�fl'P�y�i�and Operated SELECTED Independent - rt,�vtiuu�on�ts hm��: �r i6�,��.,� 12050 Crabapple Road • Roswell, GA 30075 • 770-645-1414 • Fax: 770-645-1162 www.northsidechapel.com The Sebastian Cemetery City of Sebas#.ian, Florida Receipt is acknowledged in the sum of: From: / //U/'h . ti on this �`� day of � described Cemetery Lot(s)� Description of Property: � Dollars ($T/��%D , �� ) ( 20� for the purchase of the following terms and conditions as stated herein: � Q� C Cemetery Lot(s)/��1�._ �� 0 Block Unit Purchase Price: i , � Dollars ($ �� L��, �'C' ) 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: I Purchaser signature Purchaser signature The City of Sebastian agrees to sell the above mentioned property to the above named purc,haser(s) on the terry�s-and conditions stated in the above instrument. of Se a�stia � Witness �� ~ U L. Q\ � ►` � F ��,� P .E''7�S �� - City of Sebnstian 1225 Main Street 0 Sebostim, Floridc 32958 Telephone (561) 589-5330 ❑ Fa�c (561) 589-5570 E-Mail: cityseb@iu.nat January 13, 2000 Mr. Scott Gates 702 S.W. Barker Street Sebastian, FL 32958 Dear Mr. Gates: Enclosed is Cemetery Dced No.1707 for Lots 7 and 8, Block 19, Unit 4. Also enclosed is a form - Retum 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. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, P. O. Box 1028, Vero Beach, Florida 32960 or you may ca.11 or call the Department of Revenue at (904) 488-9487 for more information regarding the completion of this form. We aze enclosing two copies of each the receipt and ask that you sign and return to us the copies marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience. Sincer y, �' � •��Z,�:�'� �.� Kathryn M. 0'Halloran, CMC/AAE City Clerk KOH:Img Enclosures