HomeMy WebLinkAbout4-19-34�tf� i1f �P�tMB#tMri
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NO.
� 1857
THIS INAENTURE MADE TWs .....27.t�.......... day of .....AU�LI�.T .............................. A. D.,�Q�..2,Q,�2
bet��een ll�e Clty of Sebastian, a municipsl corporstfon ezistIng undcr the lewa of the 3tate of Florida, ee Grantor and
........................................ THOMAS BUSCHBAU.M.................................................................
12480 83RD STREET
..... .....................................FELL.S.M�RE,.. �'L•QR•��A • •3•2948...... . .. ... .. .......... ..........................
of the County ot ...INDIAN RIVER ..................... enl 3tate ot ...k'�..O�ZRA.......................................
te Grantee, WITNES9ETH�
That the Grantor for and in consideration of the sum of $,,,700 • �� . . .,.,, 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 4 , . , Block, , . . 19. . , UNIT . . .�i . . . , , . . . . , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 of the public records in the ofSce 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 ptovided 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 de'ed 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 pazt 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.
_�
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�/�/% �.� �-- �.:..........
Attest: ... (� � �
City Clerk
Fign , S aled und Dclivered
in Pr sence of: ` •
n
. . . . �. . . �/���'� • •T /' •� . . . . . . .
STATE OF FI.ORIDA
COC�NTY OF INDIAN RIVER
CITY OF SEI3A8TIAN, FLORIDA
Br .VV G��. .�. �Ov�.'✓`Q° . ... . ..... .......
Ma�or
�
((flit� �e�1)
I HEIiEBY CERTIFY, 3'hat on this . . . . � �.��i' . . . . . . . . . . . . .day of . . . . Allg•US � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., ]��2.Q,� 2
betore me petsonally appenred Wa 1 t e r W,. . .Ba rne s . . . . . . . . . . . . . . . . . . . . . . . . . . . . gna . .�a 1.1.y � A y• • •M$1: O • • � • • • • • • • • • • •
respectively Mayar end City Clerk of the City ot 9ebastian, a municipal corporntion under the laws of thc State of Florida to me known
to be the individuuls und officcrs described In und who exeeuted the foreguing cowveyunce to
Thomas Buschbaum
.......................................................................................................................................
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, aiid severully acknowledged the execution thereot to be their free act and deed
as such officers thereuuto duly nuthorized; and that the Officixl seal of said corpuration ia duly affixed thereto, and the said conveyance
is thc i+ct nnd deed of said corporation.
WITNE83 my signsture and officlal seal st Sebaetian, in the County of Indien RIver and State ot Florlde, the day and �esr
last afuresaid. '
�
ti�:� P''•• H. JOANNE SANDBERG
=ia �__
t, .: MY COMMISSION ri DD 089532
:a�. �a�= EXPIRES: April 3Q 2006
^'�,�,of��?:`� BondedThruNoteryPub�CUndenvrilers
�,.�.���...... .�. . .................
Nota�rb%�i'ubllc, State ot Florida at Lar .
My pinznteslon expireot
Name�
�
Unit
Block �
Lot _.�.�
Date of Mark-out
Date of Burial �A � % /� `Z.-•� � Time � ' a� /" '
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Name of Funeral Home � f ,�G� /,! '
Authorized by � � v " �C.`'�.'L't-�JL�� /1
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Paid by CEMETERY Receipt No. . . ,l 4:6 6 . . . . , , , Dated . . . . . 8 �.? 7 � z OO 2; , , , , , , . , , ,
List Price $ , . � �.� •.� � , , . , , . Maximum No. Burial Spaces . . . . . . . . . . . . . . . . .
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THOMAS BUSCHMAUM
NO.
Net Paid $ . . 7 Q.Q.•.0 Q . . . . . . Monument permitted . . . . . . . . . . . . . . . . . . . . . . . 1 8 5 �
LOT 34, BLOCK 19, UNIT 4
(Data above this line for City Record only) (Mary E. Buschbaum interred)
FLORIDA DEPARTMENT OF
HEALT
A. (TYPE)
1. Name of First
Deceased
2. Place of Death
County
I ndian River
3. Name of Medical
Certifier MiChBel
State of Fiorida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
Middle Last
Mary Ellen
City, Town or Location
T
_ � �Medical Examiner � �
4. Name of Funeral Home/Biroe�Bi�pe�e}•
Establishment
M.D.
Buschba
����3y
Date Month Day Year
of
_ Um � Death
Name of (If neither, give street address)
Hosp. or
Inst. Inri:�.� D:.,.... ��.�___
1355 37th Street, #302
Vero Beach, FL
Aug. 24 2002
�OSpI��
Phone Number
772-770-4888
Address Fla. Lic. No.lReg. No. Phone No. (Area Code)
1623 N. Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b� � Tricia was contacted on 8/26/02 .
He/she venfied that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Tonner will complete and sign the medical
certification of cause of death within 72 hours.
c. �
6. Funeral Director/
�P��
� was contacted on He/she verified that
, Medical Examiner, will compfete and sign the
of cause of death within 72 hours.
F.E. No./Reg. No.
1862
Date Signed
8/24/02
B� BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-02-0359
� 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.
rar or �— Date Date Certificate
SubregistrarSignature /'�_ Issued: 8/24/02 Due: 8/29Jp2
�� AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Approval Number: Date
Medical Examiner, , gave authorization by telephone to
Funeral DirectodDirect 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.
�� CEMETERY OR CREMATORY
ethod of Disposition: Place of Disposition Sebastian Cemetery
BURIAL �STORAGE Date of Disposition g/� J'��
� CREMATION
Signature of Sexton 1
or Person-in-Charge �
�OTHER (Specify)
, , � __
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral DirectoNDirect 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, 8/97 (Obsoletes all previous edilions) Distribution: White: Cemetery or Crematory
;Stock Number. 5740.000-0326-2) Yelbw: Funerel Director or Direct Disposer �
Pink: Local Registrer
/�--Q�� �
'�'�ie ���as�.a.� C�rne�.��y ��s %
Ci��y of �e��st�i�, Fl���a.
Receipt;is acicnowledged in the sum of:
, ;
,� �
�, ; � � '
% � � %' Dollars ($ 7C�z? : �� )
' % �%������ ' 1��"� ���'an �? -
From: + / ��/YI/� � ��/� SC'�/��4%//ZJ
0
/��Z 1;' .�SU vf'3 �'� � T -
t—��! Si���,C�E� �� �'.�/��� -.j� ��'�
on this � day of ��ir��� , 20 C' . for the purchase of the following
described Cemetery Lot(s)/Nich�(s) upon the terms and conditions as sta.ted herein:
Description of Property:
Cemetery Lot(s)/Niche(s) r��' Blocic /� Unit '�jJ
i y-,� �/ �
Purchase I'rice: �.-� .;��..r��r1 SC.�i.������� Dollars ($ 7� r� �l )
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 teims and conditions sta.ted in
the foregoing instrument:
Purchaser signature
Purchaser signature
The City of Sebastian agrees to sell the above mentioned property to the above narned
purchaser(s) on the terms and conditions stated in the above instrument.
;� ,l / /
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� City of Sebastian ���`� Witness
�-
ki�llJfE �F P�EL��#hl 15�i.AT�D
August 29, 2002
Thomas Buschbaum
12480 83`a Street
Fellsmere, Florida 32948
Dear Mr. Buschbaum:
Enclosed is City of Sebastian Deed number 1857 for Cemetery lot 34, Block 19, Unit 4. Also
enclosed is a copy of your receipt.
If you have any questions, please contact our office.
Sincere
� �
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City Clerk
s�:; S
enclosure
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Goldman Sachs Funds
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