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Home My WebLink About4-14-02~itg ,af ~rbttsftttrc THIS INAENTURE MADE TWa ..... Z $ TH. , , , , , .. „ day of .....A.UOUS.T .............................. A. D., A~ • .2L~02 bet«-een lire City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ALBERT WILLIAMS . ............................................................. .................................................12405 ROSELAND ROAD ............................................. ...S.EBAS.T.IAN,.. ELOR.IDA..3.295.$ .... ...................................... of the County of .........INDIAN RIVER ............... and State of ...FL.ORIDA....................................... ................ as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ ...1 J.4 ~ ~ • ~ ~ ... , 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) 1 & ~ .. ,Block, ..14 ... ,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 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. ,... ~--- Attest: .......... ...`.... ........................... City Clerk CITY OF SEBASTIAN, FLORIDA i Mayor Signed, Sealed and Delivered in the Presence of: . ~. r.~... ~~ ............ STATE OF FLORIDA COUNTY OF INDIAN RIVER 28 t.h..........day ~t ...........August ..............................,~>~,..2,002 I HEREBY CERTIFY, That on this ........... Walter W. Barnes before me personally appearcd ........................................................... and ...Sa.1.1y...A...Mal.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 conveyance to Albert Williams ....................................................................................................................................... ....................................................... 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 dear last aforesaid. •~~.y :Pi;~'•,, H. ,JOANNE SANDBERG ;~•/: .. ... :.... ~4"~C~ ................ . ~~''~ •.~: Not~(a ..ublie, State of Florida at Large. _,,: :*: MY COMMISSION # DD 089532 ~;~o` EXPIRES: April 3Q 2006 My cd isston expires r ''~;P ; ~d: `~ f3onded Thru Notary Public Underwriters Name" !~ ~~ /~` 1 ~"t +-~._ . ~~ r`ti`n Unit Block Lot Date of Mark-out `=_L ~ ` ~ ~ ~ •"--- Date of Burial c-~ ~ ~ v'? i/ Time ~-~' Name of Funeral Home _ ..~`" ,~' /`~~ ;;,r ~~`i~t.,.,.. Authorized by - ` , . ' n, :~ ,~ ..,~.. - -,- _ .-- ~ , .~ __- ~ ~ _ ao 1- ~ N . J d .. ~ h ~ ~. ~ .... ~ d ~. F ~ . ~ ~- . ~ _ ~ ~, . _ _~ A ~v v ~' Li Z ~i ~' ~ ~ ~ a 0 _ ~ -' ~ ~v a ~ ~ o ~ ~ ~ SO ~) ~ e -- d v c~ r r ~ <v~ Q'~ ~ f ~ ~ ~ ~ ~2 ~ ~~ ~ ~~ y Paid by CEMETERY Receipt No....~ 9 6 6 ...... ,Dated .. $ ~ ? 8 ~ ~ 2 List Price $ ...1 ~.~+~~ . ~~ ................ . ' ' ' ' ' ' ' • • Maximum No. Burial Spaces . Net Paid $ .. 1 ~,4 O O . ~ ~ ............... . ' • • • • Monument permitted ...................... . 7nmc i ~ ., ALBERT WILLIAMS NO. '185 ~~ L ~..~--++i.~ Y _ _ `/.'~~r i F#~1VtiE t')~ PELi~A-N IS~ND September 3, 2002 Albert Williams 12405 Roseland Road Sebastian, Florida 32958 Dear Mr. Williams:: Enclosed is City of Sebastian Deed number 1859 for Cemetery lots 1 & 2, Block 14, Unit 4. Also enclosed is a copy of your receipt. If you have any questions, please contact our office. Since ~~_ io, , .,: .., City Cler_.k "" SAM:js enclosure J ' Tie Sebastian Cemetery City of Sebastian, Florida Receipt is acknowledged in the sum of: -- Dollars ($ % ~~ - ~ ) From: .f1 ~` ~~.~'7~ ~~/i~~./f,~/~%S 5~,~~s"T/~,~~ ~~~.~/.,~~9 ~~~SSI~ on this ~ day of ~ Lam. 20 D,~ for the purchase of the following described Cemetery Lot(s)/Nich )upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)/Niche(s) / °~ r;L Block /~ Unit r, Purchase Price: ~~-~t~L. ~' i ~~l-'~~~~ ~ Dollars ($ /, ~'~Y` . ~G~ ) Terms and Condition of Sale: This contract shall be binding upon both parties, the seller and the purchaser, when approved by the ovcmer 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 FLORIDA DEPARTMENT OF ~~ L/ ~ / y L Z HEALT State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL -TRANSIT PERMIT A. (TYPE) 1. Name of First Middle Deceased Last Date Month Day Year Joan Ann of Williams Death Aug. 22 2002 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. 3. Name of Medical Address S Certifier Sajid S. Qaiser M.D. 1750 Cedar Street Phone Number Medical Examiner Physician Rockledge, FL 32955 4. Name of Funeral Home/ 321-633-1981 -Bisflenal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N . Central Avenue Strunk Funeral H me Sebastian, FL 5. Check 1228 772-589-1000 a• The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b ~ was contacted on He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that certification of cause of death within 72 hours. will complete and sign the medical c. ~ +~ was contacted on He/she verified that mg ' al c ific ton use of death within 72 hours. ~ Medical Examiner, will complete and sign the 6. Funeral Director/ i atu F.E. No./Reg. No. .Date Signed ~este+spese,`-. 1862 8/23/02 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted 228 Oe 035 an 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. @.r~9+s~a~aF-. Date Date Certificate SubregistrarSignature Issued: 8/22/02 Due: 8/27/02 ~~ 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. Awaiting period of 48 hours after death is required for all cremations. D' CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery BURIAL STORAGE Date of Disposition /p-~ ~i / -~ CREMATION OTHER (Specify) Signature of Sexton or Person-in-Charge ~ phis 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 vithin 10 days to the focal County Health Department in the county where disposition occurred. ~H 326, 8/97 (Dbsoletes all previous editions) Distribution: white: Cemetery or Crematory hock Number: 5740-000-0326-2) Yellow: Funeral Director or Direct Disposer Pink: Local Registrar 7 t d N S O 1 0 9 O tO 7 • f i 'T ,~,~ a °g v m O1 ~ c r` ~\ 7 d b S O i O 9 0 m' 7 • K f • 0 9 g 7 m' d ~ a U m ~' 00o g g o g g S o ~ g o o O Z ° S S o ~ ° 0 0 0 o cn 0 cn 0 cn 0 cn 0 o o m 3 m CJ S N ~ (00 O c1pODa O p O mm O ~ O ON_ O ON_ O ~ O ~ O (pNp O S m 3 m cB = O ~ 3 ~ n o O C7 3i n~i ip x `~ Q' N T (D `~ `~ O' Q O_ d d ~ m C7 cn m c~ 4 o_ o_ m ~ n o ~ N ~ ~ ~ ~ z J w w '~ J O O N ~ C A (p ((pp N O. 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