HomeMy WebLinkAbout2-40-08A�
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Certificate No. 2331
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Wilma White &/or Kimberly Waltermire
5690 N. Tropicana Drive
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 2, Block 40, Lots 8& 8a
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 10t" day of April, 2012.
CITY OF SEBASTIAN, FLORIDA
'��AI Minner
City Manager
ATf E ST :
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Sally A. aio, MMC
City Clerk
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FI41YtE L3F �PE�;ICAN !�[.At�1D
City of Sebastian Niunicipal Cemetery Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
, � L�F��f�-
r:�l,i i(�rn G� Ck v� c�/� � � i av� b�_ Y' �-- �r.� a t�"� �( nn `t Ir � C� ��� ll �fe,t-�
Name(s) '
`�JCoQ1� IJ, r-oPtCC�n� �ri �/�� ��10RS-i��C�v1 �Z�S� -
Address , .
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Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
��tl`a �i��.,�4�t./.1C� �`�' ' �� ----�-� --J Dollars (� �.C�Ob, o� �
on this. /��'' day of �Tp�' c( , 20� for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit _�, Block � Q , Lot(s) �� Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4-$20) Opening & Closing
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
_ ,
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Signature of Purchaser
Interment
/W O H
Circle One
Disinterment
Tc��� � � �G�U vo
���m�
ity of Sebastian
The following documents were provided as Proof of
Residency:
i:IM�V-�ATA\.nqs-Gemetery\RFCFIPT-�or I
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE - 4 4 5 b
RECEIPT
Name �b �j :��� �( Cash
Date �� � d�� Z ❑ Check #
No.
001001 208001 Sales Tax
001501322900 Garage Sales
001501341920 Copies/Bid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees
Amount Paid
601010 343800 Cemetery Lots �„(1[��
LoUNiche O �' �a, Block �_, Unit �_
001501 343805 Cemetery Fees
w�-��Q�-�Q� Total Paid , �(�(j.C7D
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
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LO
T AVAILABLE FOR SALE
UNIT BLOCK �C� � , LOT -�'
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Date of Burial
Name of Funeral Home ��� � �-? � � �
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Authorized by �
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�'TY°F 071278
CITY OF SEBASTIAN � WACHOVItI CHECK NO.
1225 MAIN STREET 712 7 8
SEBASTIAN, FL 32958 .
�� � �'' � . "� GENERAL ACCOUNT
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HOME OF PELICAN ISLAND
VENDOR CHECK DATE
10074 05/08/200
*********61 DOLLARS AND 40 CENTS
63-643
670
CHECKAMOUNT
$61.4
PAY patricia Jacobi L ID IF`NOT PAID WITHIN 90 DAYS
127 Curtiss Parkway #34 iii
TO THE Miami Springs FL 33165 /� -_ I/��
1. ._.__ .'�J . 1 . . _
ORDER
--_ __._.______ -.._... __-_-._.__ _ __
TWO SIGNATURES REQUIRED
��'07i2`�8�i' �:06 70064 3 2�:20000273L6296ii■
71278
CITY OF SEBASTIAN SEBASTIAN, FL 32958
INVOICE DATE INVOICE NUMBER INVOICE DESCRIPTION
05/06/09 RUFUND-Cemet Lots 8& 8A-Unit 2 blk 40
100745 Patricia Jacobi
LACP4GL
050809
NET INVOICE AMOUNT PO NO.
61.40
61.40
nr
ror
i�71278
69905
71278
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� CITY OF SEBASTlAN! i
I CHECK REQUES � {
� Accourrting Use (?nty �
�Input Date Fiscaf Period �
Document # Entered By
Document Amount # of Lines Totai HC Hash
#
To Be Compieted By Department
�Due Date �/8/2009 Single Check Y/ N Y Vendor Number
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� Document Organization Object Project
LN TC Reference Code Code Code Amount
601011 534959 $61.40
�,mount $61.40
Description Refund minus fiees
for lots in Unit 2, Bik 40, Lots 8& 8A
(deed has been surrendered}
�_ �SSUE CHECK TO �
NAME Patricia Jacobi
ADDRESS 127 Gurtiss Parkway #34
e
Miami Springs, FL 33166 `
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APPROVED BY �� !�, � � � �` DATE ,�. .,�r l� j �
BUDGET APPROVAL (53400d D 535450 ONLYj
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SEBASTIAN MAIN POST OFFICE
SEBASTIAN, Florida
329589998
1169180454 -0096
05/05/2009 (772)589-4397 03:34:49 PM
- Sales Receipt
Product Sale Unit Final
Description Qty Price Price
CONYERS GA 30094 Zone-4 $18.90
Pri ori ty Mai 1
13 lb. 13.2 oz.
Return Rcpt (Green Card} $2.20
"'"' Regi stered $10.00
Insured Value : $0.00 •
Article Velue : $0.00
Label #: RE134440432US
Customer Postage -$31.10
Subtotal: $0.00
sss'ms:s=
Issue PVI: $0.00
Total: $0.00
Paid by:
"" Save this receipt as evidence of
insurence. For information resardin5
domestic insurance, visit our website at
usps.com/insurance/postoffice.htm
Order stamps at USPS.com/shop or call
1-800-Stamp24. Go to USPS.com/clicknship
to print shipping labels with postage.
For other information call 1-800-ASK-USPS.
Bill�t: 1000402801715
Clerk: 05
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
****************************************
***«*«**********************************
HELP US SERUE YOU BETTER
Go to: http://9x.gallup.com/pos
TELL US ABOUT YOUR RECENT
POSTAL El(PERIENCE
YOUR OPINION COUNTS
********************«*********«,�*******«
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Customer Copy
— Registered No. �f34440432US
Date Stamp
Reg.Fee ;ld.�� �4�J�
Handling • Return • a5
9 Charge Receipt
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a p Delivery
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mao Received by �^�^+.,� Domestic Insurance up to
T $25,000 is included in the fee.
h m Wlth Postai � Intemational Indemnity
Customer Must D a� � �nsurance is IimRed.
Full Value $, � yy�thout Postal (�e Reverse).
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C��f Sebasti.an
1225 Ma.in Street
Sebasti.an, FL 32958
Mr. Joe Whi
c/o Manastery of Holy Spi�rit
2625 Hi.ghway 212 SW
Conyers, GA 30094-404/+
Receipt for Registered Mail Copy 1- Customer
0-02-000-905i) (See Information on Reverse) J
tic delivery information, visit our website at www.usps.com �
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THIS INDENTURE MAD� Thia ..... 9tI1.... ... daq of ... AU9USt ................................. A. D., 197�...,
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, ns Grantor and
Robert L. and Ruth E. Jacobi
.......................................................................................................................................
.............. P.,.�,.. Box, 353i..Roseland......................................................................................
of the County or . . . . . . Indian. .Riyer, , , , , , , , , , , , , , , , , , , , , an.3 State of . . . . . Florida
.. .............................................
as Grantee, WITNESSETH:
That the Grantor for and in consideration of the sum of $**.�.?�*.Q�.** . ................ to it in hand paid, the receipt whereof
is herewith acknowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee. .�.h6,�T. heirs, legal
representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit:
Block 40, Unit #2
. . iill . . .of Lot S . 6d�8A. . . . . . . . . . in Section . . . . . . . . . . . . . of Sebastian municipal cemetery as per Plat Number 1 there-
of recorded in Plat Book 2, at page 68 of the public records in the office of the Clerk of the Circuit C'ourt of St. Lucie
County of Florida.
To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of
the 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, heretofore, now and hereafter adopted or provided for the government and operation of said ceme-
tery. The conditions, restrictions and requirements contained in this instrument shall be covenants runtl�ng with the land. In the event of
the failure of the owner of any property situated within said cemetery to observe 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 shali revert to the City of Sebastian, Floridu.
IN WITNESS WHEREOF, T�ea�d party of the first part has caused this instrument to be executed in its name and on its be-
half by its Mayor and attested by its City Clerk and its corporate seal to be heteto affixed, the day and year first above written.
�7 ` � .
�tteSt: ...�:� ......... .. .. ........................
A88t City rk
Si ned, Sealed and Delivered
i the Presence of: �'
1
. ��l.�t�-.o....�........L�'L:.i:`:"`.'.�:.�: v� ............
,
...........................� ..... .... . ��
CITY OF SEBA6TIAN, FLORIDA
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B] ....._..Y... . . ... . ...... .. . . ..
a or
(f�'rkg �ett1)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER � / �.
I HEREBY CERTIFY, That on this . . . .��` . . . . . . . . . . . . . day ot . . . . . . . . . . �. . . . . . . y . . . . . ., 19 7 .,
F: Eu ene Cra tlsie m. Cam bell
before me personally a$�P �d ........... �.......... �9 ................................. and .....................P.................
respectively Mayor and'�y C'lerk 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
...................R.ctb.e�.�. �,..a�d.RUth. E....J.a�ob.1..........................................................................
........................................................ 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 canveyance
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. '
� . . . . . . . . . . . . . . . . . . . . . . .f,!t!. . � . . �/7<C` •_'•' •�—�'
Notary Public, State of Florida at Large.
My Commission explres: Florida at Large
NotarY Public, State of arch 1, 1976
Mv Gommission Expires M
�onded by Aetna Insurance ��^�'�anY
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HOME OF PEUCAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENT FORM
I, Patty Jacobi, on behalf of Robert & Ruth Jacobi (deceased), Grantee(s) of City of Sebastian Cemetery
Deed # 258, do hereby transfer my/our interest in the following:
Lot(s) 8& 8A, Block 40, Unit 2 of the Sebastian Municipal Cemetery to:
The City of Sebastian
1225 Main Street, Sebastian, FL 32958
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow intermenis in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation. "
P/ease check one:
� 1 hereby certify that I am selling back to the City of Sebastian my interest in the above referenced
site(s) and will be reimbursed the purchase price at time of purchase, minus 5% administrative cost set
out in R-08-27 and any other mailing costs. (Please provide the original deed when returning this form)
I hereby certify that I have received no remuneration for this transfer. 1 request the consent of the
City of,Sebastian.
---' �r r`�; ; ��'� � � � • f� i�
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Signature of Original Grantee
State of —S��`°`�"'``�
County of �C ,
Be�ore-rrre; anr this ,� day of ,�� personally appeared r�����('lP.� ��� ��G�,:�f�C ,
known to m� r who produced as identification, who acknowledged to me that he/she/they
sa f r the uses and purposes herein set forth.
� _ .
, � -,yp �'`""'� ANGELA C. WILLIAMS
otary b ic i nature Printed Name: MY coMM�ss��j � Zo 2 9
My Commission Expires: a r� v� ���� �
Notary Stamp: '�", ° "'"`�"�'
By:
n hereby consents to the transfer of burial rights:
AI Minner, City Manager
Approved as to Form and Legal Sufficiency:
Robert A. Ginsburg, City Attorney
1WAS\CRyCIeACWpq\WOM Dala\WW-DATAUAsCemeteMTransferof Interest Porm.doc
ATTEST:
Sally A. Maio, MMC - City Clerk
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HOME OF PELICAN ISLAND
SEBASTI�N MUNICIPAL CEMETERY
1921 N. Central Avenue, Sebastian, FL 32958 •(772) 589-2545 ■ Fax (772) 228-9927
April 29, 2009
Patty Jacobi �
127 Curtiss Parkway #34 �
Miami Springs, FL 33166
Dear Ms. Jacobi:
The Sexton gave me a copy of your letter to him requesting the disinterment of your parents
from the Sebastian Cemetery. To begin this process please mail the original deed to me along
with the attached form filled out and notarized.
I want to reiterate that the amount you will be receiving back will be the purchase price of
$150.00 minus the administrative fee ($7.50) and shipping costs (to be determined).
Please do not hesitate to call me if you should have any questions.
Sincerely,
,./ �j
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' o/ �`_.......-�-
Sally . Maio, MMC
Ci lerk
Attachment
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HOME OF PELICAN ISLAND
SEBASTIAN MUNICIPAL CEMETERY
TRANSFER OF INTEREST IN BURIAL RIGHTS
CONSENTFORM
I, Patty Jacobi, on behalf of Robert & Ruth Jacobi (deceased), Grantee(s) of City of Sebastian Cemetery
Deed # 258, do hereby transfer my/our interest in the following:
Lot(s) 8& 8A, Block 40, Unit 2 of the Sebastian Municipal Cemetery to: � [�
The City of Sebastian
1225 Main Street, Sebastian, FL 32958
in accordance with Section 34-13 of the Code of Ordinances of the City of Sebastian which states:
"Sec. 34-13. Sale of interment sites.
No interment site owner shall allow interments in their interment sites for a remuneration, nor
shall any transfer of interest therein be valid except by written consent of the city. No interment sites shall
be bought or sold for speculation. "
Please check one:
I hereby certify that I am selling back to the City of Sebastian my interest in the above referenced
site(s) and will be reimbursed the purchase price at time of purchase, minus 5% administrative cost set
out in R-08-27 and any other mailing costs. (Please provide the original deed when returning this form)
I hereby certify that I have received no remuneration for this transfer. I request the consent of the
City of Sebastian.
Signature of Original Grantee
State of _
County of
Before me, on this day of , , personally appeared
known to me or who produced as identification, who acknowledged to me that he/she/they
executed the same for the uses and purposes herein set forth.
Notary Public Signature
Printed Name:
My Commission Expires:
Notary Stamp:
The City of Sebastian hereby consents to the transfer of burial rights:
By: ATTEST:
AI Minner, City Manager Sally A. Maio, MMC - City Clerk
Approved as to Form and Legal Sufficiency:
Robert A. Ginsburg, City Attorney
IWAS\C0yC1eAcWppl\WOrtl Data�WW-0ATA\MsCemetery\Transfer of Interesl Fortn.tloc
April 21, 2009
Sebastian Municipal Cemetery
1225 Main Street
Sebastian, Florida 32958
Attn: Mr. Kip Kelso
Dear Kip,
Thank you for taking the time to explain the procedures to remove & ship
my parent's remains from the Sebastian Municipal Cemetery to Honey Creek
Woodlands Burial Grounds, in Conyers, Georgia.
Please let me know the cost to remove my parent's remains & ship them to
the following address:
Honey Creek Woodlands
2625 Highway 212 SW
Conyers, Georgia 30094
Attention: Joe Whittaker
I am enclosing a copy of the cemetery deed, as per your instructions.
It is my intention to sell the burial plot back to the City of Sebastian.
Please deduct the cost to remove, & ship my parent's remains from the sale
of the plot back to the City of Sebastian, & send me a check for the balance.
I would appreciate it if you could store my Father's head stone, until I
can make arrangements to retrieve it. I do not want my Mother's head stone.
Please let me know when this can be arranged, & I will mail the original
cemetery plot deed to your attention. Please let me know if you require
any additional information to make the arrangements.
Sincerely,
��
� �.�-
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Patty co
127 Curtiss arkway #34 Miami Springs, FL 33166 (pejacobi@yahoo.com)
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3 6 9 9
RECEIPT
Name�� r �
❑ Cash
Date �Check #_,.J�2--�
No. Amount Paid
001001208001 Sales Tax
001501322900 Garage Sales
001501341920 CopieslBid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Election �ualirying Fees
601010 343800 Cemetery Lots
LoUNiche �:�, Block � Unit �
001501343805 Cemetery Fees � ��
�. ���
Date of Mark-out "`��M
,
Total Pai� 1�
Initia
White - Dept of Origin • �eliow - Finance • Pink • Applicant
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Date of Burial ��'G ��' � Time '�� +�a � �C'
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N m of Funeral N�mp j�d�'� �� �� --
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Authorized by