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Home My WebLink About1-32-21I UNIT 1, BLOCK 32, LOT 21 (2 cremains) Kenneth E. Roth Deed #1160,Rec. #506', 402 .SW. Ash St. Sebastian, Fl. Carmen E. Roth interred 311-1196 ROTH), KENNETH E. DEED #1160 REC. #506 A02SW Ash St.,Sebastian LOT 21, .,BLOCK 32, UNIT 1 (2 cremains) Carmen E. Roth interred 3 1/88 Paid by CEMETERY Receipt No ...... 0 6 , , , ....Dated.... 225/8$ List Price $ .... 200: ........ 00 .......... 0 ......... Maximum No. Burial Spaces. ?..Cremains Net Paid $ .... 2 0 0...0 0 .... ... . . Monument permitted ......... . Carmen interred .(Data above this line for City Record only) Titu of $PIiMSftttri Lot 21, Blk. 32 No, Un.l Kenneth E. Roth llso 402 S.W.Ash st.,Sebastian AT w,r t r t r r # PP�1 NO. 1160 THIS INDENTURE MADE TWa • • • • 25.th........... day or .... ...........F.ebrua.r. fir ................ A. D., I9 ..8$., between the City of Sebastian, a municipal corporation existing under the laws or the State of Florida, as Grantor and ............. ..........................Kenne th• . E,. • RR t ............ ........... ............................402 S.W. Ash St. , Sebastian,.. F.l.• ........ ............................... of the County of ...............Indian River as Grantee, WITNESSETH: as State of .............. Florida ............... That the Grantor for and in consideration of the sum of $ 200.00 grant, bargain, sell, release, convey knowledged, does by this instrument ' ' ' ' and ' ' • co • • nf ' irm • • • • • • • • • • • . to it in hand paid, the receipt whereof is herewith ac- the the following property situated in Sebastian, Indian River County, Florida, to-wit: unto the Grantee tt' S , heirs, legal representatives and assigns All of Lot(s) ,? 1, , , ,Block, „ 3 2. „ , UNIT 1 municipal Book 2, at page 65 of the public records in the office of the Clerk oft a Circuit Court f St. Lucie County of Florida; Number aid land thereof recorded in Plat in Indian River County, Florida, ring and being 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 ted serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed of conveyances thereof hen he id 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, Attest: 4 )i, C"' City Clerk Signed, Scaled and Delivered In the Presence of: .. ..... ... .... ........... ....... STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ... , , . ?Tid CITY OF SEBASTIAN, FLORIDA By ... ^ ....:. Mayor .day of ....... March• .... before me personally appeared • • • •.: •Gene •Harris Kathr . .y . n ..M ....0 . Halloran respectively Mayor and City Clerk of the City of Se and Ka . bastian, 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 ..... ........................Kenneth E. Roth... ..... 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 Se last aforesaid. bastian, in the County of Indian River and State of Florida, the day and Year Notary public Stat of Florida �• "' • • at Large. My commission expires: NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP DEC.10,1988 BONDED THRU GENERAL INS, UND, TA/ //,I �3 KI SEAS /FAe, �, A Sp,,,E oiv /414',' e' � /fI l,QNoFlyC -,e-v e-7 /e/9 ✓'�- I THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS BEREBY ACKNOWLEDGED OF THE SUM OF: oo 4j �oo - _Dollars ($ 2-v o, o ) FROM:-- - K % Al/ZI G % l' T , W p C' s W, on this 3 J 11day of described Cemetery Lot (s) u n� B the arms and conditions ashstated herein; Description of Property: Cemetery Lot (s)N �a / Block# Unit# Purchase Price: � °° �O() Terms and conditions of sale: 02 C 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 intrument: 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 f7 c� •� wry �, w w • SoYP f3Rc � ('o` ":c i k b•� �o f� � � GH�J�: FN in,�C Sr} is w ,J.l. s aR pr • c N,�'16 A P' Pa'r M�+r2KPR5 �H % o.Ca N1t 7-Ii+S'�:30('•^'!' v� ,. — n r D 5 t. SD r) S nir� Soi.D Aen� /4'� =: Dolfl. i9 ✓e �s °.n „ pox 9� 5ol..D ;.� . i- ��j0 Ts ;Ita �bHN ToE� % GN�I� AZT- � C,D,a.w„� K tr OL. !%F�dI) fCE�FNk� �1EtFNE:° =- 3lil (8B - ,, Iq yy ✓. - ✓ . i4R Pq s� ys /�41 a er 7, n, h s t 31 33 4S � t o O }. -U ='. •D 4� �. n�• i' I • SoYP f3Rc � ('o` ":c i k b•� �o f� � � GH�J�: FN in,�C Sr} is w ,J.l. s aR pr • c N,�'16 A P' Pa'r M�+r2KPR5 �H % o.Ca N1t 7-Ii+S'�:30('•^'!' v� ,. — n r Kenneth E. Roth was born on June 2, 1921 and passed away on Saturday, August 17, 2013. Kenneth was a resident of Sebastian, Florida. Name 114 Unit ! Block Lot L Date of Mark -out G Date of Burial -�—��J Time ZQ r COX, la Name of Funeral Home Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name izy I Y ram �u Date q- 5-13 No. 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies /Bid Specs. 4815 ❑ Cash Check # 6 - Amount Paid 001501 341910 LDC /Code of Ordinances _ 001501 341930 Election Qualifying Fees _ 601010 343800 Cemetery Lots _ Lot/Niche Z, Block 32- , Unit 001501 343805 Cemetery Fees _ cl r/ Total Paid V • tJ Initials White — Dept. of Origin • Yellow — Finance • Pink - Applicant SOUTHERN MICHIGAN SERVICES 12700 Fairlane 4900 Fernlee Avenue Livonia, Michigan 48150 Royal Oak, Michigan 48073 Of Kenneth Edward Roth Date of Death 8/17/13 Cause of Death Renal Failure Place of Death Oakland County, MI SMS Ident. No. 11580 Date of Cremation 8/19/13 Funeral Director Sawyer- Fuller Next of Kin Helen Jones Roth aft JTATEMENT DATE /, / TERMS TO ADDRESS IN ACCOUNT W17H i� 277 �a Xe> ®a c 3 C,4 5w DC5812 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY ttoMf C4 I'f IIC AN ISLAND For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589 -2545 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax. (772) 589 -5570 FUNERAL HOME: ADDRESS: PHONE #: (Check ne) OPEN BURIAL LOT Lot _Block 3z. _Unit OPEN CREMAINS LOT Lot __Block Unit _-- __OPEN COLUMBARIUM NICHE Niche Block Unit W BURIAL DATE AND SERVICE TIME: ; Q / b;®o�_ FOR DECEASED:j,/�/�� i\jarT)e NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) G� /6�/j 6_�/v /Vt Name SignatA Date I 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 NAIv1E AND SIGNATURE OF LICENSED FUNERAL DIREG -TOR. rvame 'Signature Date - ------------------------------------------------------------------------------------------------------------------------- Cemetery Sexton Certification: I certify that I have checked the ownership infonriation by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid eri� eterySexton Date This form to be provided to Clerk's Office by Sexton, for permanent record upon completion.