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HomeMy WebLinkAbout1-34-19 Paid by CEMETERY Receipt No 442 Dated 6/25/86 NO. List Price$.....$.7.00.,110.. Maximum No.P uciai Spaces 2 Net Paid$ $700. 00 Monument permitted –F l d t- Unit #1 Rosalie 3 . 1083 F mio Block # 34 8615 95th Ave . Ve Ko 13 I O t ' S 1 R 31 Q (Data above this line for City Record only) l Win , Fla . 3"994F8 CITY OF SEBASTIAN — CITY CLERK'S OFFICE 4^ t RECEIPT / c w o 0 oo 5 ' w to Name 'ZO t �Q ((/' o 3 o o co '�` 3 0 Cash N o a. -, Date / 7 ° c° Check# /.7 J~` w 7 o U\ w Amount Paid I ( 001001 208001 Sales Tax o r`-3 m rn 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC/Cade of Ordinances p 001501 362100 Community Center Rent N 001501 362100 Yacht Club Rent h O 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots 0 601010 343800 Cemetery Lots co Lot/Niche�' Block r ,Unit 001501 369400 Interment Fee :'.a 001501 369400 Weekend Service -' rn • 680800 220681 Yacht Club Security Deposit 6808 i �220682 Community Center Security Deposit 680800 220683 Riverview Park Security D eposit t Initials Total Paid White Dept.of Origin• Yellow-Finance•Pink•Applicant Qlitt of 9rtaLIti T a nt r i e r g il e t it NO. r 1083 THIS INDENTURE MADE This 25th day of June A. D., IY$ , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Ros:al.ie..J....F.i.l.om.ia 8615 95th Ave . Sebastian , Fla . 32958 of the County of Indian R i y t~r awl State of F 1 o r.i.d a as Grantee, WITNESSETHa That the Grantor for and in consideration of the sum of$ 70 Q ,.Q0 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) 188,19,Block, 34 ,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 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 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. CITY OF SEBASTIAN FLIP 'I s (A Attest—.. 44'^,-J e• BY 41V '`+ 40..q' }- --C-'4--(/ City Clerk f/ . . r Signed, Sealed and Delivered --_ — j in t e Presence of:4 / __.„ , f wiz �'�. - ' STATE OF FLORIDA COUNTY OF INDIAN RIVER p// I HEREBY CERTIFY, That on this s2- day of , Ie Q.., before me personally appeared ...r. ',,^ I and ' /117 respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me nown to be the individuals and officers described in and who executed the foregoing conveyance to aSa4..i.1: J. TiLO/4, / 0 and severally acknowledged the execution thereof to be their free act and deed as-such_officers thereunto duly authorised; and that the Official seal of said corporation is duly affixed thereto, and the said conveyance is the act and deed of said corporation. -.1--- --"r—W.--C___- U r • 1,frI.V-IP. / ( C11•14'4 t)TERMS L___ i ' _! : -.---____./- _— __ _ _____RATzN_C.r_._.._._.______. —..._,,y..,.r.2.T. •"(Nr\ i..d GO . . <C414' . i/ 5- ,.\ 6 'A i .,e3 r 6 eP■.'(°f1;,' C?../ '--\ : ..." - ev • II:I:y:1'1(f /ILI F' ill ok II 61-At; .hr,• • ./ L,(‘- ye I, i N VY oi,17 ,r' ,, q I , og, A..,-,, ,, 1' . ,,-,4' 0 gl, . vo v, A •Hib . (1' ....„......„, 4.1.... ......._ •1 G ": •A66 " b E nn ps.9 ,z7 ,' ,I . •, ..- 7 690/.14,1,6 e ,' - OA ,--- 5 ,'. . -- .,----00, ' t, ,i tA / C-, , . ma. ZU/ -S--izt/d 3 ' . 3;- .7 got 17 tt7 ra. r"'"- tv.k5sr tzy II l I'',t' • , ., 0" / , . 1 .,..h.-- _,. . II ll i—i-----1 I 1 1 0 ii—T—I-Turr 1- -I- it FLORIDA DEPARTMENT OF Q 3'7/ DEALT State of Florida, Department of Health, Vital Statistics 1 APPLICATION FOR BURIAL-TRANSIT PERMIT a r A. (TYPE) 1. Name of First Middle Last Date Month Day Year Deceased Rosalie Jenny Tefoe Filomio Death June 25, 2002 2. Place of Death City,Town or Location Name of (If neither, give street address) County Brevard Melbourne Hosp.or Mariner of Atlantic Shores Inst. 3. Name of Medical Address Phone Number Certifier Dr. Ruiz 200 E. Sheridan Road (Medical Examiner rx7Physician Melbourne, FL 32901 321/725-4500 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg.No. Phone No. (Area Code) Establishment 1010 E. Palmetto Ave. Brownlie-Maxwell Melbourne, FL 32901 0000049 321/723-2345 5. Check a. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. [ Dr. Ruiz's Office was contacted on June 26, 2002 He/she verified that this death was from natural causes,that there was no accident nor other external cause of death, and that Dr. Ruiz will complete and sign the medical :ndian River certification of cause of death within 72 hours. bunty c. ❑ was contacted on . He/she verified that , Medical Examiner,will complete and sign the 'bastlan Cemetery medical certification of cause of death within 72 hours. 6. Funeral Director/ Si f�atu F.E. No./Reg. No. Date Signed Direct Disposer 1948 June 26, 2002 B. BURIAL -TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 402C089 ©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 certific-te-has-been requested. Registrar or Date _ Date Certificate Subregistrar Signature `' Issued: ( . % •!`•) . — Due: C. 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. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Sebastian Cemetery Method of Disposition: Place of Disposition Sebastian, Florida DBURIAL ❑STORAGE Date of Disposition A pA .?_..7 CREMATION ❑OTHER(Specify) Signature of Sexton or Person-in-Charge } ,J y / `• 97 . This 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 within 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326,8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number: 5740-000-0326-2) Pink: Local Registrar