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Home My WebLink About4-41-32"3 o Ck1 Name ANfve H. 0�6r"en Unit y Blo^I' 4I L,l 3a Date of Mark -out 1-11-19 q - 21 ' f ' Date of Buria� Tim^ f �'- Oo fu Name of Funeral N9rM1,If IC L� $ -T Authorizetl bar (`/' H FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY no, I va--) City Clerk's Office — Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or388-8214 ctesta0citvotsebastian.ora For information contact: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax. (772) 228-9927 FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue. Sebastian, Florida. 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot -32 -Block -41 -Unit 4 Lot -Block -Unit Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: 11:00 AM Saturday 9/21/2019 at Sebastian Cemetery graveside service FOR DECEASED: Anne E. Hill O'Brien Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Margaret Cutrie Marg reg t Cua tt ;yam 9/19/2019 Name Signature Date 36 Beechtree Road, West Caldwell, New Jersey, 07006 1 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. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Name TM MooK Signature 9/19/2019 Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN 11884 ADMINISTRATIVE SERVICES RECEIPT Name' tzL w- (nr P3f1 L- ❑ Cash Data XCheck # ❑ Credit Amount Paid 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001208001 Sales Tax 450010369900 Airport Badge 001001218010 CobraServe 001501 354100 Cade Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 220030 PD SHOP 001501366602 PD SAFE 001501 366603 PD c�OPE� y CY` ;1 -Cl 3H3�Ca OfC gyp" �Ct.Do �k�4f •Lcs_xa ,}��{ aC�7�1 XTotal Paid Initials White - Dept. of Origin • Yellow -Admin. Svcs. • Pink -Applicant 09/19/2019 8:40 A9 FAX 7725892585 STRUNK FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, -Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office – Cathy Testa City Hall, 4225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388.8244 ctesta0citvofsebastian.ora FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue. Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) 2QM OPEN BURIAL LOT_ Lot 32 -Block 41,Unit 4 _OPEN CREMAINS LOT ____OPEN COLUMBARIUM NICHE Lot—Block Unit Niche Block Unit N S F W fm 0001/0001 BURIAL DATE AND SERVICE TIME: 11:00AM Saturday 9/21/2019 at Sebastian Cemetery graveside service FOR DECEASED: Anne E. Hill O'Brien Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Maroaret Cutrie Marnare cAttrie 911912019 Name Signature Date 36 Beechhee Road. West Caldwell, Now Jersey, 07006 1 certify that I have determined the ownership of the above described site that all she fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Tx Matink Name Signature 9/192019 Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid 9/l91 /9 emetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. ;;\.>".;'1 "'Paid bY~'METERY Receipt No.. ~~....... . Dated. ..~ !.~~(.~9................ dst Price $ . ~.~~: .q9..... . .. Maximum No. Burial Spaces........ ... ., ... . Net Paid $ . ~.Q~: .Q9........ Monument permitted................ ....... Lots 31, 32 Block 41 Unit 4 NO. (Data above thl. line for City Record ooly) Frances Vandevent4:t?q~ 1138 Breezy Way Apt. 113C Sebastian, Fl. 32958 atity of &tbastiun Q!rmrtrry D rrb NO. .1295 THIS INDENTURE MADE 11aIa ... .ZJ.E?~.. day of ..... ~~P.t;..~~P.~.:t;"........................ A. D.. 19. .~R., between the City of Sebastian, a municipal corporation existing undcr the laws of the State of Florida, 8. Grantor and Frances Van De Venter ........................ '''Ti38' 'B'reez'y' 'Way;' 'Apt'~" iij.c.............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~g p. ~~. 1;..~? P. ,. . Y;I, 9.+.],. ~~ . .~.4 9. ? e. . . . . . . . . . . . . . . . of the County of ..~ndJ.~n..~.t~~r...................... anI State of ......~.~q~.~.4~..................................... I. Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ ~9~.. .Q~. . . . . .. . . . . .. ... 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.. .l:t~~.. heirs,legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s)~ t.,;3.2 , Block, . ~.l. . .. ,UNIT ..~.......... , 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 shan 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 lUst 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 afIIXed, the day and year lust above written. Attest;~ ~ In.: .{).;ja.1..W/?~.......... ~~~~l" . City Clerk C'T:,0MZ;~........ (OHtu ~e211) ST fE OF FLORIDA COl'NTY OF INDIAN RIVER I HEUEDY CERTIFY, That on this... ..21 s t.. . . ... . .... .day 01 ...... Septembe.I'.............................J 19.9.Q b~lllre lI1e personally appeared . ~r... .~.!.. ~9.~Y~~~... . . '" .. .... . . . . . . . . . . . . . . . . . . . .. and K~.th;r:y'~.. Q .'.a;~.l:.;J,~+.~n........ respl'ctively Mayor and City Clerk 01 the City of Sebastian, 8 municipal corporation under the laws of thc State 01 FlorIda to me known to be the Indh'idulIls IInd officers described In ond who executf~d the fort.golng cORveyance to ............................... ........ ..Jf.:t;'!3n~.~.~. .Y~.l). .p.~. .Y~nt.~;r;......... .......................... ...................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and scverally acknowledged the execution thereol to be their Iree act IInd deed as such officers thereunto duly authorized; and that the Official sell I of said corporation Is duly affixed thereto, and the said conveyance is the act and deed of said corporation. WITNESS my signature and officIal leal at Sebastian, In the County of Indian RIver and State 01 Plorida, the day and 1ear last aforesaid. /Lg.,. . ..~?';e~..~./~~.................. Not Public, State of Florida at Lar,e. /. My ormalsslon explrell r:~);D1' r.:":':", ~~1~~ c: [;':r',,!l r.~'J ((mm:~.:'::c;1 r:.:~.':; r~ .~~ 2f\, t~~,1 e?nj-"f TI.!\! Tr-:f r('",in -:. .W .-......" !.',.. Name \..J rr" VA tV D eV-e n + -e R Unit ~ ...! I Block Lot '? " ",,)<:l'!o. 1;/),1 .,./9D 7(J, /2/ .ji/i t.l t) ki (/~ /9D Time /9 \ ::;'0 II, /lI1 ' Date of Mark-out Date of Burial Name of Funeral Home Authorized by i '''',< . \",(.~ // ' ~-,tc~..:- ...4/7. ~. I '-)''''' 1 "- 'I /l--- I ) :5 .J " UNIT 4 BLO~ LOT 1 32 \V S~ ~hl-t"0> c.ifJ ~~..'_"<'" :..;.:y:J' 'I"."-'~'."">"'"'''' ';!;~r;~A.~;!y//,/;,.{ " DEED 111295 Frances Van De Venter 1138 Breezy Way, Apt. #3C Sebastian, Florida 32958 ;/,':/f.-"-i:;d, ~~ - ~ t1 ~ 3J '- - "- - Paid by CEMETERY Receipt No.. ~~.~.......... Dated 9/21/90 . . 400 00 ...............:.............. List Pnce $ . . . . . . . . . . . . . . . . . . . . Maximum No. Burial S 4 paces................. Net Paid $ .. .Q~: .Q9........ Monument permitted fIJ~ ~ ~/ !'-cl;1.;;.k.;;..... (Data above this line for CIty Record only) Lots 31, 32 Block 41 Unit 4 NO. Frances VandeventEfl?q ~ 1138 Breezy Way' . Apt. #3C Sebastian, Fl. 32958 C!!itl1 of l'fbasttau atrmrtrry Irrb NO. '1295 THIS INDENTURE MADE 'I1aJa ... .~.l.I?t;.."....... day of ..... p~P.t~~P.I?X........................ A. D., 19..~~L between the City of Sebutlan, a municipal corporation alstlng under the laws of the State of Florida, as Grantor and Frances Van De Venter ................ ...... .........Ti3S..Breez.y: 'Way;' 'Ap't'~ ..ii3.C...... ...... .................. ..... .., .... ................. .................. ..............:;;.~J:?~~J.:i;.?P:". .~;I,9.r.J,.~~. .~.49.?~. .... ........ ... .....,.................. .............. ...... of the County of ".J;P:9..:!-.(:H1..~.:!-~~f"...................... an'J State 01 .... ..:f.:I;.qf".:!-.q.~..................................... u Grantee. WITNESSETH. That the Grantor for and in consideration of the sum of $ fI: 9.Q ...Q P. . . . . . . . . .. . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, sell, release, convey and COnIttm unto the Grantee ...l:t ~ f.. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: 1 )!l2 , Block, . ~.l. . .. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at age 6S 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 iver County, Florida. >107 .3/ StJl-ZJ !31){!)( TO {!IT;Y 3-~f-{/~ 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 sha1I 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 sha1I revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the iust 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 iust above written. Attest:~~rn.,.OI.N.~.......... .~-~--"" City Clerk CIT:,O;;;;Z;~..:..... (QIii" JieaJ) ST E OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this ... ..21 s t............ .day 01 ...... Septembe.J;:'.............................. 19.9.Q before me personaJly appeared . ~r... .~.!.. ~9.~1Y~1=:~.... ...... ...... . .. ... .. ... . .. . " .. and K~. th;r:YJ;l.. Q .'.<<~J;J,~+.~n....... respectively Mayor and City Clerk of the City 01 Sebastian, a municipal corporation under the laws of the State 01 Florida to me known to be the Individuals and officers described in and who executed the foregoing cORveyance to . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . .. . . . . . f.J; ~ ~~. ~.~ . . y ~.~. . p.~. . ~ ~ P: t.~,t;' .. . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . .. and severally acknowledged the execution thereol 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 Bnd 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 aforesalcl. N~P.bIk.SW..~~................'. My ommlssfon expire.. r;!'Jt~~v ti;!'!,!k, Sii3tO <;j n'j";~<Ll f~~ {'~nlmi~5i~.~~ fEp.r.:j~~C;j fJ~;.;ri! SO; i994 2ond;;ld Thw Trc:y Fc.in ~ lr.;::vr::n~~; tI1':. -<' . . . City of Sebastian POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978 TElEPHONE (407) 589-5330 0 FAX (407) 589-5570 September 24~ 1990 Frances Van De Venter 1138 Breezy Way, Apt. #3C Sebastian, Florida 32958 Dear Mrs. Van De Venter: Enclosed is Cemetery Deed No. 1295 for Cemetery Lots 31 and 32, Block 41, Unit 4. If you wish to have this deed recorded you may do so at the office of the Clerk of the Circuit Court, 2145 14th Avenue, Vero Beach, Florida. Also enclosed is a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. We are enclosing two copies of Receipt No. 643 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience. . Very truly yours, ~fJJ f)l/~ Kathryn M. O'Halloran City Clerk KMO: j s enclosure ~~':, ~ . (,ok .~ t. I ..) . THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida . I FROM: RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: /~a~) ~4L~eL'-----,_.._- t~ ,()~ 2~~y~-d~/ //,i? /.:i~ Jt~", ~ // de'- d~~A-/.' ///'--a_d~ on this /':lld~ day of ~~ 19f'd for the purchase of the following described Cemetery Lot(s).upon the terms and conditions as stated herein: Dollars ($ ~1d.~ ) r:t.~-?l- ~p ~ .302- Y...S'-S:- Description of Property: Cemetery Lot (s) fI 1...1/' ^ 3c2 Blockfl ~ / Purchase Price: r~ tfi,::'?~e~ Unitfl .y Dollars ($ 'Ytft'. t:;z7 ) Terms and' conditions 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 terms and conditions stated in the foregoing instrument: 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. fL~~/~h~ ~lty of Sebastian --i L/ ~ ~ . ,1..U:1 AUJl<l~.___........___... Ill_A t 0 ~ . Jilg> ~ · ~Jlf ' o ~ 12~ = 01_ i: :;, F C!J ::v ... U-I I, .D .D . - .. o IJ"2 -,J o o IJ"2 IJ"2 ... g\.." .. ~ ~~ Ll1 .D o OJ ... ru . 0: ~< ~d O;! 'TIm z > i 6It o o r- 5: ~ ~ :II ...C I~ f1J Z 'TI mo ~ ~i ~om - ~ ~ ;n~r- ~ ,... ::c Iii em m ... ~ ~ ~ ~i CD !(b.~l State of FIOrjd~artment of Health and Rehabilitative sere Vital Statistics ~L1CATlON FOR BURIAL - mANSIT PERMIT ~ 3d- (j ~I flf A. 1. Name of Deceased (Type or Print) First WILLIAM Middle CHARLES Last DATE OF VAN DE VENTER, SR. DEATH Month Day 9/20/90 Year 2. Place of Death County INDIAN RIVER 3. Name of Medical Certifier NOOR MERCHANT, M.D. 4. Name of Funeral Home/ Direct Disposer STRUNK FUNERAL HOME 5. Check a 0 Appro- priate Box b e City, Town or Location Name of (If neither, give street address) Hosp. or Inst. 1138 BREEZY WAY-APT. 3-C Medical Examiner Address Phone Number 7744 BAY STREET X Physician SUITE # 2 SEBASTIAN, FLORIDA 32958 407-589-0879 Address Fla. Lic. No.1 Reg. No. Phone Number (Area Code) 1623 N. CENTRAL AVENUE SEBASTIAN, FLORIDA 32958 #1228 407-589-1000 The medical certification has been completed and signed. A completed certificate of death accompanies this application. . SEBASTIAN LYDEE was contacted on 9/20/90 within 72 hours after death. He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that DR. MERCHANT will complete and sign the medical certification of cause of death. c 0 medical certification. was contacted on . He/she verified that ,Medical Examiner, will complete and sign the 6. Place of SEBASTIAN Final Disposition: CEMETERY 7. Funeral Director/ BirecI UISpu:se!' In state cemetery/ SEBASTIAN, FLORIDA county: INDIAN RIVER COUNTY F.E. No.1 Reg. No. 1/1672 Removal from state Donation Date Signed 9/20/90 B. BURIAL - TRANSIT PERMIT Permit No. 1228-90-4~~ Permission is hereby granted to dispose of this body. o A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. o No extension of time for filin he death certificate requested. Registrar or Subregistrar Signature Date Issued: 9/20/90 Date Certificate Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature or Medical Examiner, , Medical Examiner Date , 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 Methods of Disposilion: a:SURIAl o CREMATION o STORAGE o OTHER (Specify) 4? <;. x:;;.?' Place of Disposition Date of Disposition SEBASTIAN CEMETERY SEPTEMBER 22. 1990 Signature of Sexton ) or Person-in-Charge ) 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2) J.