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Home My WebLink About1-41-01Name r) 3 C . A Unit G d d elo" LAI Ln't L S -G— 15 Date of Mark -out 5 — ll' kc� G^ Date of Burial Time 0 Name of Funeral Home? Authorized by J ? 6Rs CG f c na:ny�� 05/06/2019 2:41 Fill 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, 1225 Main Street Sebastian, FL 32956 Office (772) 388-82f5 or388-8214 ctesta(a)citvorsebastlan,orr( FUNERAL HOME: Strunk Funeral Nome and Crematory ADDRESS: 91617th Street, Vero Beach, Florida, 32960 PHONE#.- 772-562-2325 (Check One) _ _ ....... _ _ __ )0= OFEN BURIAL LOT _. __ LM 11,BID* 41 Unit 1. _OPEN CREMAINS LOT ----OPEN COLUMBARIUM NICHE Lot_Block Unit Nlche Block Unit N S E W :o 1)001 BURIAL DATE AND SERVICE TIME: 10:00 AM, Saturday, May 11, 2019 Committal of Cremains FOR DECEASED: Mary Jean Braz Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Natalie Flemina NataLLeFLeVRLV,q 5/6/2019 Name Signature Date 5725 Palm Avenue, Okeechobee. Florida, 34972 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: William B. Whittaker, Jr. ckhMan'8 c4ittakea, ix. 5/6/2019 Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owners deed and confirming with Clerk's office and that all fees have been paid: / X97 • �q• CenfeterVSexton Dat This farm to be providedto Clerk's Office by Sexton for permanent record upon completion. 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 �-y Fax: (772) 228-9927 City Clerk's Office - Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta0citvofsebastian.ora FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 916 17th Street, Vero Beach, Florida, 32960 PHONE#: 772-562-2325 (Check One) MM OPEN BURIAL LOT OPEN CREMAINS LOT _OPEN COLUMBARIUM NICHE Lot 1 Block 41 Unit 1 Lot -Block -Unit Niche Block Unit N S F W BURIAL DATE AND SERVICE TIME: 10:00 AM, Saturday, May 11, 2019 Committal of Cremains FOR DECEASED: MaryJean Braz Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Natalie Flemina Natant FLttuL" 5/6/2019 Name Signature Date 5725 Palm Avenue, Okeechobee, Florida, 34972 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: William B. Whittaker, Jr. CHIOME. %Mftahed, A 5/6/2019 Name Signature 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. Place of Death -County City, Town or Locallon State of Florida, Department of Health, Bureau of Vital Statistics Oil a BURIAL TRANSIT PERMIT HFaJI4 DATE PRINTED: May 6, 2019 TRACKING NUMBER: 2019054782 1. DECEDENT INFORMATION Name of 0ecessed Data of Deem MARY JEAN BRAZ Much 29, 2019 Place of Death -County City, Town or Locallon Name of facility, or street address If not a facility INDIAN RIVER VERO BEACH CLEVEIAND CLINIC -INDIAN RIVER HOSPITAL Name and Address of Formal Home/Dliect Disposal Establishment Fla. Uc. NOJReg. No. Phone Number STRUNK FUNERAL HOME AND CREMATORY-VERO BEACH FN18N Folle0s (7]2)562-2325 9161TfH ST VERO BEACH, FLORIDA 32960 Funenl DlreclorlDired Disposer Fla. Lia NOJRe9. No. WILLmM B WHITTAKER F026900 Medical Verification Statement LORI at the certifying physician's office, was contacted on 0410112019 by the funeral director listed above; helshe Indicated that PETER MICHAEL MARZANO III, certifying physician, will complete and sign Me medical cartificatlon of cause of death within 72 hears. 2. BURIAL - TRANSIT PERMIT The Florida Department of Health, Bureau of vial Statistics hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes. Permit Number: 2019-F041ao 5124 Data Issued: April 1, 2019 State Registrar 3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL -AT -SEA, or HOSPITAL DISPOSITION Authorization given by Medical Examiner District 19 Approval Number: Clg.11s bSTRK15 4. CEMETERY OR CREMATORY Place of Disposition: VERO BEACH CREMATORY Method of Disposition: CREMATION Date of DispositM n: EDRS maintains all statutorily required information regarding the death record and related burial transit permit, therefore, returning the permit to the county health department is no longer required. If the Place of Final DisposiBon wishes to retain the copy of the permit for their file they may do so. OH 326E, 10112 HIV -1.01 1, Florida Administrative Code CITY OF SEBASTIAN 11684 ADMINISTRATIVE SERVICES RECEIPT Name S4R UnYL1 D24y ❑Cash I/ Date �,/'7 j 1_[J Check# /3 -Ai' U Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees COIScl 343205 ` 0?so. °0 I k Lrr I oe Total Pai Initials White - Dept. of Origin • Yellow -Admin. Svcs. - Pink -Applicant 0 Ctv of behastis (gem r# try ID ttb NO. 1630 THIS INDENTURE MADE TW .......14th.......,. day of ...... Februarq ........................... A. D. 10.85... between the City of Sebastian. a municipal corporation existing under the laws of the State of Florida, as Grantor and Mary Jean Braz , .. . ...... ............................... . .. . ......................... . 9ZKX3KX,R5VF,K,V 4 1114 0 U . S . # 1 (kn � ............. Sebas . t1an m..F1 orida... 32958 ............. . ......................... ................... . ........................ I....... .... .. of the County of ... Indian .River ....................... an'l State of ..... Florida .. a Grantee, WITNESS$THr That the Grantor for and in consideration of the sum of i 300 ..00 .. . . . ... . .. . .. . . 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 , ,her... Imhh low representatives and assigns the following property situated in Sebastian, Indian River County. Florida, to-wit; Ali of Lots) , 1 & ?, , , Block, , , , 4 ?, , , . UNIT 1, a d d i t i on of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Piet Book 2, at page 65 of the public records in the office of the Clark of the Circuit Court of St. Ludt 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 ably 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 debd 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. Attests ...... ` ............. ".1........... �� Cltt Clerk Rigned, Sealed and Delivered In the ace ofm .. .".k ............... ..... .............. STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, F IDA By.. ............... xyor :��•. I HEREBY CERTIFY. That an tkb .......14th ...........day of Februarml ....................w�.,, before me personally appeared ...... Jim, Gel .. ............................... and . 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 wbo executed the foregoing conveyance to Aq can Braz ��`•�� v ..•...<.> .. ............................... and severally acknowledged the execution thereof to be their free act and deed ai� ' such -office .Is thereynto duly authorized; and that the Official seal of saki corporation Is duly atflxed thereto, cad the said conveyance k tt a aeC, sod :deep of aJW corporation. WITNESS my slsnature and official need at Sebastian. In the County of Indian River and State of Florida, the day and year Irt e?ardeN. . :. J. ' Notes d'ubllc. State of 8brlda a My commwas eapdrmn �. State of Florida My Commission Expires Aug. 22, 1488 aaadad Ttrr Troy him • Infarnace, Inc. 2KE SERASTIAN' CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUN OF: FROM: i on this jy l-W day of , l9 ft -for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot (s) M Block# Unit# Purchase Prices�.t1 ,'„ra1.�1 moo mllars($ll'11'd ) Terms and conditions of sale: �Ur. .. /'tz - a� This contracteshall 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 proper n 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. City of Seb;3itfan Witness r J • 1 �a Ot IyUC�M �N Cit) (f Sebastuzn Jim Gallagher POST OFFICE BOX 127 O SEBASTIAN, FLORIDA 32958 -0127 Deborah C. Krages Mayor TELEPHONE (305) 589 -5330 City Clerk July 16, 1985 Mary Jean Braz 11140 U.S. #1 Sebastian, Florida 32958 Dear Mrs. Braz: Attached please copy of Cemetery Deed #1038 and Receipt #399. If the original deed is returned to us, we will promptly forward it to you. Your card on file here at City Hall has been marked as to the loss of the original deed. If you have any questions, please feel free to contract us. Very truly yours, Deborah C. Krages City Clerk DCK/kn attach. GEM lox: NEWCEM Search b_q Field C)ntents City of Sebastian, FL — Cemetery Lots Last Name BRA; First Name MARY JEAN Address 1 439 S. W. Fordham Address 2 City Sebastian Deed # 1038 Date Unit # 1 —A Block # Lot Number 1 Interred Lot Number 2 Interred Lot Number Interred Lot Number Interred Comment Comment Monday, Jan 03, 2005 02:31 PM State F1 02 -14 -85 fhount 41 Bernie Braa (vet) <N >ext < Zip $300 Dte Dte Dte Dte 32958 — Interred Interred 02 -15 -8t, Interred Interred 1