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Home My WebLink About2-30-07w c_yZazz� L 0 o. i ,ylv 0 N a r,? 0 Name / Unit A Block 3� Lot r Date of Mark -out A.1 �. a Date of Burial `/ZO Time :5c-)" Name of Funeral Home %9 i✓i .r Authorized by i I ' o ` 1y Oc Z rn u i tl i I INI x 7 I� i L Total Paid Initials White - Dept. of Origin • Yellow - Finance a Pink • Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE 4258 RECEIPT Name 1' ` y `�"Sy n Cash ?^ Date �— 3 ' [I Check # No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501 341920 Copies[Bid Specs. 001501341910 LDC /Code of Ordinances 001501341930 Election Qualifying 601010 343800 ,Fees Cemetery Lots v I r91 rl ;a Wild S 011 LoUNiche I . Block, Unit 001501 343805 Cemetery Fees O.00 Total Paid Initials White - Dept. of Origin • Yellow - Finance a Pink • Applicant 1Jignity FOUNTAINHEAD MEMORIAL CEMETERY ♦ FUNERAL HOME ♦ CREMATORY 7303 BABCOCK STREET, S.E. PALM BAY, FL 32909 CERTIFICATE OF CREMATION THE UNDERSIGNED CERTIFIES THAT THE REMAINS OF ViR& iN(a W 161-5 o t-A WHO DIED ON: t4y 19 , 2003 , WERE CREMATED ON: t4N f Z j- , 2003 AND THAT ALL LEGAL REQUIREMENTS OF THE STATE OF FLORIDA WERE OBSERVED IN PERFORMING SAID CREMATION, AND THAT THE CREMATED REMAINS OF THE DECEDENT HAVE BEEN PLACED IN A PROPERLY IDENTIFIED CONTAINER. THE REMAINS WERE RECEIVED BY US FROM FOUNTAINHEAD MEMORIAL FUNERAL HOME BURIAL - TRANSIT PERMIT #- -19'4 �- 03 CREMATION CERTIFICATE # _2q7G "� SIGNATURE OF CREMATOR Mky 1-4 2003 DATE FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SE" ""I 0i PELICAN 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 -6214 Fax: (772) 589 -5570 FUNERAL HOME: ADDRESS: PHONE #: (Check One) PEN BURIAL LOT Lot Block Unit PEN CREMAINS LOT Lot Block 36) Unit -OPEN COLUMBARIUM NICHE Niche Block Unit W BURIAL DATE AND SERVICE TIME: f10 �'' o�- FOR DECEASED: - ivame 14AME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) 411A Name Signature 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 NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTGR. Al 1.4 Name Signature Date ------------------------------------------------------------------------------------------------ ----------------------------- Cemetery Sexton Certification: I certify that I have checked the ownership inforfnatfon by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid ,X/'o , , /, Z" Z/_0 Cechetery,$exton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Name its 5 0A/ d Paid by CEMETERY Receipt`No..... 9 : Dated 11 / 1 S,/ . 4 ... :.:..., .. .::. :t List Prices ,175.00 .. Maxintwa 1�io. iBt Sp.oer s ::. 3.... 4;.., i.; Net Paid $ ...... 5 25 . Q0.: Monwneat permitted; s i X' et .:..... i Lots 5 & 79 B1k.30, Un.2, William Hageman Intel a ll /Alitl& i %h ciiy > oo*d ooly) Replacement Paid by CEMETERY Receipt No.. Deed .. August 9 , .2001 ..... Dated .............................. List Price $ .................. Maximum No. Burial Spaces ................. Net Paid $ .................. Monument permitted .......... :............ Replacement Deed for Deed Vs 266 & 1121 (Data above this line for City Record only) 6/12/87 No. Title transferred j, Z-J from Florence Hagemdtl to Archie & Virginia Watson and /or Andrew Watson 601 Barber`Sti;Sabastian VIRGINIA F. WATSON NO. UNIT 2, BLOCK 30, LOTS 6 & 7 01812 J WATSON, Archie W. & Virginia F. Deed 4!1121 and /or Andrew W. 601 Barber St. Sebastian, F1. 32958 Lots 5 & 71 Blk. 30, Un. 2 (See HAGEMAN, Wm. & Florence) Block 30 Lots 5, 6, 7 Unit 2 Hageman, Mrs. William (Florence) Deed #266 Hageman, Mr. William (Interred) Mrs. Hageman's Mother 70 Phyllis Drive - Whispering Palms Wabasso, Fla. 1,0 1- x 'r0? r » 1-- ', 4Kc 141 r� � V!Rri�NrF} Wf}?So.✓ — 6 !�Y /g% se r Replacement Paid by CEMETERY Receipt No.. Deed Au u g.. s t 9 2001 ........Dated..... ......� .............. List Price $ .................. Maximum No. Burial Spaces .......2 ........ Net Paid $ .................. Monument permitted ..... ............... . Replacement Deed for Deed #Is 266 & 1121 (Data above this line for City Record only) Tttg of Orba,ottatt VIRGINIA F. WATSON NO. UNIT 2, BLOCK 30, LOTS 6 & 7 01811 AT 01811 ,,.,rut jet P r I r e b NO. THIS INDENTURE MADE Tills ........th........... day of .. AugLls. t .. ............................... A. D., .2001 between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Virginia F. Watson ........................................................................................................ ............................... 833 Beard Avenue, Sebastian, Fl 32958 ............................................. ............................................ .................................... I....... of the County of . Indian ..River....................... and State of ..Fjq. ride as Grantee, WITNESSETHr That the Grantor for and in consideration of the sum of $ $ 3 5 0... 0.0 .... . ..... . . . 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) . 6 , & . ?Block, . 30.... , UNIT .... 2...... , . , 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 This Deed supercedes Deed #'s 266 dated 11/15/74 and Deed # 1121 dated 6/12/87. Lot # 5 was sold back to City of Sebastian on 8/8/01. 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;egulations, 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 desed 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. Attest: .... .............. City ark Signed, Sealed and Delivered I Pre sence ofs ........... �. �. O .... .I. .. .......... stATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By .. .FAJ� ..1! V .AWE!!. " :............. . Mayor (0tg deal) I HEREBY CERTIFY, Thst on this ....9th ..............day of .... August...... .............................., 201 before me personally appeared ..............ter....arnes ................ ....... and ..ally.,,A,„ iai,q S 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 who executed the foregoing conveyance to Virginia F. Watson ........................................................................................................ ............................... ........................................................ and severally ack as such officers thereunto duly authorized; and that the Official seal of said Is the act and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the Count last aforesaid. �, IIIN1 MAN COMMISSION V MY COSION i CC I2M s� EXPIRES: Ahrch 18, tow Bonded Thm "I P*ft "nnwsns e execution thereof to be their free act and deed Is duly affixed thereto, and the said conveyance 7fI an River an4, tate o Florida, the day and year !�1?rti.........' ..... P ............... ary Public, State of F at Large. commission expirese WtiL tit wrau llan. ii rmrtrr No. 11 1 �G THI9 INDENTURE MADE Title .... 1%.tll .......... . day of ........... June ........................... A. D., 19..87., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ....... .......... Arc. hie.,W.._and. Virginia F... ..W..►�on.nA�l.Qx..�.�x�w.W.•.. �1e.G 4? ................. . 601 Barber Street Sebastian Florida 32958 ................................................ ............................... ......... ............................... ...... of the County of ...........Indian River ■n :� state of .............Florida as Grantee, WITNESSETHi .................. ............ That the Grantor for and in consideration of the sum of S' .5 2 5 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 Orantee ,their heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s)5 , & , ,� , Block, .30. , , , , UNIT , , , 2 , , , , , , , , , of Sebastian municipal cemetery as per Plat Number I 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. This Cemetery Deed #1121 supercedes Deed 1'266,.dated 11/15/74, which was for three Lots, Nos. 5, 6, and 7. Lot No. 6 was used for the interment of William Hageman. The original deed was.issue.d to Mrs. Florence Hageman. 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,�ordlnances 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 he Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. Attests Q�l .M.'. /.4rf!L. ..... Clty Cler Signed, Sealed and Delivered i the Presence of :� .... . ... Y"' ' c'G Gt �...... . CITY OF SEBASTIAN, PLO A B et/i Mayor (414 Meal) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this .....�. .........day of , before me personally appeared .........y, , , �"!�!L and ate o w respectively Mayor and City Clerk of the City of. Sebastian, a municipal corporation under the la a of the f ' -rid, to t e know to be the individuals and officers described In and who executed the foregoing conveyance fb Archie W. and Virginia F Watson and /or Andrew W. Watson •••• ................ .......I.......•- .............. and' severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly outhorisedi 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 Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. ............. Mary Fu�Uc, ate of i?lorida at Large. My commission explrnr NOTARY PUBLIC STATE OF FLORIDA NY CONNISSION EXP DEC 10,1988 BOWED TNRU GENERAL INS. UNO. T rm pt or re � N° 266 THIS INDENTURE MADE This .. R f t ®®nth, ...... day of .. Nvu .0.41r .............................. A. D., 19.74.., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ... mrs,..william. _ Hageman ............................. ........................................ ............................... 70 Phyllis Drive - Whispering Palms - Webasso, Fla. ...................................................................................................... ............................... of the County of ' ?diel't., River end State of ... Florida .......... ............................... as Grantee, WITNESSETHe 525.00 --- - - - - -- {o it In hand paid, the receipt whereof That the Grantor for and in consideration of thb•:eum of $ .......................... Is herewith acknowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee. tbitjl"•Y heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wits Unit 6.,,..7 ...... in l HOW ...2......... of Sebastian municipal cemetery as per Plat Number 1 there- of recorded in Plat Book 2, at page 66 of the public records in the office of the Clerk of the Circuit Court 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 rending 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 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 be- half 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: .... .... .. ...... �.- . . City Clerk Signed, Scaled and Delivered In Presence of: . ..r...L..........tit:.............. ........................... ............................... STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By.... ; ....!..: ........ .� r........ Q Mayor (Giv ' *A) I HEREBY CERTIFY, That on this .............. 26th....day of . December ........ ..............................1 19 ?4., before me personally appeared F...E.Ug9tta.Cragig.................................... and .Elorenea.L...Phsl ®n........... 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 who executed the foregoing conveyance to ... Mr.s,_ Willi ism. Hageman ...................................................................... ............................... ........................................................ 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 Sebastian, in the County of Indian River and State of Florida, the day and year lest aforesaid. f� Notary Public, State of Florida at Larg My commission expires: iVO!O'Q PV il". SFa�C OE ��0:" 37 0 ..nry