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Home My WebLink About1-31-08 p Unit Block Lot • Date of Mark-out / 0 Date of Burial - Time Name of Funeral Home / =.• Authorized by STATE OF FLORIDA / O ■ OPARTMENT OF HEALTH & REHABILITA. SERVICES /j VITAL STATISTICS, i' / ��1,M1_ " AN APPLICATION FOR BURIAL—TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF ANDREW SCOTT SRIVATTANAROTAI DEATH OCTOBER 26, 1987 2. Place of Death City, Town or Location Name of (If neither,give street address) County Hosp.or INDIAN RIVER • VERO BEACH Inst. 66TH AVENUE & 73RD STREET 3. Name of Medical p Physician Address FT. PIERCE Phone Number Certifier FREDRICK HOBIN, M.E. ® Medical Examiner 4001-B VIRGINIA AVE. FLA. 464-7378 4. Funeral Home/ Name Address Phone Number (Area Code) Direct Disposer STRUNK FUNERAL HOME 1623 N. CENTRAL AVENUE SEBASTIAN. FL 305-589-1000 5. Check a ❑ The medical certification has been completed and signed.A completed certificate of death accompanies Appro- this application. prate Box b ❑ was contactedorr within 48 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 will complete and sign the medical certification of cause of death. c ts DR. HOBIN was contacted on 10/27/87. He/she verified that HE , Medical Examiner, will complete and sign the medical certification. 6. Funeral Director/ Signature Fla. Lic. No./Reg. No. Date Signed -9ireet-Bnpecor- ., '/(.. 72— /D _2 717 B. BURIAL—TRANSIT PERMIT Permit No.1228-87-398 Permission is hereby granted to dispose of this body. ❑A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted. If it cannot be filed within this time limit, a "Funeral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death oc- curred. ❑ No extension of time for filing t .eath certificate requested. Registrar or "1// Date 2 j Date Certificate Sub-Registrar Signature - U- Issued: ° 7 Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA Signature , Medical Examiner Date or 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 r P Method of Disposition: Place of Disposition ej.41-f ej (_, ... BURIAL ❑ STORAGE Date of Disposition /() ' 3C.)- V ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) it/3°or P ) , 7 7 - 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. HRS Form 326, May 86 (Replaces Apr 81 edition which may be used) (Stock Number: 5740-000-0326-2) 1,1Y Of r f , — 1- r =;s � F PEA ICAI"1 FRAN D, Certificate No. 2081 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Deborah M. Dillahay 1101 Turtle Run Dr., #107,Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $450.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot/niche: Unit_1_Block 31_Lot(s)Niche(s)_8, 9 & 10*_ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 1st day of May 2006. CITY fi F SEC A IAN, FLORIDA ATTEST. rim , : A P, inner Salll t M`aio, MMC City Manager City Clerk *Replacement Deed for Deed #1077 Srivattanarotai , Andrew Scott - Interred 10/30/87 lot 8 Blk. 31 Un. 1 Stanley Dillahay P. 0. Box 1239 Deed ##1077 Sebastian, Fl . Receipt #436 Lots 8 , 9 , 10, 11, 12 , 13 Mary Learned interrred Lot 9 - 5/6/86 i UNIT 1 Dillahay, Stanley Block 31 PO Box 1239 Lots 8,9 10,11,12,13 Sebastian, FL 32958 Deed #1077 Receipt #436 Mary Learned interred in Lot 9 - 5/6/86 Scott Srivattanarotai interred Lot 8 - 10/30/87 !II! J . ' DILLAHAY, Stanley Unit #1 PO Box 1239 Block 31 Sebastian, FL 32958 Lots 8,9,10,11,12,13 Deed #1077 Receipt #436 Mary Learned interred in Lot 9 - 5/6/86 Scott Srivattanarotai interred Lot 8 - 10/30/87 Learned, Mary Interr6e/d Lot 9 , Blk. 31 , Un. #1 Stanley Dillahay Deed #1077 P. 0. Box 1239 Receipt #436 Sebastian, Fl . Lots 8 , 9 , 10, 11 , 12 , 13 Andrew Scott Srivattanarotai int . Lot 8 - 10/30/87 L ea - At /a /G (27- GAG cc3Cl 04, vR v+ -7,. m, CITY OF SEBASTIAN CHECK REQUEST Accounting Use Only Input Date 5/1/2006 Fiscal Period Document# Entered By Document Amount #of Lines Total HC Hash To Be Completed By Department Due Date 5/5/2006 Single Check Y/ N Y Vendor Number Organization Object Project LN TC Reference Code Code Code Amount 601011 534959 $450.00 Number of Lines Amount $450.00 & Description Sell Back to City, cemetery lots described as Unit 1, Block 31, Lots 11, 12 13 for $150.00 each. Copy of Deed #1077 attached. ISSUE CHECK TO NAME Deborah M. Dillahay ADDRESS 1101 Turtle Run Drive Apt. # 107 CITY Sebastian State FL ZIP CODE 32958 DRAW CHECK FROM SEE BELOW' APPROVED BY DATE 5/1/2006 BUDGET APP I MAIL ATTACHED DOCUMENATION(Except for remit slips,requesting department should attach a copy of documentation along with the original) I__ I OTHER INSTRUCTIONS II --� fiitg of Orhastisn C0 py Trutrftr !Bert( NO. . 1077 THIS INDENTURE MADE Tkis 28th day of March A. D., 19 86 , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Stanley Dillahay ?o Sox.7.239,..Sebastian of the County of Indi~afl.1Uver and State of ...Elarida u Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of S 900.00 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 heirs,legal representatives and assigns the following property situated in Sebastian,Indian River County,Florida,to-wit: 8,9,10,11 All of Lot(s)-1,2v.13,Block, 31 ,UNIT 1 ,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. E 4.Zzlede.t.lotoa' 0/70,10,P.' /6e4W1 /d?? / 01400 6 4&'z ieie•••°' - . 00 h . 4- , Q To Have and to Hold the same forever;provided that said property shall be used solely an exclusively for the inte nt 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 = 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- r d c t mp -with such rules,regulations,resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner _.ind to said property shall terminate and the same shall revert to the City of Sebastian,Florida. IN ATINESS 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 s-.-test by its City Clerk and its corporate seal to be hereto fixed,the day vear first ab e 4'WRJDA • Attest— •- —,'f- '�..C.-- j7./ - .�.t-, B . ' r...1'f -. �... !L.. City Cleric % -itAl►or. A. / Signed, Sealed and Delivered D in the Presence of: ;i70 � G1 , . 2/I V's (gig cal) /, STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 28th day of March • 19.•86 of-fore me personally appeared L. Gene Harris and nehorah.G...Kr.ages 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 Gladys Phillip 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. • (City of Orbitottatt TPZttrtvrj. iPPb NO. 1U? THIS INDENTURE MADE This 28th day of March A. D., 19 86 , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Stanley Dillahay Po of the County of .. and State of ...Florida as Grantee, WITNESSETH: That the Grantor for and in consideration of the sum of$ 900.00 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 heirs,legal representatives and assigns the following property situated in Sebastian,Indian River County,Florida,to-wit: 8,9,10,11 All of Lot(s) .13,Block, 31 ,UNIT 1 ,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, FLO; 'A y / Attes : ' � t�> .,i... r...a :�c z _ By, f 4, City Clerk { Mayor Signed, Sealed and Delivered in the Presence of: ((city ,*pzt,) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 28th day of March , 19..84 before me personally appeared L. Gene Harris and nehonah.D...Krages 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 Gladys Phillip 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. WITNESS my signature and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. Nota Public, of Florida a P Large. My commission expires, Notary Public, State of Florida My Commission Expires Aug. 22, 1988 bonded Thru Troy Fain-Insurance, Inc. !Irk Paict%by CEMETERY Receipt No Q Ill Dated....Mar.ch..2 +.,..19.86 • NO. List Price$...9QQ:.QQ Maximum No.Burial Spaces...Six Net Paid$ 900.00 Monument permitted FIAT 10 77 Lots 8,9,10,11 ,12,13 Stanley Dillahay Block 31 , Unit 1 (Data above this line for City Record only) PO Box 1239 - Sebastian,FL Gifu of forbaifian TPi eter1J ElPP I NO. 1077 THIS INDENTURE MADE TMs 28th day of March A. D., IY 86 , between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Stanley Dillahay e0 lioy;.?2 9.,..Seaas.Uan of the County of .. R>.vnr aril State of ...F.larida as Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of$ 900.00 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 heirs,legal repretentatives and assigns the following property situated in Sebastian,Indian River County,Florida,to-wit: 8, 9,10,11 All of Lot(s) 2.,..13,Block, 31 ,UNIT 1 ,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 rust 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, FLO; Attest; —`err` �...��. .i •.ii B City Clerk °]ttaxor y • Signed, Sealed and Delivered in the Presence al Rje,c,e( - . STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this 28th nay of llar.ch , :4 9.,i, before me personally appeared L. Gene Harris and Dehorah.0...Kr.ages 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 Stanley_Dillahay 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. WITNESS-my signature-and official seal at Sebastian, in the County of Indian River and State of Florida, the day and year last aforesaid. Nota Public, State of Florida a Large. My commission expires, Notary Public, State of Florida My Commission Expires Aug. 22, 1988 OonJad Ihm Loy F.m-Inwonce,Inc. i i a • TO: CITY OF SEBASTIAN RE: CEMETERY DEED - LOT #'s 8, 9, 10, 11, 12, 13 BLOCK 31 / UNIT 1 AUTHORIZATION IS HEREBY GIVEN TO TRANSFER THE ABOVE LOTS OF CEMETERY DEED CURRENTLY OWNED BY STANLEY DILLAHAY TO: DEBORAH M. DILLAHAY P.O. BOX 78-0666 SEBASTIAN, FLORIDA 32978 THIS TRANSFER IS EFFECTIVE IMMEDIATELY. y� I, r STANLEY I IL •ilr Y /7- /7/ - Gx� f 7c2�u°� Notary Public, State of Florida -T My Commission Fxpi.cs arch 25, 19193 Bonded Ti.tu Troy Fain-!nsuranco inc. (,0_,ec Cc- a cC�� STATE OF FLORIDA 2 /`2 COUNTY OFC�Ct fi Before me personally appeared Cl/IAV/7 �1�/- ___ �/ to me well known and known to me to be the pez`son descri>hed in and who executed the forgoing instrument, and acknowledged to and before me that �� executed said instrument fo`r the purposes therein expressed. WITNESS my hand and official seal, this day of A.D. , l yU . ' No ary Public State of Florida Notary Public, State of Florida My commission expires My Commission Expires March 26, 1993 bonded Thru Troy Fain-Insurance Inc. (notary-a) - T. Q -,MS i v - /, ul / ix d • T S R ANAk ! 1. 1 s�� •v lj L 1 aPlet/Q SA b NA M' Twa :SW A 43 hz p,__,,_ div11.4_ , `"4'-'-''' o f tdS6)4• , • ' h M 7 )O O 4:01. Y 3 /N ,� /a a 7'lZi / t r, . (LA 0-c--:,4-:-,,_'r lIa i _ _ b ,, J : /...,,_, i v ti'1" (o.,., Q CJV'`\' .J/,0_ N/,p r . /y to' ,/b' 1./ �! a• • r��....-.�' 1' I ` /,/t., .//o .,ip ,t/G • .. , e n 1.h. ID 1.1/7/ '. c,R,, i- 1- 3 �3 3S' / ' J{ 4 14J ,1 / 7,- '3P J v K fi 7d r.. • v / lg'l4 i4ls< 1`k1 lei < o?.p - 1_\7 r-1 '. V6- ‘j CI' • i t STohrG n/c,N/ i N one M/1 �� JC/ax'N•CQ j 1 RI _..FIIIiI1 111 1i � Ii ; f ;S, �, -1 ''''''4'4-..:.i:—....'''', .t N .. �' • ; "x _ 1 Yw(n h I L� R 6 - N.,1?' � v 1 M1t+A.r1 r.. k r �.r�.r1RT?C,. ,, • • THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: 41 7L.�,4„ ,, Dollars ($ 'gO() Ca ) — FROM: t , i (70 . on this N day of)-i ,i,44 , 19k6 for the purchase of the following described Cemetery Lot(s) upon the terms and conditions as stated herein: Description of Property: Cemetery Lot(s)N )O/)j / Block# i1 Unita 1 ha Purchase Price, ,, Dollars($ 9 p n .9 ) Terms and conditions of sale: 6Da. i/7L This contract shall be binding upon both parties, the seller 4134 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: 4F —7( 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 Seltr Witness • • • TO: CITY OF SEBASTIAN RE: CEMETERY DEED - LOT #'s 8, 9, 10, 11, 12, 13 BLOCK 31 / UNIT 1 AUTHORIZATION IS HEREBY GIVEN TO TRANSFER THE ABOVE LOTS OF CEMETERY DEED CURRENTLY OWNED BY STANLEY DILLAHAY TO: DEBORAH M. DILLAHAY P.O. BOX 78-0666 SEBASTIAN, FLORIDA 32978 THIS TRANSFER IS EFFECTIVE IMMEDIATELY. \ STANLEY OIL 4 r7 Y ztzt ) _Ceed_4?7' -/7/ - 41/Cile-v'/ _ . Notary Public, State of Florida — My Commission Expi;cs March 26, 1993 Bonded Thru Troy fain•Insurance Inc. /,tie F pctta cite-,�1 `7t_CtR 'r��acr�