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HomeMy WebLinkAbout4-28-32Date of Murk -out ~ Date of Burial Name ofFuneral Home Authorized by nmo_ ` Q[i1 ,1 of Orhastialt 1627 .9rutettry Berb THIS INDENTURE MADE Tluls ... 27�.............. any of .......ray................................. A. D., between the City of Sebastian, a municipal corporation existing under the law. of the State of Florida. ns Grantor .,,it Mrs. Rose L. Finch ........................................... P.O. "&7x"133......................................................................... ............................................F(4lslnere, FL 32948 ................................................................................... of the County of ...Indian River ........................ .1 State of ..FlQrids........................................... ............... as Greater, WITNESSETHu That the Grantor for and N consideration of the sum of S .... I) Q :Q........... to It in hand paid, the receipt whereof is herewith ae- knowledged, doe b this inatrvment grant, bargain, sell, release, convey and confirris unto the Grantee her .... heirs, legal representatives and assigns the following prop y dtuate0fln =b the Indian River County, Florida, to -wit: AB of Lolls) ,1 &32 Block 28 , , UNIT 4........... .. f 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 to .=idea. with the Mies and regulations, ordinances and resolutions of the City of Sebastian, Florida, herato- fora, now fled hereafter adopted or provided far the government and op airkm of mid comaery. The condition., rasalothm. and regNemonts contained N this Instrument shall be covenants running with the land. In the event of the failme of the comer of any property situated within said cemetery to ob. serve and comply with iuch rules, regulation% resolutions and ordinances and the conditions of the dead of conveyance thereof then the title of such owner in and to said property shall terminate and the same shall covert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the Rrst part has mused this Instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clark and its corporate seal to be hereto affixed, the day and year fist above written. Altesh Clly Clerk 1_6 ..:..... STATE OF FLORIDA COUNTY OF INDIAN RIVER CITY OF SEBASTIAN, FLORIDA By c�� -FL[ZffjF. .................... Mayor (Mita 5val) 1 HEREBY CERTIFY, That on thio ..27th................day of ........May....................................... IRS_, before nue personally eppaOr.d ,. Ruth Sullivan ((aft,,..,,,, M. Orlda110ran .................................................. anal ...."`.!.•.'............................. respectively Mayor end City Clerk of the City of Sebastian, a municipal corporation under the Iowa of the State of Fiord. to me known to be the Individuals and offleera described in and who executed the foreauing conveyance to ..... ........................................... Zka,..li4s0.I.. i'Y:iarh ............................................................ ........................................................ and severally as arch officers thereunto duly authorised; and that the Official acut of Is the net and deed of said corporation. WITNESS my signature and official seal at Sebastlan, In the Ca lest aforesaid. ION I June mvledgrd the execution thereof to be their free act and deed corporation 9 dyly­urf(xed thereto, and the said conveyance of Florida, the day and year .. ...................................... Nato ublle to of Plo i a ak Large. MY mem on-plress r� FT�1-0�RI�D�AiDAT ARiM@Ir OF State of Flook, Department of Health, Vital Statistics AMWA 02 8 APPLICAI . j FOR BURIAL — TRANSIT PERMIT Z/ / A. (Type or Print) 1. Name of First Middle last DATE Month Day Year Deceased OF Alvin Jason Finch DEATH March 20, 1998 2. Place of Death City, Town or Location Name of (If neither, give street address) County Brevard Melbourne Hsp.orHolmes Regional Medical Center Inst 3. Name of Medical Medical Examiner Address Phone Number Certifier 1430 Pine Street Silas Charles M.D. x Phvsi.ian Melbourne, FL 32901 (407)952-0898 4. Name of Funeral Home/ Address Fla. Lic. No./Reg. No. Phone Number (Area Code) Direct Disposer 1010 E. Palmetto Avenue Brownlie—Maxwell Funeral Home Melbourne, FL 32901 0000049 (407)723-2345 5. Check a ❑ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b ® Dr. Charles Office 3/23/98 was contacted on 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 He will complete and sign the medical certification of cause of death. c ❑ medical certification. was contacted on . He/she verified that , Medical Examiner, will complete and sign the 6. Place of Sebastian Cemeteryy In a cem e / Removal Final Disposition: Sebastian. FL n'c mag �, a/county: n from state n Donation 7 Funeral Director// gy+a r F.E. No./Reg. No. Date Signed Direct Disposer /C 1049 March 23, 1998 B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 498r'96 �} 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 t' e limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direct Disposer Report' will be filed with the o I Regi gr f the County in which death occurred. ❑ No extension of time for filing th' de , art quest Registrar or f Date Date Certificate Subregistrar Signature r� Issued: 3/23/98 Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL—AT—SEA G] 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. Methods of Disposition: ® BURIAL ❑ CREMATION Signature of Sexton ) or Person -in -Charge) ❑ STORAGE ❑ OTHER (Specify) CEMETERY OR CREMATORY Sebastian Cemetery Place of Disposition Sebastian, FL Date of Disposition Ae,,e This permit must be endorsed by the Secton 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. DH 326. 10/96 (Replaces HRS Form 326 which may be used( (Stock Number 5740-000-0325-2)