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HomeMy WebLinkAbout4-49-29Paid by CEMETERY Receipt No....6..8.6.. List Price $ .]: ,.2..q 9... 9.9 ..... let p d, .t..,3.0. 9.'..o.o. ..... 1FIIg(/Q1 .... :.'..'.: ................ Maximum No. Burial Spaces ................. Monument permitted ....................... Lots 29 & lock 49 mit 4 30 "1340 (Data above this ~ine for City P. ecord only) (gemetery leeh NO. ' 1340 THlS INDENTURE MADE ~ ...... ~.~..~.~1. .........day of ;.0..c..~.9.b. ?..r. ............................... A. o., ~..9..1.., between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Margaret Littlefield ........................................ I I0Z ' 'I/iffi'~B' 'l~i'i~ ................. ' .............................................. ........................................ ~.a..r ~...?~.o. ~...~..a.y. ,.. ~L..9.2.9. Z.~. ...................................................... Indian River Florida of the County of ............................................. an'] State of .............................................. . ......... es Grantee, WITNESSETH~ That the Grantor for and in consideration of the sum of $ . .~.~. ~.0 0., ~] 0 ............ to it in hand paid, the receipt whereof is herewith knowiedged, does by this instrument ~/ant, barEai~, sell, release, convey and confirm unto the Giantee ......... heirs, legal representatives and assigns tile following property situated in Sebastian, Indian River County, Florida, to-wit: 29&30 49 4 ' All of Lot(s) ....... , Block ......... , UNIT ............. , of Sebastian munldpal cemetery as per Plat Number 1 theseof recorded in Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucia County of Florida; said land now lying and being in Indian River County, Florida. To I~hve 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 acconlance with the piles and reguhtions, 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, restlictions and requirements contained in this instrument shell be covenants.sunning 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 inch rules, reguhtions, 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 WlTNESS WHEREOF, The said party of the £ust 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 {/ City Clerk Signed, Sealed and Delivered STATE OF FLORIDA CITY OF SEBAI/TIAN, FLORIDA COUNTY OF INDIAN RIVER 12th November I MERE~Y CERTIVV, rh, t on ~i, ..... d.y of .~.~ before me personally appeared W, .~. *., .C. ,o. ,n.y.e..r..s. ................. and .~..a..t.h..c.y..l'l...~.......0.! .H..a..]..1..O..r..fl..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 thc foregoing coaveyance to Margaret Lit tlefield slid 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 Rlverand~Stute'of Florida, the day and year ~ntn of Florida f; ........ ~Y~'~/Commbslon Expires June 18, 1994 City of Sebastian POST OFFICE BOX 780127 [] SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589-5330 [] FAX (407) 589-5570 November 12, 1991 Margaret Littlefield 1102 Indigo Drive Barefoot Bay, FL 32976 Dear Mrs. Littlefield: Enclosed is Cemetery Deed No. 1340 for Cemetery Lots 29 and 30, Block 49, Unit 4. 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. 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, Veto Beach, Florida. We are enclosing two copies of Receipt No. 686 sign and return to us the copy marked with an other copy for your records. A stamped, is provided for your convenience. Very truly yourS, O'Halloran City Clerk and ask that you "X" and retain the self-addressed envelope KMO:lml enclosure Unit Block Lot Oate of Mark-out Date of B. rial "~ , ~.~.~: Name of Funeral Home~ < . ~%~ !~ ,v ~' Time /"// " ' Paid by CEMETERY Recei~ NO....6..~.6. ......... D:ted..1..0../.~. ~ r,.i,~: .t...,.?.o.9..' 29..... Maximum No. Burial SI~C~: ................. Net Paid $.................. ]' ' 200 · O0 Monument permitted ....................... Lots 29 & Block 49 Unit 4 3O '~1340 (Data above this line for C~I~' lLecard only) THE SEBASTIAN CEMETERY Cit~ of Sebastian Sebastian, Florida RECEIPT IS ','--dT- . , ' . . described Cemetery Lot(s) upon the terms and conditi~n~ as stated here~n.~ ...... Description of Propertg: CemeterF Lot(s)#~ Block~ ~_~____Unit~ ~ Farchase, 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 propert~ above described. I, or we, agree to purchase the above described propert~ on the terms and conditions stated in the foFegoing instrument: The Cit~ of Sebastian~grees to sell the above mentioned propert~ to the above named purchaser(s) on the terms and conditions stated in the above instru~e~t. State of Florida, Departme~l~f Health and Rehabilitative Services, Vital S APPLICATII~IFOR BURIAL -- TRANSIT PERMIT (Type or Print) 1. Name of Deceased First Kenneth Middle Last DATE Month Day OF 10/23/91 Littlefield DEATH Year 2, Place of Death County Indian River City, Town or Location Roseland 3. Name of Medical Gedifier Farhat Khawaja, bi.D. 4. Name of FuneralHome/ Direct Disposer Strunk Funeral Homes, Name of (If neither, give street address) Hosp. or Inst. Humana Hospital, Sebastian J Medical Examiner Address Phone Number 13865 us# 1 ---~Physician Sebastian, Florida 32958 (407)589-3000 Address /Fla. Lic, No./Reg. No. Phone Number (Area Code) 1623 North Central Avenu~ P.A. Sebastian, F1 32958 | 1228 (407)562-2325 The medical certification has been completed and signed. A completed certificate of death accompanies this application. was contacted on ~ within 72 houm after death. He/she verified that this death was from natural causes, that then was no accident nor other external cause of death, and that F~rhat Khawaia. M.D. will complete and sign the medical certification of cause of death. was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. 5. Check a [] Appro- priate Box b c [] 6. Place of Sebastian Cemeter,~-~ In state cemetery/ Removal Final Disposition: , 7V[--"~cmmatory -,.~e/county: Indian River ~ from state 7. Funeral Director/ ~// //Z ,Sign/u~.,. F.E. ,o.Z.~ Dim,~t-Die=i~sec ~ ~ ~ ,/ ~~~ I [~ Donation Date Signed !0/23/91 B. BURIAL --.TRANSIT PERMIT Permit No. 1228-91-0450 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 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. [] No extension of time for filid~i~he death certificate reque~d. Registrar or ~ /,,~ //~ ~/-,_~,~,z.~ / Date /0-~3~/ DateCert~-e,~'~,~::-F/ Submgistrar Signature / ',J ~..-.c.~'~ ~' -' ~c..-,. ~ /~-z.~--~- -~ Issued: 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. Methods of Disposition: [~BURIAL [] CREMATION Signature of Sexton ) or Pemon-in-Charge ) CEMETERY OR CREMATORY [] STORAGE [] OTHER (Specify) - Place of Disposition :SEBASTIAN CEMETERY Date of Disposition Oc't-~h~_r 26,: I qq I This permit must be endorsed by the Sexton or pemon-in-charge (or by the Funeral Director/Direct Disposer when then is no Sexton) and returned within 10 days to the local HRS County PuMic 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) ,_) .