HomeMy WebLinkAbout4-49-30ust $ .t.,.?.o.9...9.o. ..... Ho. .................
Net Paid $ ]' ~ 200 · 00 Monument permitted ...
Lots 29 & 30
Block 49
nit 4
" 1340
(Data above this line for City Record only)
OIemetery e ell
NO.
1340
THIS INDRNTURE MADR ~ Z5th d.y of ' October A.D., 10..9..1..,
between the City of Seb~tia~ a m~lc{~ corporation existing under the laws of ~e State of Florid~ as Order and
Margaret Littlefield
........................................ II0Z"I ai'i " f'i ................. ..............................................
........................................ }~.$9~ ~...~!~,.. ~L. 3Z~6 ................ . ........
of the ~unty of Indian River a.-] st,re ot Florida
~s Grente~ WITNEaSE~
T~t ~e G~to~ fo~ ~d
~owledged, d~s by t~s ~ument ~t, b~, ~, tel~,
the fo~o~t pwp~y sit~i~ ~ Seba~,.I~
29&30 49 4
~ of Lot(s) ....... , Blo~, ........ , ~ ............. , of Seba~ mu~dp~ ~metery as pe~ Pht N~z 1 ~ereof ~e~ded in Phi
Book 2, at p~ 65 o f ~e public ~e~t~ ~ ~ offi~ o f the C~tk of t~ Ck~t Co~ of S~ Ludo ~ty of Flat.a; ~d ~d now I~g~d b~
~ In~ Ri~r County,
To Have and to Hold th~ same fol~vez; pxovided that said t~ope~ty shall be.used solely and exclusively fo r the interment of the hnm~an dead and shall
bo used, kept and maintained at all times in accordance with the ~ules and regulatmns, ordinances and resolutions of the City of Sebastian, Florida, heIeto
fore, now and hereafter adopted or provided for the §o'~'nment and Operation of said cemetely. The conditions, res~ictions and l~qukements contained
in th/s instrumant shah be covenants xunning with the ]and. In the event of the faiinle of the owner of any propelly situated within saki cemetery to
serve and comply with iuch rules, re~uhtions, resolutions and ordinances and the conditions of the deed of conveyance tire,eof then the title of such owner
in and to said property shall temtinate and the same shall revelt to the City of Sebastian.
IN WITNESS WHEREOF, The said parly of the fi~st part has caused this instrument to be executed in its name and on its behalf by i~s Mayor and
attested by its City C[mk and its corporate mai to be hereto affixed, the day and yea~ first above vattten.
Signed, Sealed and Delivered
CITY OF SEBASTIAN, FLORIDA
STATE OF FLORIDA
Unit
Block
Lot , / ' '
Date of'Mark-out "/ :?'/'''' ~7'.~? ?
Date of Burial
Name of Funeral Home
Authorized
Time : // ' C),tD ,/~'
LITTLEFIELD,~ Margaret
1102 Indig~ Drive
Barefoot Bay, FL 32976
DEED #
Lots 29 & 30
Block 49
Unit 4
Kenneth C. Littlefield interred 10/26/91 - Lot 29
1340
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Burial - Transit Permit
First MiddLe Last Sex
MARGARET LITTLEFIELD FEMALE
Age If Veteran of U.S. Armed Forces,
10/15/2001_ 96 War or Dates N/A
e of Death Hospital, institution or
City,Town or Village PORT JEFFERSON Street Address MATHER MEMORL4L HOSPITAL
Manner of Death ~ Natural Cause [] Accident ~ Homicide[~[ Suicide ~ Undetermined ['~ Pending
Circumstances Investigation
Certifier Name Title
KA THY BIERSA CK ,MD
UPPER $1~EEp PASTURE RD, SETAUKET, NY
Register Number
Death Certificate Filed District Number
City, Town or Village POET.I'.~FF-EREO~, NY 5149
-- Cemetery or Crematory
Burial 10/19/2001 SEBASTIAN CEMETERY
[ ] Cremation Address
SEBAETIAN, FLORIDA
Date Place Removed
Removal / / and/or He d
-- and/or
Hold Address
Transportation 10/16/2001
Point of
Sh pment LA GUARDIA AIRPORT, NEW Y
-- by Common
Carrier
] Disinterment
] Reinterment
Destination
M~BO~E, FLORIDA
Cemetery Address
//
Cemetery Address
//
Permit Issued to
Registration
00238
Number
Name of Funeral Home BRYANTFUN~P~L HOME, ENC,.
Address
411 OLD TOWN RD, SETAUKIz'T, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
R egist ra r o f Vit al Stat istiCS ~,~Z~,.~,-~2~ N_~/,,42~.f..,~E~
Date issued 10/15/2001 · ~
(signature)
District Number 514.0
Place PORT JEFFERSON, NY
Name of Sexton or Person in Charge of Premises
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition / / Place of Disposition
(section) (lot dumber)
'/(pleaSe print)'
Title
(grave number)
DOH-1555 (9/98) (over)