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Home My WebLink About4-48-04 emelery Dee NO. 1108 THIS INDENTURE MADE ~ ...... ~.~. 3t ....... day of ...... ~r~Z~p~ ............................ A. D., 19~..., between the City of Seb~stian, a munielp~ ~ratinn exiat~ under the laws of the State of Finr~ ne Oran~r and .............. .... ........................................... of Ihe ~unty of I~i~.,~v~r ......................... anl 6late of .......... ~0~ .................................. ~ Gr~ntee~ T~t the Gr~tor for a~ ~ ~n~derefi~ of the ~um of $ ....... ~, ~.~ ........... to ~owbdggd, d~s by ~s ~ru~nt grant, baa&h, ~, reims, ~nvey and ~nf~m ~to the Gr~tee ......... ha~s, the foUowing property ~(ed ~ ~hast~n, lnd~n River County, Florida, to-wit: All of Lot(s) ~..~..~ , B~ck,..~. .... UNIT ...~ .......... of ~ha~ muni~l ~metery Book 2, at p~c 65 of Ihe pubUc re~rds ~ the offl~ of ~he C~rk of ~ C~it Court of St. Lu~ County of ~r~a; ~ ~ now l~ ~ b~ m Indi~ River County, Flo~da. To Have and to Hold the same forever; provided that said proper~y shah be used solely and exclusively for the interment of the human dead and shall bc 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 provid0d for the government and operation of said cemetery. The conditions, restrictions and requirements cont~nod in Ibis instrumcnt shall be covenants running with the land. In the event of thc failure of the owner of any properly situatod within saki cemetery to ob- serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the de~d of conveyance tharoof than tho Utle of such ownor 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 pa~t has caused this instrument to be executed in its name and on its bohalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above wtitten. .............. COUNTY OF INDIAN RIVER beto,e me personally appeared L. Gen~. ~a~ ........... and .~V..~...~J~ .......... respectively Mayor ami City Clerk of the City of Sebastian, a municipal corporation under tha inwi of t~ ~tate of Plor~a ~ me kssown ........... Laui~. D~f~ ................................................................................................... "S SlICll ofiieers thereuuto duly author~dl and tMt the OlficiM ~al of ~BI corporltion la duly afflz~ theretl ~ 1~ ~ld is thc ~ct m*d~d ~l ~1~ W1TN~SS my signature a~ offlelid ~ at Se~tinn, In the ~unty of l~sdlan River and State of Pinrida, the da~ and year [~st ............ :' My co~lad~ explr~ NOTARY ~BLIC $ll~ ~ ~Y COR~ISSION EXP DEC Rkme Unit Lot Date of Mark-out Date of Burial Name of Funeral //:o 0 Louis Donofrio 524 S. Egret Circle Barefoot Bay, Fla. 32958 'DEEo# ~o8 Lots # 4&,5.. { I/1N/h, Block #48 Unlit #4 ~t ~,i,~ $..~.o.q:.o.q ......... Net Paid $ 800. O0 Louis Donofrio 524 $. Egret Circle Barefoot B~4 , Fl~, ._32958 Maximum No. Burial Spaces .... .2. ........... Flat Monument permitte~ ....................... (D~ta abo~ this 11~ for alit l~eord onll,) Lots 4 Block THE SEBASTIAN CEMETERY Citg of Sebastian Sebastian, Florida RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF: O0 Dollars ($ descri~ Ce~t~r~ ~t(s) ~n =he =erms ~nd ~ndi~l~ns ~ st~ed ~rein~ Description of Propertg: Terms and' conditions of sal~: Unit# This contract shall be binding upon both parties, the seller and the pur~h4mer, when approved bg the owner of the property above described. I, or we, agree to purchase the above described propertg on the terms and ~ondi~ions The City of Sebastian agrees to sell the above mentioned property to the 4~ve named purchaser(s) on the terms and conditions stated in the above Witness State of Florida, Departt of Health and Rehabilitative Services, Vi~tistics APPLICATION FOR BURIAL -- TRANSIT PERMIT (Type or Print) 1. Name of First Middle Last Deceased Louis Peter Donofrio DATE Month Day OF 09/22/1996 DEATH Year 2. Place of Death County Brevard 3. Name of Medical Certifier Craig Bado'lato, M.D. City, Town or Location Me 1 bourne 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, P.A. Name of (If neither, give street address) Hosp. or InstHo]mes Regional Nedical Center Medical Examiner Address 95 Bulldog Blvd~ #100 ~Physician Nelbourne, Florida 32901 Phone Number (561) 727-3495 Address 1623 North Central Avenue Sebastian, F1 32958 Fla. Lic. No./Reg. No. Phone Number (Area Code 1228 (407)562-2325 5. Check Appro- phate Box a [] hX'A c [] 6. Place of Sebastian CemeteJ~ln s~t,~te cemetery/ ~/ Removal Final Di~position: /~ c~,~atory - nan~/c,~ty: Indian River ~ from state 7. Funeral Director/ j/t/ //P~ature / /~/~ ~ ~ ~FF.E. N~. eg, No. I~'~'D~"~ser ~,/~,/~ ~/(,~,-,/ ffY"~ <-'"'"-'-'-'--'~"-~-"~ The medical certification has been completed and signed. A completed certificate of death accompanies this application· C1 a~'~ was contacted on-Q9,/-.2;.-~ 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 tha~Fa'i ,cJ Bado"l ato, N, D. will complete and sign the medical certification of cause of death. . was contacted on . He/she vedfied that , Medical Examiner, will complete and sign the medical certification. ,//' ['--1 Donation Date Signed O9/23/1996 B. BURIAL -- TRANSIT PERMIT Permit No1228-96'0441 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 fired within this extended time limit, a "Funeral Director/Direct Disposer Report" will be tiled with the Local Registrar of the County in which death occurred. ' [] No extension of time for filing the death certificate requested. ~ ~ ~'~ ~ Issued:Date Due:DateCertificate Subregistrar Signature Signature or Medical.Examiner. AUTHORIZATION for CREMATION, DISSECTION or BURIAL--AT--SEA Medical Examiner Date ga¥~ 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 ) · .: ':CEMETERY OR CREMATORY [] STORAGE [] OTHER (Specify) Place of Disposition · Date of Disposition 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 HRS County Public 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}