The URL can be used to link to this page

Home My WebLink About4-48-05 eme er Dee NO. 1108 THIS INDENTURE MADE ~ ...... ~.~..9~; ......... d~r of ...... ~'~71la~II~ ............................ A. D., 19~..., between the City of Sebastian, a munlcJp~ ~oration ~lsting ~der the laws of the State of Florid~ as Gr~r and ............. ....... ..................................................... c/ ............... ~,~..~.., ~r~.~. ~ir~.!e ..... ~fe~ ~, .~.. ~ ..... ~ ........................................... of the County of ..I~.~Va~ ......................... anl Bt~te of .......... ~0~ .................................. ss Grant~, W1TNE~SETH~ T~t lhe Gr~tor for and ~ ~n~eia~on of ~c sum of $ ....... ~.~, ~ ........... to know,deed, docs by tlds ~ru~flt g~ant, ba~, ~, rel~, ~nvoy and ~nfkm unto t~ Grantee ......... t~ foUowing property allied in Sebaatan, I~ian Rivet County, Florida, All of Lot(s) ~..~..~ , Block,..{~. .... UNIT ...~ .......... of ~hea~n mu~ ~motery as ~r Phi Number I t~mf r~tdad in P~t Book 2, at ~ge 65 of the pubUc re~r~ ~ t~ offl~ of the C~k of t~ Ckc~t Co~ of St. Lu~ ~ty of F~t~a; m~ ~ now l~g ~d bei~ m Indi~ Riwr Cousuy, Florida. To Have and to Hold the same forever; provided thai said property shall he used solely and exclusively for the interment of the human dead and shah be used, kept and mah~tained at aS times in accordance with the ~ules and ~egulations, ordinances and rcsointions of th~ City of Sebastian, Florida, hereto- fore, now and hereafter adopted et provided for tho government and operation of said cemelety. Tile conditinns, restrictions 'and requirements contained in this instrument shaU be covenants running with the land. In the event of the failure of tim owner of any p~operty situatenl within said cemetery to ob- serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the dasd of conwyance thereof then the titl~ o£ such owner in and to said property ahaU terminate arid the same shall revert to the City of Sebastian, Finrida. IN WITNESS WHEREOF, The said party of the lust paxt 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. Signed, Sealed at~d Delivered STATE OF FLORIDA COUNTY OF INDIAN RIVI~R 0'7 I HEEEllYCERTIFY, Thatonthia ....... ~2~.~; ........... day of ............... .......... ...... ;.,.~..., ~'' IS.~L, before me parse,ally appeared L. Gene Har~s and .~h~R.~,..~J~ .......... respl.ctively Mayor aBd City Clerk of ~e City of Sebastian, a umnicilml corporation under the laws of the State of Plor~a to me known .............. ~o. ui~ . Don f~ ..................................................................................................... .......... '.' ............................................. a.d ae~er~l~ acknowledged the ~ecutinn ~e~f to ~ ~lt fv~ act and da~ Unit Block Lo, Date of Mark-out ,,a,. o, B.r,., /,/~ /~'.~ '1 - Name of Funerel Home Authorized by f.o.f :?. ......... ~onYrio Egret Circle Bqrefoot Bau. Fla. 32958 Maximum No. Burial Spaces .... .2. ........... Monument pe~m/tted. (Data above this II~e for City R~ord only) Lots 4 & 5 Block #48 STATE OF FLORIDA ~ HEALTH & REHABILITATI~J~[RVlCES VITAL STATISTICS APPLICATION FOR BURIAL--TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Da,/ Year Deceased OF VINCENZIRA I~a~¥ DONOFRIO DEATH JAIqUAR¥ 6~ 1987 2. Place of Death CiW, Town or Location Name of (If neither, give street address[ CounW Hosp. or INDI~ RIV~ ROS~ InsL ~h ~OSPIT~-S~S~ 3. Name of Medical ~ Physician Address CertHier ~R ~ N.D. ~Medical Examiner 13855 US t 1 S~S~ ~RI~ 32958 4. Funeral Home/ Name Address Direct Oisposer S~ ~ ~S ~62~ NOR~ C~ S~STI~ F~RIDA 32958 5. Check Appro- priate Box a [] The medical certification has been completed and signed. A completed certificate of death accompanies this application. b [] ,~,' 2' was contacted on //~/~' . He/she verified that this death was horn natura[ causes, d~at H)ere was no accident nor other external cause of death, and that D~. N~R ~ N.D. will complete and sign the medical ~t~fication of cause of death. c ~ . .. was contacted on . He/she verified that Medical Examine~, will complete and iign the medical certificabon. 6. Funeral Director/ [,] S~gn~ure, Direct Oisp°ser ~_.~,/~-/f~/),~j,~),.,,~-~')~ ..- Fla. Lic. No./Re9, No. Date Signed B BURIAL-TRANSIT PERMIT Per-r'n~orl is he~by-granted}o dispose ol lhis bodv; ...... 1228-87-005 Permit No. [~A five day extension of time for filing the death certificate (exclusive of weeker~ds) has been requested and granted, If ~t cannot be flied within this time limit, a "Funeral Director/Direct Disposer Report" will be filed with~3,,e Local Registrar of the County m which death occulted. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT--SEA Medical Examiner ,gave authorization by telephone to __ Funeral Director/Direct Disposer. Date The Medical Examiner's appioval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death CEMETERY OR CREMATORY Method of Disposition: Place Of Disposition [] BURIAL [] STORAGE Date of Disposition [] CREMATION [] OTHER (Specify) or Person-in-Charge This permit must be endorsed by the Sexton or person in-charge (or by the Funeral D,rector/Direct Disposer when there is no Sexton) and returned within 10 clays to the local County Health Department in the County where disposition occurred. HRS Fo~m 326, APR, 81 (replaces previous editions which may be used )