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Home My WebLink About4-48-11 Net Pa/d $ .. BO/] o.0c) ...... William E. interred Lot 12 - 4/28/87 : Lots ...... Dated.. 7/10/87 Maximum No. Burial Spa~s..2. .............. Monument permitted .... Flat ............. (Data above tilts line for ~lty E~cord only) & AZ, BAK.~, unmt ~ NO. 1126 Alice A. Lewis . 1431 4th Court Veto Beach, Fi. 32960 OIitg of 6ebastiau ( emeJery NO. 1126 between the City of Sehestlan~ a municipal corpor&tlou existing under tbe laws of the State of Florld$~ aa Grantor and Alice I. Lewis .......................................... .1.4 3..1...4.~.h... ¢.q.gf.t. ,...V..~ ~.O.. ~.e.o.¢.h., .El.or id.~.... 3.~.9.6. Q .................. af the a,unty al ....... Indian.iixzer ................. un.l state af ......... F.lor. i.da .................................. f~ Grantee, WITNI~-SSETHI That the Grantor for and in consideration of the sum of $.........................$ 800,0 . to it in hand paid, the receipt whereof is herewith knowledged, does by ~ instniment grant, bargain, sell, release, convey and conf'um unto tha Grantee .. hez.. bek% legal representative~ and assigns the following property situated in Sebastian, Indinn River County, Florida, to-wit: AU or Lot(,) iL. a ,~a ..... 4//., uNrr ... a .......... or Seb~ a~ap~ ce~e~ry a, ~r ~tst Sumber ~ th~reor recorded a ~t Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lude County of Florida; said land now lying and being in ~ndian River County, Florida. To Have and to Hold the same forever; pray/dad that said property shaft be used solely and exclusively for the interment of thc human dead and shah be used, kept end mamta/~d at all times in accordance with the niles and ragulat/ons, oldinances and resolutions of the City of Sehast/an, Florida, he,eta- fore, now and hereafter adopted or pnivided for the government and operation of saki cemetery. The cond/tions, restrictions and requirements conta/ned in this instrument shall be covenants runni~ with tha land. In the event of the failure of the owner of any property situated within said cemetery to ob- serve and comply with ~uch rules, raguhfions~ resolutions and.ordinances and the conditions of the deed of conveyance thereof then the title of such owner /n and to said properly thall terminate and tho same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said pafly of the f'ust part has caused this instrun~nt to he executed in its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to bo hereto affixed, the day and year first above written. (/ City Cle~ Signed, Sealed a~gl Delivered I~ the Presence afl ................... COUNTY 0F INDIA~ ~IVRR CITY OF SEBASTI~ ...... .J.p, Ly /:17 ~ Hm~Y C~ETIFY, ~.t o. th,.. ............... ,,.y o, ....... ...................................... ,,~.'., before me persomflly appeared ............. ~4,...Gelle.. Har. ri~ ................. ~~. f ~ ~; ... respectively Mayor and City Clerk of the CI~ of 8ebasttsn, a municllml corporation under the ~ws of the State of Florida to me known to be the individuals and officers de~ri~ in and who ~ecuted the fore~ln~ cunveyan~ to Alice i. Lewis ........................................................ and severely ~knowlcdgt~ the exeeutiuu ther~f to ~ their free act and de~ aa aneb officera thereunto d~y author~dl ~d that the Official seal of ~id corporation '" duly ufflxed the~tu, mid thc said conveyance is the act and decd of ~ld ~rsflen, WITNESS my ii,naCre aM official ~ ~t ~bost~n, in the ~enty of Indian ltlver u~ State of Florida, the day and year last ~ forea~d. Name Unit Block Lot. Date of Mark-out Time P~/d by CEMETERY Receipt No .... b.°. 9. :.°.°. . ......... ~. ~d $ .. ROil ..Off ...... William E. interred Lot 12 - 4/28/87 Lo.ts 11 & 12, Maximum No. Btulal Spaces..2. .............. Monument permitted .... F1 ~.t ............. (Data nboye Ibis line for City Record only) Blk.48, Unit 4 ~: 1126 Alice A. Lewis i' 1431 4th Court Vero Beach, Fl.i 32960 LEWIS, ALICE A. Rec. No. 468 Deed No. 1126 1435 4th Court Vero Beach, Fi. 32960 Lots 11 & ~ Block 48, Unit 4 William~ E. Lewis,ii~terred in Lot '12 - 4/28/87 L. Gene Harris Mayor City of Sebastian POST OFFICE BOX 780127 [] SEBASTIAN, FLORIDA 32978-0127 TELEPHONE (305} 589-5330 Kethryn M. Benjamin City Clerk July 14, 1987 Mrs. Alice A. Lewis 1431 4th Court Vero Beach, Florida 32960 Dear Mrs. Lewis: Enclosed is Cemetery Deed No. 1126 for Lots 11 and 12, Block 48, Unit 4. 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, Vero Beach. We are also enclosing a form Return for Transfers of Interest in Florida Real Property- which must be filled out by you and completed by the Clerk of the Circuit Court's office. Very truly yours, Deputy City Clerk LR Enc. Ct=~ of Sebastian Seb~stian, Florid~ RECEIPT IS REREB¥ ACKI~OWLEDGED Olin THE SUM OFt Eight hundred and no/lO0 ....... '--__ ~llare ($.8 00. O0 Alice A. Lewis 1431 4th Court Veto Beach Florida 32960 on thie.~Q~o_da~ of ' July , 198 7 for ~he pure. haas of the following described Cemetery /~t(a) u~n ~e ~er~ and ~dici~s as s~a~ed herein~ ~s~rlp~ion of P~c~e P~tce: T~ ~d c~dltio~ of sale~ Uni t #_4 Dollars($ ~00. ?his co~traot shall b~ binding upon both parties, the seller and the purchaser, when approved bg ~he Owner of the propert~ above described. I, or we, agree to purchase the above described proportg on the terms and conditions stated in th~ foregoing intru-~nc~ ?he Cit~ of Sel~s=ian agrees to sell the ~bove mentioned property to the above n~med purchaser{s) on th~ terms ~nd Conditions s=~ed in the above insCru~nt. Wi tn~s A. (Type or Print) State of Fl~a, Department. of Health, Vital Statistics APPLIC~IIN FOR BURIAL -- TRANSIT PERMIT 1. Name of Deceased 2. Place of Death County Saint Lucie 3. Name of Medical Certifier Jay I. Scheft, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Home 5. Check ~ a [] Appro- priate Box b [] First Middle Last DATE Month Day OF Alice A~lnes Lewis DEATH 3/:29/98 City, Town or Location Name of (If neither, give street address) Hosp. or Fort Pierce Inst. Beverly Health & Rehabilitation Center I Medical Examiner c [] Year Address Phone Number ~qPhysician 2401 Frist Blvd., Ft. Pierce, FI. 561+464-0033 Address Fla. Lic. No./Reg. No. Phone Number (Area Code) 916 17th Street 0130 561+562-2325 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Stephanie was contacted on 3/30/98 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 Jay I o Schorr~ J~. 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. 6. Place of Sebastian In state cemetery/ FinalDisposition: Cemete..,ry r"X~cremat°ry'name/county: Indian River 7. Funeral Director/Direct Disposer Removal r'~ from state ~'~ Donation ~at~'Signed ~ .~ B. BURIAL -- TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 0130-98-0158 [] 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 flied with the Local Registrar of the County in which death occurred. [] No extension of time for f'~i~the death certificate requested, ~r ~... r'~. , 0 ~ Date Issued: _~._~L~__ Due: Signature or Medical Examiner, AUTHORIZATION for CREMATION, DISSECTION or BURIAL--AT--SEA Medical Examiner Date , 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 ail cremations. Methods of Disposition: [~ BURIAL [] STORAGE [] CREMATION [] OTHER (Specify) Signature of Sexton ) or Person-in~Charge ) ~.~¢~,~ ~- [~ -.~¢.~ CEMETERY OR CREMATORY Place of Disposition Date of Disposition 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 HR$ Form 326 which may be used) (Stock Number: 5740-000-0326-2)