HomeMy WebLinkAbout4-48-12William E. interred
Lot 12 - 4/28/87
Lots 11 & IZ~ ~lK.gO, Unlt
...... Dated ..... .7. ./ .l. .0. /. .~. 7. ............ NO.
Max~num No. Bm4M Spaces..2. ..............
Monument permitted .... Fi. at .............
1126
Alice A. Lewis ..
1431 4th Court
Veto Beach, Fl. 32960
(Data above ~hl~ line for City Record o-ly)
of ebasliar
( eme ery Deeb
NO.
1126
between the City of Seb~tJan~ a munleipa~ corporathm existing ~der t~ laws of the Sta~ of F~rld~ ns Gran~e a~
Alice A. Lewis
.................................. ~.4~ 4~ C.o.vr~, ~9..~RCh.~ .El.or%d~....3.2.9~Q ..................
af th, ~ of ....... Indian. R~r ................. ,.,~ s~t, of .........F.lo~ida ..................................
~ Orant~ WITN~SSETH~
~t ~ Gz~tns for ~ ~ ~n~deza~n of ~ ~ of $ $ 8 0 0 · 0 .... to it ~ ~d p~, ~e ~ipt whereof is herewi~
~ow~dge~ does by t~ ~nt ~t, b~, ~H, re~, ~nvey ~d ~n~ ~to ~ Gt~tee .. her.. ~s, le~l :e~e~ntativ~ ~ as~s
~ fo~ow~ pmpe~y dt~t~ ~ ~ba~, I~ ~ Co~ly, Ho~ t~it:
Boo~ 2, at p~ ~5 of ae pub~ ~ra ~ ~e.offi~ of ~e C~ of the ~t Co~ of S~ L~ County of ~o~a; ~ ~d now l~g ~d
~ ~ ~iv~ Cowry, Fbg~
To l~ve and to Hold the same forever; pzovkled that ~d property shall beused solely and exchsively for thc interment of the human dead and ~
be used, kept and maintained at all times in accordance with thc roles and rcg~htions,'osdinances and resolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafter adopted of provided for the government and 0p~ation of said cemetery. The conditions, restrictions and requirements contai~d
in this instrument shah be covenants running with the land. In the event of the faJlnse of the owner of any property situated within said cemetery to ob-
serve and comply with iuch rules, regulations, resolutions and.onliuances and the conditions of the deed of conveyance the:eof then the rifle of such owner
in and t~ said propea~y shall terminate and the same shall revert to the City of Sebasthn, Florida.
IN WITNESS WHEREOF, The said party of the lust part has censed 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.
Attest~ .......
Signed, Sealed and Delivered
IQ the Preaence oh ~ ~
...........
COUNTY OF INDIAN RIVER
CITY OF SEBASTIAN, FLORIDA)
Mayor
Unit
Block '~/
Lot ~/~
Authorized by
Lots
Paid by CEMETERY Receipt No. 468 Dated 7/10/87
~= ~00.00
William E. interred
Lot 12 - 4/28/87
M~.~num No. Burhl Space. 2
Monument pemtitted .... Flat .............
(Data above this lioe for Clt~,
11 & 12, Blk.48, Unit 4
~
Alice A. Lewis
1126, ~
1431 4th Court '
Veto Beach, Fi. 32960
OARTMENT STATE OF FLORIDA ~
OF HEALTH & REHABILITA'I~I~SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL-TRANSIT PERMIT
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
WILLIAM E. LEWIS DEATH APRIL 26 1987
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
ST. LUCIE FORT PIERCE Inst. FORT PIERCE CARE CENTER
3. Name of Medical [~hysician Address
Certifier t~Id--dT,~ K. NAYYAR~ M.D. [] Medical Examiner 2580 ]U{ODE ]'S~AND A'v'~2~UE, FORT PI]G~CE, FL. 33450
4. Funeral Home/ Name
Dh<.c; ~;o.,.~r STRUNK [~3q~3~T. HOF~ 916-17TH
Address
VERO BEACH FLORIDA 32960
5. Check a []
Appro-
priate b [~'
Box
6. Funeral Director/
cE]
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
DR. NAYYAR was contacted on 4/27/87 , He/she verified that
this death was from natural causes, that there was no accident nor other external cause of death, and that
will complete and sign the medical certification of
cause of death.
medical certification.
was contacted on . He/she verified that
Medical Examiner, will complete and sign the
BURIAL-TRANSIT PERMIT
Permit No. 3.30-87-166
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. If it cannot be filed within this time limit, a "Funeral Director/Direct Disposer Report" will be filed
with the Local Registrar of the County in which death occurred.
Sub-Registrar Signature- Issued_ 4/27/87
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.
Method of Disposition:
[] BURIAL [] STORAGE
[] CREMATION [] OTHER (Specifv)
Signature of Sexton )
or Person-in-Charge )
CEMETERY OR CREMATORY
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 County Health Department in the County where disposition occurred.
HRS Form 326. APR. 81
(replaces previous editions which may be used.) .-~T,