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Home My WebLink About4-48-25 of eme ery Dee NO. 1127 )e ) ~'H]S I~D~TUa~ ~AD~ ~ ........ 17'th ........day O~ between the City of Seba~tian~ a municipal corporation exiath~g under the ]sws of the State of Florida~ aa Grantor alii ....... Re.by.. $.i b.~y.a0 ................................... [Ne.i3..¢.a~..~r.,) ............................................ 202 Cynthia Lane ........ I ndta~. Ha rb~r. ~.F. ~ r.i da... ~2937 .................................................................................... That the Grantor for and in consideration of the sum of $ .........................200 knowled~ed, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee ......... heixs, legalrepresentativei and assigns the foliowin/property situated in Sebastian, Indian Rive~ County, Florida, to-wit: All of Lot(s) ~5 ..... Block .... ~ .. , UNIT .... ./~ ........ of Sebastian munic/pal cemetery as per Plat Number 1 thereof reco~dad hi Plat Book 2, at page 65 of the public records hi the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lyint and being in Indian River County, Florida. To Have and to Hold the same fosewr; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all ~nes in accordance with the niles and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provld~i for the government and operation of said cometeiy. The conditions, restrictions and requirements con~ainad in this instrument shall be covenants running with the hind. In the event of the fa/hue of the owner of any property situated within said cemetery to ob- scr~e and comply with ~uch rules, reguhfions, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of suah owne~ hi and to said property shall tarminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The sa/d party of the f'ust part has caused this iratrumant to be executed hi its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affolad, the day and year first above wilton. Signed, Sealed und Delivered e Presence ofl STA'FI~; OF FLOltlDA COUNTY OF INDIAN RIVER I HEIIEBY CERTIFY, That on this ..... ~.~.. ....... day of .......... .~,r.:~..~.. b .frc ,,c p,r,onally ,p~arcd ..... L...Gene. Ha~r.i.s .............................. ~~d Kath~y.n..Benj.ami M..O~aa.l 3 orar respectively Mayor and City Clerk of the City of Se~slian, . munit'llm corporat on undl?r the laws of the ~tate of Florida Jo me known ...... .............................................................................................................. ........................................................ and severully scknowladffed the cxecuLlon ther~f lo ~ their free act and deco as such officers thereunto duly authored; and tl~t the Official seal of said corl~ration la duly affixed thereto, aad thc ~aid conveyance is the net arsd deed of ~ld ~rporatinu, .......................... Not.* Public, St.te of Florl,~o~ ~ O[ ~ My Cm~isilofl Cxldress ~y ~nim~s~fl E~ira bY 27, 1~ THE SEBASTI~V CEHE~ER¥ Citv of $~h~stian $sh~sti~n, Plor~d~ 018 RECEIPT X$ RERE~ A~F~I~LEDGED OP.~HE SUM OP# d~cri~d C~C~r~ ~C(s)~u~n t~ Cer~ ~d ~n~Ci~s ~ staC~ ~s~ipt~ O[ P~O~C~; ~"~:, ~,~..27 ~:o~ q~ ~,~, ~ when app~v=d b~ ~e ow~r of the pro~rt~ ~ve descried. I, or we, agre~ to purchase the above described pro/~rtg on the term~ and · he City of Sebastian agrees to sell the above mentioned properC~ Co the a~ove named purch~er(s) on t.~ terms and conditlo~ stated in the ~v~ ins Cr~ c. Unit Date of Mark-out Date of Burial Name of Funeral Home Authorized by. t'- UNIT 4, BLOCK 48, LOT 25 Deed #1127 Sibayan, Ruby 202 Cynthia La. Indian Harbor, Fl. 32937 Nell Cain Interred 7/20/87 Net ~aia $ ..... Z00.,00 ..... Lot # 25 Blk # 48 Uni t# 4 Maximum No. Burial Spaces .... ~ ............ Monument permitted .... .-.fl ~t~ ........... (Dat~ above t~is line fo~' CII~' Heeerd only) NO. Ruby Sibayan (Neil Cain Jr.) 202 Cynthia Lane Indian Harbor Beach, Florida 22q27 A. (Type or Print) STATE OF FLORIDA ,RTMENT OF HEALTH & REHABILITATtERVICES VITAL STATISTICS ~ APPLICATION FOR BURIAL-TRANSIT PERNiIT 1. Name of First Middle Last DATE Month Day Year Deceased OF Nell Chester C&in, Jr. DEATH July 16~ 1987 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Roseland Inst. Roseland Rd. 3. Name of Medical [] Physician Address Certifier Ronald L. Reeves, M.D. ~ Medical ExaminerDist ' XIX Fort Pierce~ Florida 4. Funeral Home/ Name Address xxi~mc~[~s~0~ ?otti~er & Son Funeral Home 1200 S, Indian River Dr, Sebastiant Fla, 32958 The medical certification has been completed and signed. A completed certificate of death accompanies this application, was contacted on , 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. was contacted on . He/she verified that Medical Examiner, will complete and sign the # 2358 July 17, 1987 5. Check a ~ Appro- priate Box b [] cD 6. Funeral Directo'~ ~-- ' ['~--- l~r~ature Fla. Lic. No./Reg. No. Date Signed B. BURIAL-TRANSIT PERMIT Permit No. 759-731 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- Regist rat Signatu re ~ ~'~ Issued C. 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. Awaiting period of 48 hours after death is required for all cremations. Method of Disposition: D UR'AL [] STORAGE [] CREMATION [] OTHER (Specifyl CEMETERY OR CREMATORY Place of Disposition Date of Disposition Sebastian Cemetery 3uly 20, 1987 or Person-in-Charge ~ .,% This permit must be endorsed by the Sexton or p~l'/son-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 mav be used.