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Home My WebLink About4-47-29 rm~d...d.u.n. 9...20, 1988 Paid by CEMETERY Receipt No....%. - ................. 1.let Price $ Es, 200.00 $1000.O0 Net Paid $ .................. NO. Lots 26,27,28,29,30 5 n4 MaximumNo, BurialSpaces ................. Bik.47,U · i 1'7~ ........ re~ Monum~ntpermltted ............... Stanley & Dolo · Buys 11085 Mulberry St. Sebastian, Fl. 32958 (Data above this line for City Kecord only) (gemeterg leeh NO. TillS INDENTURE MAD~ ~ ...~Q[.]~ ........... day of ................. ?~[1.~ ..................... A. D., 19.8.~.., bet~een the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and ......................... K .P.e>. P..r. ................................................... .......................... 1.1~g. 5.. ~Lulb.e r ry..S.~ ... 0.. S eb.a.s.~ J,&u.,..El ...... 3295 ~ ................................... Indian River Florida of the County of ............................................. an l State of ....................................................... a~ Grantee, WITNESSETHt 1000.00 TI:at the Grantor for and in consideration of tile sma of $ .......................... to it in htmd paid, the receipt wbereof is herewith ac- knowledged, does by tiffs instrument gray, t, ba~gaih, sell, release, convey ,and confirm unto the Grantee .their. he[% legal representatives and assigns the following property situated in Sebastian, Indian Rive~ County, Florida, to-wit: · 2 30 All of Lot (sgf~ ,.2 2 ,,~Poc'Ic, .~ ~ ...... UNIT ~ ............. of Sebastian mmricipal cemetery as per Plat Number I thereof recorded ill Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Couxt of St. Lucie County of Florida; said land now lying m~d being in Indian River County, Florida. To Have and to Hold tile same forever; provided that said property shall be used solely and exclusively for the intennent of tile human dead and slmll be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutions of tim City of Sebastian, Florida. hereto- fore, now and he[carter adopted or provided for tho government :md operation of said cemetery. The conditions, restfictinns and requirements contained in this instrument shall be covenants ~unning with the land. In the event of the faJluxe of the owner of any property situated ~fitldn smd cemetery to ob- serve and comply with ~uch rules, regulations, resolutions and ordinances :.rd tile conditions of the deed of conveyance thereof then the title of such owner in and to smd property shall terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused tilts instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk mid its corporate seal to be hereto afOxed, the day and year Hrst above written. City Clerk CITY OF SEIIA~qTIAN, FLORIDA , , ,'i ................ ¢ : . . . . : ........... Mayor Signed, Scaled nmi Delivered ............... COLqNTY~":' INDIAN IIIV~R Richard B. Votapka Kathryn M. O'Ilalloran before me personMly appeared .................................................. respectively Mayor and CRy Clerk of the CRy of Sebastian, u municipal corporation under the taws of the Sta~e of ]olorldu to me known to be Ibc individuals am] officers descried in and who exeeuicd the forcgoillg conveyance Stanley J. and/or Dolores V. Buys ...................................................... a.d severally ~cknowledged the execution thereof to be tbeir free act and deed as such officers thereunto duly authorized; and that the Offlei~l seal of said corporation is duly affixed thereto, and the said conveyance is thc net aud deed of said corporntinn. WITNI~SS ~ny signature and official s~l at Sebastian, in the ~unty of Indlalt Hirer and grate of Florida, the day and year last ~ foresaid. Nota~ t:~h~, S~e of ~oritla at Large. Name Unit Block "~ ~' Lot :;i ' '; Date of Mark'out Date of Burial /-,,;' ' Time A. (TYPE) StOf Florida, Department of Health, Vital S$ics · APPLICATION FOR BURIAL - TRANSIT PERI~T 1. Name of First Middle Deceased Johanna 2 Place of Death City, Town or Location County Indian River , Roseland 3 Name of Medical Address Certifier John Baker, M.D. i--]Medical Examiner ~Physician Last J Date Month Day Buys Jan. 30 Name of (If neither, give street address) Hosp. or nst. Sebastian River Medical Center 304 BarefoOt Blvd. Barefoot Bay, Fl Phone Number 561-668-5862 4 Name of Funeral Home/DJ~al Establishment Strunk Funeral Home 5. Check Appropriate Box Address 1623 N. Central Avenue Fla. Lic. No./Reg. No. Phone No. (Area Code) Sebastian, FI 1228 561-589-1000 a. [] The medical cerfification has been comp!eted and signed. A completed certificate of death accompanies this application. Debbie was contacted on 1/31 / 00 He/she verified that this death was from natural causes, that there was no acc dent nor other external cause of death, and that Dr. Baker will complete and sign the medical certification of cause of death within 72 hours. C. [] /'" was contacted on n~dq cedi~a use of death within 72 hoars. 6 Funeral Director/ .¢~ / / S~natu~/ A F.E. NoJReg No. Date Signed B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this bo~ly. Permit No. 1228-00- 0059 [] A five (5) day extension of time for filing the death certificete (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to comptete the medical certification of cause-of-death section of the death certificate within 72 hours. ]No extension of time for filing the death certificate has been requested. SubregistrarSignatu~'~.~, .~_~ ~ ~ ~ Year 2000 He/she verified that , Medical Examiner, will complete and sign the Date Date Certificate Issued: ,k~)k~~ Due: ~"'t k'~k AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date 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: k~]BURIAL '-]CREMATION Signature of Sexton or Person-in-Charge E~STORAGE CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery Date of Disposition ~)" '--'~ ~-~'~ ~'"~ '~i E~OTHER (Specify) 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