HomeMy WebLinkAbout4-46-16 ~ 1213 ~ots 15 & 16
Pard by CEMETERY Receipl No.... ~ ............ DaZed .... Blk. 46, Un. 4
Lht Price , .... ?..0.0....O.0. .... Maximum No. Burial Spaces ..... .2. ..........
Net P~d $...............800 · 00 ... Monument permiu~ ..................... .- FRANK, PETER C.
(Da*- above thl~ Une for City Record
NO.
1055 E. Barefoot Circle
Barefoot Bay, Fl. 32976
of ebas an
eme ery Dee
NO.
89
THI$ INDENTURE MADW. T~ 19th day et April A.D., lS ...... ,
FR~K, Peter C~ and Sadie S.
................ %~ ~.. ~ ~ ~...~.~g ~...C~g.%.~.~..B.~ ~ ~9.9.~..~3.,...~!.9~.... ~.2.~.~ ~. .....................
Indian River Florida
~ Orante~ WITN~SSETH, 800 · 00
T~t ~ Grater for ~ ~ ~n~de,~o, of ~e s~ of $ .......................... ,o it ~. the ,e~i~ whereof is he,with ~
16 4 '
15 & 46
To Have and to Ifold the same fo*~ver; pro~ided that said prepay shall be u~d mlely and exclusively for the interment of the hurrah dead and shall
be u~d, kept and maintained at all ~/mes in accordance with the rules and regulation% ordimmces and ~esolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafte! adopted or pro~ided for the government and operation of said cemetery. The condkions, resi~icrions and requkcments cont,~ned
in this instrument ~lmll be covenants nmulng with the land. In the event of the fa/lure of the owner of any property situated within ~ cemetery to ob-
serve and comply with ~uch rules, reguhtion~, te~olutions an~.ordinances and the conditions of the d~ed of conveyance thereof then the title of such owner
in and to s~Jd ptope~y shall terminate and the m~me shall ~evert to the City of Sebastian, Flor/da.
IN WITNESS WHEREOF, The sa/d party of the first part has caused tkis/nstrument to be executed in its nam~ and on its behalf by its Mayor and
attested by its C/ty Clerk and its gorporate ~eal to be hereto af£utad, the day and year fi~st above written.
CITY OF SEBASTIAN, FLORIDA
Mo4,or
Unil ~/
Date of Mark-out
Name of Funeral Home
Authorized by
- 559 1213 Lots 15 & 16
Paid by ~EMETERY R~c~ipt No ................. Dated .............................. B lk. 46, Un. 4
us~ $ 400.00
800.00
N~ P~id $ ..................
NO.
2
Monument~z~R~ ....................... FRANK, PETER C. &. S.
1055 E. Barefoot Circle
Barefoot Bay~ Fi. 32976
(Da~ ~ve ~ ~ for ~ R~o~ o~y)
STATE OF FLORIDA ~
3ARTMENT OF HEALTH & REHABILITATE SERVICES
VITAL STATISTICS
APPLICATION FOR BURIAL-TRANSIT PERMIT
u¥
A. (Type or Print)
1. Name of First Middle Last DATE Month Day Year
Deceased OF
PET~-~R C[-LA]~,E5 FB/~'K DEATHSeptember 28, 1989
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Brevard Barefoot Bay Inst. 1055 East Barefoot Circle
3, Name of Medical ]['1 Physician Address Phone Number
Certifier Neet Merchant [] Medical Examiner13875 US#1,Sebastian,Fla.32958 589-0879
4. Funeral Home/ Name Address Phone Number (Area Code)
~~ Strunk Funeral Home,1623 N.Central Avenue,Sebastian,Fla.32958 407-589-1000
Check a []
Appro-
priate
Box b []
6. Funeral Director/
c []
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Dr. Noor Merchant was contacted on 9/28/89 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 He
and sign the medical certification of cause of death.
medical certification.
will complete
was contacted on He/she verified that
Medical Examiner, will complete and sign the
Fla, Lic.
#1672
Date Signed
September28,1989
B. BURIAL--TRANSIT PERMIT Permit No,t228-89-453
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 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 filed with the Local Registrar of the County in which death occurred.
[] No extension of time for fili~ the death certificate requested.
Registrar or //~ ~ /;/- z~ ~),~ ~ ~_~ // Date Date Certificate
Subregistrar Signature il_~u ~ ~ ~ ) /,--" /.,,/,-'//~'-c~ 7~' Issued:9/28/89 Due:
(/
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
Signature. , Medical Examiner Date
or
Medical Examiner, , gave authorization by telephone to
Funeral Director/Direct Diseoser. 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 (Specify)
Signature of Sexton )
or Person-in-Charge )
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition October 2, 1989
?
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, Oct 87 (Replaces May 86 edition which may be used)
(Stock Number: 5740-000-0326-2) ~'~
.3