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Home My WebLink About4-45-20Paid by CEMETERY Receipt No. . . .~.~. DateJ July 6, 1988 200.00 List Price $ .................. Net Paid $ ...... ZQ0..Q0 .... Lot 20,Blk. 45 NO. Max/mumNo. BvzialSpac~s .............. .. . Unit 4 Charles T. Pirke 1180 Honume,t perrmtted ....................... 445 Oak St. Sebastian, Fl. 32958 (Data shew this Un~ for City l~.ord oaly) · of ebas ia. · eate ery Dee NO. 1180 6th day of July .......... A.D., 19...~.?., THIS INDENTURE MADE between the City of Sebastian, a municipal Corporation existing under the laws of the State of Florida, as Grantor and Charles T. Pirke 445 Oak St., Sebastian, Fl. 32958 of the County of ....... Indian River .... ,n-I State of Florida ss Grantee, WITNESSETH~ That the Grantor for and in consideration of the sum of $..-.................200' 00 ...... to it in hand paid, the t~ceipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee . ~lj.$ .... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) ...2..D.. , Block,..4..B ..... UNIT .... .4 ......... of Sebastian munidpal cemetery as per Pht Number 1 thereof recorded in Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall he used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in accordanoe with the rules and reguhrions, ordinances and resolutions of the City of Sebastian, Flotida, hereto- fore, now and hereafter adopted or provided for tho government and operation of said cemetery. The conditions, res~ictinns and ~quirements contained in this instrument shall be covenants running with the 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, reguhrions, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner in and to said property shall terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said pen), of the first part has caused 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. Signed, Sealed and Delivered in the Presence erg CITY OF SEBASTIAN, FLORIDA Mayor ((llit~ COUNTY OF INDIAN RIVER I IIEREBY CERTIFY, That on this 6th .day of July ~.8, b~f~re me personally appeared . .R.J:.~3a.r, .d...B.... ~'@~c3p)~ ............................... and ~;agl!r. yr! .~,...o.'..~..i.i.Q~:..an. ......... respectively Mayor ami City Clerk of the City of Sebastiaa, a municipal corporation under the laws of the State of FinHda to me known to be the individuals and officers descrihed in and who executed thc forrgoing coaveyanee to Charles T. Pirke ..................................................... and severally acknowledged the executinn thereof to he their free act and deed as such officers thereunto duly authoris~d; and that the Official seal of said c~rporatinn is duly affixed thereto, and the said conveyance is thc' act anti deed of said eorporatinn. WITNESS my signature and official ~ at /tebastlan, in the County of Indian River and State of Florida, the day and year last a foreaaid. ........... N ~. PI%KE, CHARLES T. 445 Oak St. Sebastian, Fl. 32958 D~D NO. 1179 DF:~h~ 570. 1180 Lot 20, Blk.45,Un.4 LOT 19 Block 45 Un. 4 Charles H. Pirke interred 7/7/88 - Lot 19 Na~e Unit Block Date of Mark-out ~/t7I ?':~ Date of Burial ~.,/ / ~/~ Name of Funeral Home ~ ~E2Z - Time TME SF.~ASTIAN CEMETERY RECEIPT IS BEREB¥ ACF. NOWLEDGED OF THE SUM FROM:_. ~s~lp~lon of Pro~r~g~ Ter~ ~d co~dl~o~ of fl~el This ~n~ract shall ~ hln~ng u~n ~th ps.les, the seller and tho purchaser, when approved b~ ~e owner of ~e p~rt~ ~ve descried. I, or we, agree to purchase the abo~,e described pro&~rcV on the terms and conditions stated in ~he [ore~oing lntruumnt~ The C~tg of Sebastian agrees Co sell the above m~ntloned propert~ to the lnscr~n=. State of Florida, Department of Health and Rehabilitative Services, Vital Statistics APPUCA~ FOR BURIAL -- TRANSIT PERMIT (Type or Print) 1. Name of First Middle Last DATE Deceased OF ~DNA M. P[~KF, DEATH J~me 17, 1993 2. Place of Death County Pinellas City, Town or Location 3. Name of Medical Certifier Scot~: L. Ray, M.D., D.O. Name of (If neither, give street address) Hosp. or Inst. Westchester Gardens Nursing Home Address Phone Number Clearwater I Medical Examiner 2350 Sunset Road, Suite C (-~Physician Clearwater, Florida 34625 (813) 797-3155 4. Name of Funeral Home/ Address Fla. Lic. No./Rag. No.] Phone Number (Area Code) Direct Disposer Cox-Giffo~d 1950 20th Street Funeral Home Veto Beach FL 32961 1427 (407) 562-236~ 5. Cl~ck a [] The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. palate Box b [] X ~tt ERv. M D was contacted on 0~_/!7,/97 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 h~ will complete and sign the medical certification of cause of death. c [] was contacted on. . He/she verified that -~-lical certification./% ~ , Medical Examiner, will complete and sign the · ! i In,~'~tert~rn~,~l~rw/ I ~eq~s~.an tJeme'cery Removal 6.FinaIPlaCeDisposition:°f Bu. rla~l / ~ ~-~;~n'~i'ot;'";~r~n~/cc~Jnty= / Indian River [~ from state. ,J--] Donation B. BURIAL -- TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. ,~o ~ 3 [] A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship ~uld 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 filing the death c~icate Registrar or ~'"~/ ~'~' Pate Date Certificate Subregistmr Signature j/~/ ..-¢'~~¢5''/'~ Issued: ~/, 7/~.~ Due: 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. A waiting period of 48 hours after death is required for all cremations. Methods of Disposition: [] BURIAL [] CREMATION Signature of Sexton ) or Person-in-Charge ) [] STORAGE [] OTHER (Specify) / 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 HRS County Public Health Unit in the County where disposition occurred. HRS Form 326, Feb 89 (Replaces Oct 87 ~dition whic~h may be used) (Stock Numbe~ 5740-000-0326-2)