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Home My WebLink About4-44-07 P~id by CEMETERY Receipt No ..... I · ....... .S..2.o..o. :.o. g Net ~d $ ........ $ 2,00 ,,00 Lot tt7, Blk.44, Un.4 D t ~ 9/11/87 1 Maximum No. ButYl SI~.~s ................. Monument permitted . Flat Annie J. Thornton ................ ~6~'Dorothy M. Lis 1098 Foster Rd. (Data a~ove th~ line fur City Re.rd only) Sebastian, F1 · NO. 1136 32958 leme/ery eeh NO. 1136 THIS INDBNTURII MAI)R ~ ..... ll~h .......... d,y of ........... ~.e.P.~.e..m.b..e.Y .................. A. n., ,s..87 between the City of Seb~tinn~ a munlcipld eorporatten existing under the laws of the State of FlorldlN ns Grantor and ................................... .A..n.n..i..e...J.,...%b.9g.n.t. 9.n....1~ .f. 9.r... pg..r.?.t..h..Y.. ~.....~.~.) ................................ 1098 Foster Rd., Sebastian, Fl. 32958 of the County of ......... !.~.,d.~.~.I~...R..i.v..e..~. ............... and state of ...... Florida as Gr~ntae, WITNIISSIITH~ That the Grantor for and in considcration of the sum of $ · ..2/1 0.. el0 .............. to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument 8rant, bargain, sell, release, convey and confirm unto the Grantee ... j~'. heirs, legal representatives and assigns thc following property situated in Sebastian, Indian River County, Florida, to-w/t: Aliof Lot(s) ..... .7. ,Block .... .~../4.. ,UNIT....4. ........ , of Sebastian munldpal cemetery as per Phi Number 1 thereof~ecordedin Phi Book 2, at page 65 of the public records hi the office of the Clerk of the Ckcuit Court of St. Lucie County of Florida; said land now lying and being in Indian R/vel County, Florida. To Have and to Hold the same foz=ver; provided that said property shall b~ used sobly and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in accoidance with the l'ules and teguiatinns, ordinances and resolutinns of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or prmddnd for the government and operation of said cemetery. The conditions, restrictions and requirements contained in this instrument shell 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 iuch rules, raguiaflons, resolutions and ordinances and the conditions of the deed of conveyan ce thereof then the title of such owner in and to said property shell terminate and the same shall revert to the City of Sebastian, Fintida. IN WITNESS WHEREOF, The said party of the first part has caused this instmmant 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 af£txed, the day and year lust above written. City Clerk Signed, Sealed and Delivered ......... f ......... STATI~I OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CEHTIFY, That on this ,.,.~..~.~..h. .............. Kenneth Ruth Kathryn ~. 0'Halloran before s~ per~nall~ ap~ared ......................................................... and ....................................... respectively Mayor anti City Clerk of the City of Sc~Jtlan, s municipal corporation under the laws of the State of Florida to me known .............................. 3nn$.9..~,...Th~r.g.~..<.~[..PSK?.~Z..~.:.. ~?.~ ..................................... ........................................................ and severally acknowledged the execution theft, of to he their free act and deed as ~ucil officer~ thereu,to duly aulhurh~ed; and that the Official seal of said corpvratlun Is duly affixed thereto, arid the ~id conveyance .... ..................... Unit 4, Blk. 44, Lot 7 Deed #1136 Thornton, Annie J. 1098 Foster Rd. Sebastian, Fi. for Dorothy M. Lis Dorothy M. Lis interred 4/18/89 Unit Block ¢/ ~// Lot Name of Funerai Home ~ ~' ~/ r~ ' ' Authorized by Time N~ P,~d $ ........ $ gO~ ..00 Lot #7, Blk.44, Un.4 Paid by CEMETERY Receipt No ..... .4..8.2. ....... Dated ..... ........... 9 / 11 / 8 7. ............. No. 1 Maximum No. Burial Spaces ................. Monumentpcrmittea ...... .F.1..8..t ..... .A.n..n..ie J. Thornton J.l~ib for Dorothy M. Lis 1098 Foster Rd. (Data above this line for City l~cord only) Sebastian, F1. 32958 L. Gene He~'i~ Mayor City of Sebastian POST OFFICE BOX 780127 [] SEBASTIAN, FLORIDA 32978-0127 TELEPHONE (305) 589-5330 KJthryn M. O'Helloran Cily Clerk September 15, 1987 Mrs. Annie J. Thornton 1098 Foster Road Sebastian, Florida 32958 Dear Mrs. Thornton: Enclosed is Cemetery Deed No. 1136 for Lot 7, Block 44, Unit 4. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, 2145 14th Avenue, Veto Beach. We are also enclosing a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court. Very truly yours, Elizabeth Reid Deputy City Clerk LR Eno. Set~astian, l'lorida Io98 II, 5 S'7 ~scription of Propert.g~ and c~aditioas o! ·hls contract sh;Lll he binding upo~ ~oth parties, the seller and the purchaser, when approved b~ =he Owner o£ the Prope~tg ~bove described. I, or we, egrne to purch~e the ~Qve demoribed propert~ on the terms and ~ditio~ stat:ed in the foregoing l~C~Int; s~j the ~ - / ' ' ' ~he Cltg o! Ssheatl~n ag es to ye mentioned p~o~rcg to the a~ve ~d P~ser(s) on t~ inscx~nC. ~x~ ~ ~ti~ stated in c~ ~v~ STATE OF FLORIDA ~ ~PARTMENT OF HEALTH & REHABI LIT~ SERVICES VITAL STATISTICS APPLICATION FOR BURIAL-TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF DOROTHY MARIE LIS DEATH APRIL 15, 1989 2. Place of Death City, Town or Location Name of (If neither, give street'addresa) County Heap. or INDIAN RIVER ROSELAND Inst. HUMANA HOSPITAL-SEBASTIAN 3. Name of Medical [~. Physician Address Phone Number Certifier NOOR MERCHANT, M.D. [] Medical Examiner 13875 US.# 1 SEBASTIAN, FLA ~589-0879 4. Funeral Home/ Name Address Phone Number (Area Code) Y~X*X~ STRUNK FUNERAL HOME 1623 N. CENTRAL AVE. SEBASTIAN, FLA 407-589-1000 5. Check a El The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box b ~ .: LIZ was contacted on 4/15/89 within 48 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 DR. MERC}LANT will complete and sign the medical certification of cause of death. c [] was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. 6. Funeral Director/ ' Fla. Lie. No./Reg. No. Date Signed O i Fe. lfi(~}~ ~X #1672 4/15/89 B. 8URIAL-TRANSIT PERMIT Permit No.1228-89-182 Permission ia 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 oc- curred. [] No extension of time for filing the death certificate requested. ~ C~-~ Date 4/15/89 Date Certificate Registrar or /~ Sub-Registrar Signature .~"' ~ Issued: Due: AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature , Medical Examiner Date or Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disooser. 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. CEMETERY OR CREMATORY Method of Disposition: [~ BURIAL [] STORAGE [] CREMATION [] OTHER (Specify) Signature of Sexton, ,~9 '. or Person-in-Charge ) / , Place of Disposition SEBASTIAN CEMETERY Date of Disposition APRIL 18~ 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, May 86 (Replaces Apr 81 edition which may be used)