HomeMy WebLinkAbout4-44-18
~.y CEMETERY Receipt No...~.
" List Price $.. ... ~.?~:.~~....
11/4/87 L 3 17 & 18
.........n.ted..................Z.....ii1k: 44, Unit 4
Maxilnum No. Burial Spaces.. ...............
1 Joan M. Cook
Monument pennitted..... Eat..... "6'85' S. W. Joy St.
Earl H. Cook interred in Lot 18 - 11/6/87 Sebastian, Fl.
(Data abo.e thla Un. for Clty Reeord only)
NO.
Net Paid $ ..... A.OQ ..OQ...
1143
32958
<!!tty Df &rhusttuu
Q!.ettt.et.ery
1!I.e.eb
1143
NO.
THIS INDENTURE HADE TIlIa .. ...lO.th.......... day of .... ..Nav.ember.... ... ........... ....... A. D. 19.8.7....
between the City of Srbutlan. a municipal eorporatlon exlatin, under the lawaot the State of Florida, as Grantor and
........................... ..... ....JR~~.. H.... .G.Q.q!<;................. ...... ...................................... ........... .......
... ...... ....... .............685.. .S., W ,.. Joy.. .S.t. ,. ..Sebas.tian,.. ElDrida... 329.5.8...... ......... ...... ...
of tbe County of . ......... .~~~:!-.<).~..R,:!-.V~I::.. ........... an'J Slote of .......FJpl::i.dll....................................
.. Grant... WITNBBSETH,
That the Grantor for and in consideration of the sum of $ '" ~ ~ 9. ~ ~ ~. . . . . . . . . . . . . . to it in hand paid. the receipt whereof is her~ith ac-
knowledged, does by this instrument grant, bargaiD, sen, release, convey and confirm unto the Grantee. . hel,': .. heirs, legal representatives and assigns
the following property situatedlusSebastian, Indian River County. Florida, to-wit:
All of Lot(s) ~!..~. ,Block, ~~. . . .. . UNIT . ~ . . . . . . . ... ,of Sebastian municipal cemetery .s per Plat Number 1 thereof recorded in Plat
Book 2, at page 6S of the public records in the .office of the Clerk of the Circuit Court oiSt. Lucie County of Florida; said land now lying and being
in Indian River County) Florida.
To Have and to Hold the same foreveri provided that said property shall be-used solely and exclusively for the interment of the humll9 dead and shall
be used, kept and maintained at aU times in accordance with the rules and regulations, ordinances and resolutions of the Oty of Sebastian, Florida, hereto.
forc, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements 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 air
serve and comply with Such rules. regulations, resolutions and ,ordinances and the conditions of the deed of conveyance thereof then the title of such owner
in and to said property shall tenninate and the same shall revert to the City of Sebastian, Florida..
IN WITNESS WHEREOF, The said party of the flIst part has caused this instrument to be executed in its name and on its behalf by its Mayor and
atteRed by its City Clexk and its corporate seal to be hereto affixed. the day and year first above written.
Alle'll~-J~ ~. ..b...{).#~....
,..~ CIty Clerk
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((lIitg Ji...J)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
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Date of Mark-out
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1/ 1.::- 187 'c
II /6/131'
~ate of Burial
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Time
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!'fame oi. Funeral Home ''$ 7'J::; 1.4 1'1
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'~~'@Ki JOAN M. DEED NO. 1143
685 S.W. Joy St.
Sebastian, Fl. 32958
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Earl M. Cook interred in Lot 18
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. LOTS 17 & 18
BLOCK 44
UNIT 4
11/6/87
();;!
PElT FOR FINAL DISPOSITION OjiUMAN REMAINS
ate of Birth
.t-. / (5
{j '1</
Application
for Permit
I, '-1. ()/).:.....o. . {i ~ hereby apply for a permit for the final disposition of .
the remains of the above named decedent. I agree to abide by all laws and regulations of the Tennessee
Department of Public Health and all other laws pertaining to the preparation, container, transportation,
burial an~~n ~ The type permit needed is checked belo~ -4
Signature Address ""7JLt-. . . ... ~.,
TYPE OF PERMIT REQUESTED
(Check Boxes that are Applicable)
Burial
~ Burial
o Cremation
~ Transit
e and Address of Cem tery where Remains are
o Disinterment
o Reinterment
o Scientific Use
Transit
be Interred
Cremation
ains are to be Cremated
To
Disinterment
and Address oICemetery)
Reinterment
Place of Reinterment (Name and Address of Cemetery)
Scientific Use
Name and Address of Facility Receiving Remains
Authorization of
Physician or Medical
Examiner
I certify that I have examined the remains of the above named and consent to the issuance of
the Permit for Final Disposition;
Signature of Attending Physician or Med. Examiner
Address
Permit of
Local Registrar
This permit for the final disposition of the remains of the above named is granted for the
purpose(s) checked above, in accordance with Chapter 128 Section 18, of the Public Acts of
197 . WILSON COUNTY HEALTH DEPT.
I.EBANmqctIfllQ~ESSEE
Si
.
Certification of
Person in Charge
of Disposition
I certify that the disposition of he remains ofthe above named V(ilS,made in accordante with
this permit on '" Go /? 7 at'2"'.-E&-"TM'..,.J Ur~.
Date Plac,e
~ ~ d,.....?_'. r-"'...
Signature J a ~ _ .
Add~u ~""" :lJ. ~7~,c .4;c
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PH.1&a7
VR 7t78
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