HomeMy WebLinkAbout4-44-27
~id by CEMETERY Receipt No. . . . ~
'List Price S.... .~~9~ :.q~..
Net Paid S ...... 60n ..00..
......... Dated... ...~<?X~~P.~F.. ~~.L.. 37
- 3 -
. Maximum No. Burial Spaces. . . . . . . . . . . . . . . . .
Lots 26, 27, 28
Block 44 NO.
Unit 4
Monument permitted.... .Fla.t............
1145
(Data above thl. Une tor Clt)' Record only)
Qtitll IIf 19tbastian
atrmrtrry
Irrll
1145
NO.
THIS INDENTURE MADB'I1LIa ....13th."....... day ot ...........No.vembe.r.................... A. D.. 19..8.7.,
between lhe City ot Sebutla... a aumlclpal corporation ex1ltln. under the Jawl ot the State ot Florida, 01 Grantor and
.................. ...... .J.Qn.n...f....j:J,:p.d.. .Tina.. J.... .G.tll... ............................................. ............. ......
334 Main Street, Sebastian, Florida
.............................................. ............................................. ... ... ......................................
ot the County 01 ......... J.~~~?~.J~~y.~~.... .....~.... an-J State ot .... ..f:J..Q~;i,9:c;l................."..................
u Grantee, WITNBSSETH.
That the Grantor for and in consideration of the sum of S .. ?9~: .q~..... . ........ to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, barsam. sell, release, convey and comma unto the Grantee . .~~.~;i;;- heirs, Jegalrepresentatives and assigns
the following prope~Y6sit~!D.Se~~, Indian River County. Florida. to-wit:
,','1.1,
All of Lot(s) . . . . . .. ,Block... .44 .. . UNIT. . .4 . . . . . . . .. . of Sebastian municipal cemetery as 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 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 be ,used solely and exclusively for the interment oftl1e human.Aead and shall
be used. kept and maintained at all times in accordance with the rules and regulations. ordinances,and resolutions of the City of Sebastian. Florida. hereto-
fore. 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 ob-
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 terminate and the same shall revert to the City of Sebastian. Florida.
IN WITNESS WHEREOF. The said party of the first part has caused this instrument to be executed in its name and on its behalf by its Mayor and
atteste4 by its City Clerk and its corporate seal to be hereto affixed. the day and year first above written.
Al...t~~r.n,.t)'t/~...
"~67~~'.~f"~' City Clerk
CITY OF SEBASTIAN, FLO'DA_
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MaJor
Signed. ScaJed and Delivered
I.~. - .t.cZ../1ajt..................
STATE O. .LOn:~~.f{7I~......
COUN'ry OF INDIAN RIVER
(GIne jiql)
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A.
1. Name of
Deceased
(Type or Print)
First
John
Last
Gill
/..c/
;6 ~.L.
IIi
Month Day
04/25/96
()
..
State of Florida, Department of Health and Rehabilitative Services, Vital Statistics
APPLlCATI.OR BURIAL - TRANSIT PERMIT .
Middle
DATE
OF
DEATH
Year
Medical Examiner
Name of (If neither, give street address)
Hosp. or
Inst. Palm Garden of Vero Beach
Address
1460 36th Street
Vero Beach, Florida 32960 (407)562-7777
Fla. Uc. No.lReg. No. Phone Number (Area Code)
Phone Number
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
Michaela Scott,
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral
5. Check
Appro-
priate
Box
City, Town or Location
Vero Beach
M.D.
Physician
Address
1623 North Central Avenue
Homes, P.A. Sebastian, Fl 32958 1228 (407)562-2325
a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b ~
Ri ta was contacted on 04/25/96 within 72
hours after death. He/she verified that this ~ellth was from natural causes, that there was no accident
nor other external cause of death, and that Mlcnaela Scott, M.D. will complete
and. sign the medical certification of cause of death.
c 0
6. Place of Se t lan Cemetery
Final Disposition:
7. Funeral Director/
Direct Disposer
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
Removal
from state Donation
Date Signed
04 2S 96
B.
BURIAL - TRANSIT PERMIT
Pe 't N 1228-96-0207
rml o.
Permission is hereby granted to dispose of this body.
o 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.
o No extension of time for filing the death certificate requested.
j;ie!lll..~. ...r ~ '("'v\ c... U
Subregistrar Signature . ^. · .~ --. ,
Date _. I _ _ '- , Date Certificate
Issued:~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.
D.
CEMETERY OR CREMATORY
Methods of Disposition:
I2J BURIAL
o CREMATION
o STORAGE
o OTHER (SpeCify)
Place of DispoSition
Date of Disposition
../.l-tiP-- ~--~-t-7'
~~~ ,;t~, /? ~(,
Signature of Sexton )
or Person-in-Charge )
~~ J. elc.-~
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.
HAS Form 326. Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number. 5740-000-0326-?l
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