HomeMy WebLinkAbout4-44-32
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~id by CEMETERY Receipt No. . . .'.
List Price $ ..... . .200.. 00..
Net Pdd $ ...... .4.00.. no..
12/1/87
. .. .. . . . . Dated. .. . .. .. . .. .. . ... . .. .. . .. . .
LOTS 31 & 32
LK.44,UN.4
NO.
Maximum No. Bmial Spaces..... ...?.......
1147
Cesky
Monument permitted..... Elat.......... ..Edward & Dorothy
801 Barber St.
Sebastian, Fl.
(Data above this Une tor Clt)' Record only)
32958
atttl1 II! 19tbasttan
1147
C!!rmrtrry
it rrb
NO.
THIS INDENTURE MADB 'l'Iala .. .ls.t..........,... day of ........... December................... A. D.. 19. ..81..
between the City 01 SeblUltlan. a municipal corporation exlltlnlf under the lawI 01 the State 01 Florida, al Grantor and
. . . , . . . . .. ... . . '" .............. .~4~~.:r.4.. ~:p,d... P.A:J::9.thy.. .C.~~l<;y.............. .', . . . ... .......... ............................
801 Barber St., Sebastian, Fl. 32958
.... ......................................... ............................................. ............................................
of the County of ....... ~.~4~~~. J~.~ Y.~J;................. an'] State 01 ............ ..f,l,.~:g::1-.4.~.............................
u Grantee, WITNBSSETH I
That the Grantor for and in consideration of the sum of $ .. .~~9. ~ 9.9..... ...... ... to it in hand paid. the receipt whereof is he~ith a~
knowledged, does by this instrument grant, bargaiit, seu, release, convey and conIum unto the Grantee .1: ~.~:L.;. heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
;'~. '
All of Lot(sP.1. . .f. .. ,Block,.. ~ Ii . .. ,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 theoftice of the Clerk of the Circuit Court of S1. 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 of the human dead and shall
be used, kept and maintained at an 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 zequirements contained
in this instrument shaD 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 de'edof 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 tlrst 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 afIlXed, the day and year first above written.
l
Attestl-f(~.1.....0!tI.~.~.........
. . .~ . . '.(r'~ , Clt)' Clerk
CITY OF SEBASTIAN, FLORIDA
II, ~~.~..........:.....
Halor -
SlgDLod, Sealed and Delivered
In the Presence of I
~~~..K.,~.........
& JI~~.Ii.... .nt~...................
s~::':~RIDA
COUNTY OF INDIAN RIVBR
(aIitv jiJeal)
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State of Florida, Depa.nt of Health and Rehabilitative Services, Vi.atistics
APPLI ON FOR BURIAL - TRANSIT PERMIT
A.
1. Name of
Deceased
(Type or Print)
First
Last
Month
Day
Year
Middle
DATE
OF
Cesky DEATH July 13, 1997
Name of (If neither, give street address)
Hosp. or
Inst. Sebastian River Medical Center
Address Phone Number
2. Place of Death
County
I ndian River
3. Name of Medical
Certifier
Farhat J. Khawaja,
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral H
5. Check a 0
Appro-
priate
Box
Edward
City, Town or Location
Roseland
Medical Examiner
M.D.
Physician 7754 Ba
Address
1623 North Central Ave.
Sebastian, FI 1228 561-589-1000
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Street, Sebastian FI 561-589-3000
Fla. Lie. No.lReg. No. Phone Number (Area Code)
b fji
Michelle was contacted on 7/13/97 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 Dr. Khawaja" will complete
and sign the medical certification of cause of death.
c 0
was contacted on . He/she verified that
, Medical Examiner, will complete and sign the
6. Place of Sebastian
Final Disposition:
7. Funeral Director/
~;\'P.w n:<:-l'rWr
I ndian River
F.E. No.lReg. No.
1862
Removal
from state Donation
Date Signed
7 13 7
S.
BURIAL - TRANSIT PERMIT
Permit No. 1228-97-0309
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.
~f!JilltF-- QJ'
Subregistrar Signature
Date
Issued:
7 h 3 J"
Date CertiJic/;te I tJ!Ij,
Due: 7 III ..."
I
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
"0
, Medical Examiner ". . Date.
Signature
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:
IfJ..SURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition .....Jl.f,.,:.At'.... Co hVI ~t
Date of Disposition ~ u...2 "\ I Sf 1<7 t? I)
D.
Signature of Sexton )
or Person-in-Charge) .,~. ~'. ~ ('f.. ;
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 edition which may be used)
(Stock Number: 5740-000-0326-2)
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