HomeMy WebLinkAbout4-43-26, ame
Unit
Block
Lot
Date of Mark -out
Date of Burial
Name of Funeral Home
Authorized by
Time
/
Paid by CEMETERY Receipt No. .
UstPrice$...~9.9:.9~...... .
Net Paid $ .. .6UO...OD ~.....
580' 8/18/89 Lots 24 25 26
........,.,.D.~............,....,............. ". NO.
.... Blk. 43, Un.4
Maxim~No.BudalSpacot""""""""'''h 1 tt G S 11
. ',. ';'. .' . '"' ar 0 e .. ewe 1235
Monwn.nt peimi~.ed. .,.........,..........& ,Lois Payne .
13690 Old Dixie Hwy.
Sebastian, Fl. 32958
(D.ta .bo,e thll Une 'or eu, Record om,)
...........~
atitv lIf &fbastiau
C!!rmrtrry
irrll
NO.
1235
THIS INDENTURE MADB TIaII
18th
day 01
August
.............................................
89
A. D.. 19......f
bet,,'een tbe City 01 Sebuti.... . municipal. corpor.tloll Wltin. under the l.wl 01 the State 01 Florid.. 81 Grantor and
Charlotte G. Sewell and/or Lois G. Payne
.... ..................................................:....................................................................................
13690 Old Dixie Hwy., Sebastian, .F1. 32958
............................................. ............................................ ............................................
Indian River Florida
01 the County 01 ............................................. .n') St.te 01 .......................................................
u Grantee, WITNESSETH I
That the Grantor for and in consideration of the sum of $ ..6 Q O. , p.o. . . . . ~ . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, d~es by this instrument grant, bargalD, seD, release, convey and conium unto the Grantee . J::J;1A i.r; heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
/2-'6e
All of Lot(s)24., AS , Block, . 4.~. . .. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat 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; po>vided that said property shall be.used solely and exclusively for the interment oCthe human dead and shall
be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutionl 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 iuch 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 fust part has c:aused 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 fust above written.
All.... ~,.L.. · .m:.C?tI~~..;..
...,... '~r~ City Clerk '
. .
CITY OF SEBASTIAN, FWRIDA
B, .~~.~:.V~.......:.....
M&7or
Signed, Sealed ond Delivered
In the Presence ofl
~
'j/JlJ' . .. . . ~ ' . . ... , .. ~~"""~"""""".'" ~.
/p)V1U .....~..~.rw~.........
(QIUv $&!aJ)
STATE OF FUlRlDA
COUN'fY OF INDIAN RIVER
. 19th August 89
I HEREBY CBRTIFY..That on thIa .........................d.' of ...........................................~........ 1......
belore me penonall, appea...d ..Ri;~h~~.4..~ t.. :V~t.~P~~..........,. ~............ aDdK.~.~h~.Y!?-..~:.. ~ .1.~~.~~9.~.~~...
reapeetively Mayor .nd City Clerk 01 the CIty of Be_tla... a municipal corporation undeJo the lawI 01 the State 01 Florida to me knowlI
to be the Indlviduall and ollleera deac:rlbed In and wboexeeuted theJOrt'lOln, COJtveY.IlC!e to .
Charlotte G. Sewell and/or Lois G;Payne
. . . . . . . . . .. . . . .. . . . . . . . . . . . . .. .. .. .. . .. . .. .. .. . . . .. . .. . .. .. . . . ., . . . 0- . . .. . . .. . . . .. . . .. .. . .. .. .. .. .. ~ eo .. ..
.. .. . . . .. . . .. . .. .. .. . . . . . . . .. . . . .. . . . . . . . . . . . . . . . .. .. . .. . . . . . . .. . . .. . .. .. ..
. . . , . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . ~:. . . . . .. . . . . . . ., . . . ..... seyerallY achowledled the IlUCUtion thereol to be their Iree act and deed
IS such olllc:ers tbereunto duly .uthorlled, aDd that the Ollldal aeal "01 aal!J"'corporatlon .. dull' affixed thereto, and the Aid conveyanee
Is the lid and deed 01 aald COI]1OMUoIlo . e' _ - .
WITNESS lD)' Ilgnatare aDd. otllelal .... at' Sehut.... In the Col(nty 01 Indian River and State 01 Florida, the day and 7e.,
last a10rellald. - ,~
~ ~_..~ Jd~
..N~~ii:'~~;W~.....................
M" COIIIIII....... aplreat 1'" pL'
r:otary UulJr. State ., FrorHler
My (Dmm;!:ion bpircs D~(. 10, 1992
lIlncIed lhru Troy ~..,,,. .....,allC. Inc.,
C,;".',
c:.~~:i~",:...
. ",....-,,)-r;-Ir~~ __,~l;:_:":"""':,?<~';':'<;1_~fJl","",.~
-;~:;~:::"""}';.,.; ',.,-,
;-~-;"~~;:;-
.. L. d
~ 73
vi
State of Florida, .tment of Health and Rehabilitative servl.ltal Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
A.
1. Name of
Deceased
(Type or Print)
First
LOIS
Middle
G.
Last
PAYNE
DATE Month Day Year
OF
DEATHAugust 5, 1990
2. Place of Death
County Brevard
City, Town or location
Melbourne
Name of (If neither, give street address)
Hosp. or
Inst. Holmes Regional Medical Center
Physician 160 1 S .
Address
1623 N. Central Avenue
Sebastian, Florida 32958 1228 407-589-1000
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Apollo Blvd, Melbourne, Fla. 407-768-2816
Fla. lic. No.lReg. No. Phone NUIl.l!?,er (Area Code)
3. Name of Medical
Certifier
James W. Battaglini
4. Name of Funeral Home/
Dill8Ct BbJ.lV<>=-
Strunk Funeral Home
5. Check a 0
Appro-
priate
Box b gg
Medical Examiner
Address
Phone Number
Dr. Batta~lini was contacted on 8/6/90 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 He 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
medical certification.
6. Place of
Final Disposition:
7. Funeral Director /
!:lir.li-ct Qi81988er
Removal
from state Donation
Date Signed
Au ust 6, 1990
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228-90-422
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 t eath certificate requested.
. ..--
Registrar or . ,,-
St ''''"''gili'trlilr Signature
Date /J A::X? Date Certificate
' Issue<t.'C<<4- ~/ A1~ Due:
r '
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA .
Signature
or
Medical Examiner,
, Medical Examiner
Date
, 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:
~ BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
5--1 9 ,~<~ 0
Place of Disposition Sebastian Cemetery
Date of Disposition Augsu t 8, 1990
Signature of Sexton )
or Person-in-Charge )
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: 5740-000-0326-21
1