HomeMy WebLinkAbout4-43-32
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Paid by CEMETERY Receipt No. . . . .
LiltPri.. s.. );1.~~9...9g...
1,800.00
NetPoIdS ..................
...1~......Dated....g,.~~.(~~.............. Lots 3' &32
Block
Maxbnum No. BarlIISp._. ............... Uni t 4
Moll1llllllJlt permitted.................. ......
NO.
14'(9
(Dat. ....... tilt. line f. C1'" a-rd oaIy)
QUtu I1f j;, ballttan
"1479
C1trmrtrrg
Irrll
NO.
THIS INDENTURE MADB ".
28th
November 94
d., of ............................................. A. D.. I........
beh.em II.. Clt, of Seb~n, . .unlelp" eorpmatloa allU". under the Ja.. of the Sble of FlorIlb. .. Ol'Ultor uod
Clarence F. Duval
........................................... '8600"U; S';' '1';' 'I;O't. .143......... ........................ ................ ........
.................... ...... ........... .......~~~~?,.. ~~l?J?~~~ ..~~?.?.~.... ....... .......................... ..................
of th. Colon'" of ... ,:!:mU,(l.J). .R:LY.~~............. ....... on1 Stole of ...... .F.1Q;r:!da....................................
u OroJltee, WITNE88BTH.
TIIIt the Gnntor lor and In consIdentlon 01 the IUlft 01 S ..\ ,.~Q9... 9.Q............ to It In hand p.Id, the seeelpt ..hereolII heleWlth .c-
tnowJedaed. does by thlllnstrument put, boJpIft. IOn. mea.. COIlftF and confirm IIItto the Grantee ., h :t.t!! .. heIn. \epllepnl_toU- and ......1
the 10UO..... pIOperty lItuoted In Sebolllan, Indian IUftr County, FIorldo, to-wlt:
AnolLot(l) .~~.~.llock, !!~..... ,UNIT .....4....... ,olSebastIan munldpal cemetlltyuper Plot Number 1 the_lI.corded In plat
Book 2, ot PlIO 6S 01 the public IecordIIa tlle omco 01 the Clerk 01 the CIrcuit Court of St. Luclll County of Florida; said land no.. IJinI and beInI
In Indian Rmr County, Flodcla.
To Hmt and to Hold the IIftlO fo_; pIOYIded UIat said property shan be UIOd solely and lIlIeIuIhoely lor the Interment of the Itumm dead .nd shan
be UIOd, kept and maIntaJMd at an timelln acconIallCll with tile rules and 1efU1otIoM, ordInances.nd _Iutkml of the City of Seboltlan, FlorIda, hereto-
fore. now .nd '*-ftor adopted or prowlded lor tile ..-nment and operation 01 IIklcometllty. TIle condition.. NIlricllonl and lOllulremento COIItoIned
In thillnltrument Iha8 be ccmMDtl runnJna with tile land. In tile _ 01 the lallure 01 tile owner of any pIOperty lItuated within said cometory to oil-
_ and oomply with iuell ruIeI, IefUlotlon.. _lotions and .oldtnan- and the conditions 01 tile d8ed 01 conftyanco the_1 then the tIdo of lIUch owner
In and to ..... pIOperty shan tenn1ualll and tile ._ shan nnert to the CIty 01 SebutIan, Florida.
IN WITN1!SS WRERIlOF. TIle ..... p.rlJ 01 the lint p.rt hal ..used thillllltrument to be executed In It I name and on Its behalf by Its Mayor and
attlllted by Its CIty Clerk and It. Cl)rporate ... to be heleto af1IxecI, tile day and year I1nt aboft written.
AU ~.<~... m....t).tI~..
~ CI.,. C1.rk
!II. I""', S led and D~~1' ,..----,
In the P nee 0" #. .' ./
." .. ..............~..()..~.~."!.~~!-~.....
..~..~..............
~TE OP FLORIDA
COUNTY OP INDIAN RIVBR 26t November 94
I HEREBY CERTIFY, Thot on thla ....................... ~a, of ............. ......... ................ .......... .... I.....,
~
lIPIo,. _ penonall, appeared J:r;.~h~:r;.. ~... ..~.;~~.~.C?~............................ and . ~~ !:.~~y.~. M.....9.~n~~.tq~~~.
respertlvely M .'0' .nd City Clm of the City 0' 8ebutlan, 0 munlrltl&l eo'J1O.oUon under the 1...1 0' the Stote 0' Florida to me known
to be the Individual. and offlren dne,lbed In and who neeuled the f.....lIOlnl c:GIIveyanc:e to
Clarence F. Duval
crTYO':ifih~
By ........... .. .. .. .. . .. . ..f... ... .. .. .. .. .. .. .. .. ..
Ha,.o,
(aIilt ~W)
.......................................................................................................................................
.. .. .. . .. .. .. .. .. . .. . .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... oDd .en,"'" oek ..led..... the aeeuUon thereo' to be their free ad and deed
II IUch oftleen thereunto duly authorlled; .nd thot the Ofnelal _I of.. eorporotlon II duly .fnaed thereto, uod ..hi eon..,.nee
I. t"" ad and deed of ..lei eorporotlon.
WITNESS ...,. olpat1lre and offlel.. -' at 8ehutJan, In tile
hiot aloreoolcl.
CD LIIlIMM.8M.LEY
.~'IlCmr24
........... -
..........,NlII......
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.1
Unit.
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Block </3
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Lot . a "'+
.Date of Mark-out
. roII;-I()~
."
Date of Burial ./0/11 /0 rt/
Time
/0 ~ 00 A .
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If. ..ilt . ii F i> ./.. .. /. .... · ...... '.. .... .
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(Copy
CITY OF SEBASTIAN
Nam~ ~~~
.... - H___.cJ'~ - ~4~S-
AIIIount PI!
001001 208001
001501322900
001501 341920
001501 341910
001501 362100
001501 362100
001501 362150
001501343800
601010343800
001501369400
001501369400
680800 220681
680800 220682
Sales Tax
Garage Sales
CopiesJBid Specs,
LDClCode of Orcinances
Community Center Rent
Yacht Club Rent
Non Taxable Rent
Cemetery Lots
Cemetery Lots
LotJNiche
. Block
Unit_
Interment Fee
Weekend S8fVice
Yacht Club Security Deposit
Community Center Security Deposit
~1S:(l,
~
,... /u '/ ~
li~ ri.rJ'~_nn ~
() _ ~/ _ Total PaId ff: cJ
. Initials
WhIa - Dept. al Origin. 'Ill.. - FI..... . PIIIl. A,pHeallt
680800 220683
N
m
N
<11
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State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
1-'13 ~ 32-
FLORIDA DEPARTMENT OF
A.
1. Name of
Oeceased
(TYPE)
First
Middle
Last
Month
Day
Year
2. Place of Death
County
Brevard
3. Name of Medica
Certifier
Clarence
City, Town or Location
Francis
Date
of
Duval Death
Name of (If neither, give street address)
Hosp. or
Inst.
Oct.
11
2002
Address
Holmes Regional Medical Center
Phone Number
Mel
rne
jd Qaiser, M.D., A.M.
Medical Examiner Physician
4. Name of Funeral Hom~."ct BiG!'e_1 Address
Establishment 1623 N. CeI'1tral Avenue
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
1750 Cedar Street
Rockledge, FL
321-633-1981
Fla. Lie. No.lReg. No. Phone No. (Area Code)
b.D
" was contacted on
He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death,
.and that will complete and sign the medical
. certification of cause of death within 72 hours.
Johnni
c. ~
was contacted on
10/111/02
He/she verified that
, Medical Examiner, will complete and sign the
6. Funeral Director!
f death within 72 hours.
F.E. No./Reg. No.
62
Date Signed
10/11/02
B.
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-02-01123
o A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within
72 hours.
DNo extension of time for filing the death certificate has been requested.
Subregistrar Signature
Date
Issued:
10/11/02
Date Certificate
Due: 10/16/02
4h.,,;~t.AI \,1.-
C.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
7'<--
Approval Number:
Date
Medical Examiner, . gave authorization by telephone to
Funeral DirectorlDirect 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.
Method of Disposition:
~BURIAL o STORAGE
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
Date of Disposition //':J./ )7.~ "'Z../
D.
DOTHER (Specify)
} ,(f1 f ;r:1k?
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral DirectorlDirect Disposer when there is no Sexton). and returned
within 10 days to the local County Health Department in the county where disposition occurred.
DCREMATION
Signature of Sexton
or Person-in-Charge
OH 326, 8/97 (ObIoIeIe. all previous editions)
(Stock Number: 5740-000-0326-2)
Dl8tribution: White: Cemetllf}/ or Crematory
YeUaw: FI.IIfII'lIl Director or Direct Disposer
Pink: lOClll Registnlr