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Home My WebLink About4-43-06B '''""",Y~~' ""~"'~iii<'~;;;r:,.i"" C!trmrtrry m rrb '1439 -- J ;:-f) 0 .., (jJ' 0 ?-,1 (!titt! Df t;ebnstinu NO. THIS INDENTURE MADE 'l1aIa 29th day of December 93 A. D.. 19....... ~ .. N N ..... ...... .................................. between lbe City of Sebw;tlan, a municipal corporaUon exlstin.. under the laws of the State of Florida, as Grantor and RmJAN TO Mary L. Moody L ..........:................... . . .. . .. .. .. . . '125' 7' . Ge ar'ge . . S'tre et.. .. . . .. . .. . . .. . . . . . . . . . .. .. .. .. .. . . .. .. .. .. . .. .. .. . . .. .. .. Sebastian, Florida 32958 .... ....... ... ............................... ....... ....... .........., ................... ........ ........ ............................ C7\ N of the County of ....... J.I,1.4;i;~I,1..~;i; y.~.r;................ anJ State of ..... .f.+.q~j..9..E!-..................................... II Grantee, WITNESSETH I That the Grantor for and in consideration of the sum of $ ....... ?~ 9. ~ ~9. .. . .. . ... to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, sell, release, convey and confirm unto the Grantee. be.);'. .. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) . . . . ~. , Block, . ~. ~{!!,. , UNIT ....... ~. . . .. , of Sebastian municipal cemetery as per Plllt .NlIri1ber 1 the~f recprded in Plat Book 2, at page 65 of the public records in theoftlce of the Clerk of the Circuit Court of St. Lucie County 01 Fforida:; said land now IYmgand being in Indian River County, Florida.' . . ~ ' o 1~4 ~! :z:- :z: DOtUMEHTAIlV STAWS DEED $ -< I~ NOTE $ JEffReY K. BARTON. GU,", INOIA" AlVflt COUNTY ~()OPtO "E~~~N'( , :.-.iW ~. ~,...n\Jf\1' J&.'""C",~,. ~ ~~ Q\.fJ\"- AfJiI' Qo,J' f ,', \lllO~ . .' '. . ~ ." ::II: fSS N - 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 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 de'ed 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 iust 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 fust above t CITY Attes~Lh~.m.:.{)fIa~~~. I City Clerk . ... .a;{1..= ................ ........ 4~--",-e.~~~...... ~~t~~~~FO:II~~~~ RIVER;;,,; ,,";i::ltf;;{~' '. I HEREBY CERTIFY, That on thil .... .Z.9. ~n........... ..day of ............ ..D.~~e.JP.b~t:'.;.,t\ , Lonnie It. Powell ' Kathryn M. before me personally appeared ........................................................... and ....................................... respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known !5 . to be the individuals and officers described in and who executed the foregoing cORveyance to - .......... ....... ....... ... ... ... .......... .~~~y.. .I,..... .~.qRqy'. .......... .:... ... ......................;... ..... .... ....... ... ...~ .f:"- . . . . . . " . . . . . . . . . . . . . .. . . . ... ... .. . ... .. .. ..... . .. . .. '" and severally acknowledged the exeeution thereof to be their free act and deed\) as such officers thereunto duly authorized; and that the Official &eal of said corp()ratlon Is duly affixed thereto, and the said conveyance en is the act Ilnd deed of said corporation. <=> WITNESS my signature and official seal at Sebastian, In the 1ea~ . last aforesaid. +:- \.0 .~~f~.. UNDA M. GAU.EY l*:'i]:*: t8'( COMMISSION # CC334817 EXPIRES ~:. .: j June 18. 1994 1o~:l: ;;;.....;'#) BONIlED THRU TllDV FAIN INSUIWlCE.INC. ilIfj",'~ ......,-----:''_~~7'r:"''V''"':.;<;:r:r.::~#.S:t;_~,}'~'~<'',~~',~-'(';~_:_' - Name of Cemetery/Funeral Home ~ c:. ~ ~ 4 ~ \ RECEIPT OF CREMATED REMAINS AND RELEASE OF LIABILITY The undersigned hereby certify that they have the legal right to take custody and make disposition of the cremated remains of the deceased, and hereby acknowledge receipt of the cremated remains of: . The undersigned further assumes full d proper disposition of said cremated remains. NAME OF DECEDENT: The undersigned hereby agree to indemnify and hold harmless the above named cemetery/funeral home, its agents and employees from any and all liability, including reasonable attorney fees, and against any loss it or any of them may sustain in connection with the receipt of, shipment of, or disposition of said cremated remains. Further, the above named cemetery/funeral home shall be held harmless from any defects or faults of any container not supplied by the cemetery!funeral home. Dated .this 9ft73,/~daYOf uJ@' /9 1-/ H. el.~T Street 1~A. . City rJ. ' , State '3'Z..?~e. Zip Address Signature: Authorized Representative SSN #/photo ID Relationship to Deceased Signature: Witness: Authorized Re~ntative ~- d~~. Re resentative of Ce etery/Funeral Home SSN #/photo ID Relationship to Deceased GBN-SQ24 REV 12191 White - Cemetery Copy Yellow - Customer Copy I 4')( :s I (eef fVli1I)f))) , $41CJ Unit Lot Date of Mark-out. 9~ J-.9f-O~ 9-"J-9 - 05' .&Mr~.\ Time f{);]ol1#r Date of Burial t9."- .'/-',1</':4:-'r-,~ ...'''. (,- -~_~':"""J~.:_.:?~&:,,;~....~ ~" ..n_,.:........,':........_'__..,_. ..._____>...........'.;._.'.'.__.._....'.._'......'-.'........'......_...n.._--.........__ .'.............".- '._:<--:.> ,:-_:.... < :._ ':-;, _~._.-..;'<'-':. ," "_r-----'.'.'-_..: - ',';' "_ --..: ,'" 'r-' .,-,' .-. II.OOq ...aqll....:o \;3.0000'11: 00:1'13. qO'1 ~.._-"--~--'-"" 8 8 8 8 8 8 8 J i ~ - s - - - - g ~ ~ S 8 0 - - - ~ ~ ~ ~ ~ I I ~ ~ - - - ~ CD ~ - 0 i CIIJi~11 I I , ~ , ~ 0 i lit i f i a- n Ii ~n . n~ ~ ~i~ !: UI I I ; 5-'" I i ~~ :!I l ""!t .. . ~~ . II . ... Ii w:- oof c ~i f i ~ i i~ ~l . - I~ ~ w +=-- i ~ ~ f\J ,..!~.. ..f'--",'".,- ~ , c,..r','.... .',,", Oi, CE..... Index:RECORD . City of Sebastian~ FL - Cemetery Lots Last Name Address 1 Address 2 City Deed . Unit . MOODY 1257 GEORGE STREET First Name MARY L. SEBASTIAN 1439 Date 4- Block . Lot Number ___ Interred Lot Number IIZ (...Interred Lot Number 73 Interred Lot Number Interred L State FL Zip 32958- 12-29-93 Amount $250. 4~ Dte Interred Dte Interred Dte Interred Dte Interred Comment Comment <F>wrd <B>ack <E>dit <D>elete <N>ext <P>reu <R>e-search <L>abel <T>a <Ese> . ~ ! t1 ~ -cJ1 J,6\ ~~t/ ~~ \~' q\ Friday, Apr 08,2005 09:13 AM ~) FOUNTAINHEAD MEMORIAL CEMETERY + FUNERAL HOME + CREMATORY 7303 BABCOCK STREET, S.E. PALM BAY, FL 32909 CERTIFICATE OF CREMATION THE UNDERSIGNED CERTIFIES THAT THE REMAINS OF MARY MOODY WHO DIED ON: SEPTEMBER 14, 2005 WERE CREMATED ON: SEPTEMBER 22, 2005 AND THAT ALL LEGAL REQUIREMENTS OF THE STATE OF FLORIDA WERE OBSERVED IN PERFORMING SAID CREMATION, AND THAT THE CREMATED REMAINS OF THE DECEDENT HAVE BEEN PLACED IN A PROPERLY IDENTIFIED CONTAINER. THE REMAINS WERE RECEIVED BY US FROM NATIONAL CREMATION SOCIETY BURIAL-TRANSIT PERMIT #2005-402-113 CREMATION CERTIFICATE # 6261 ~~<- ""\ SIGNATURE OF CREMATOR SEPTEMBER 22. 2005 DATE i'I/JRIDA DEPARTMENT OF .---. :J-IEAL T Name of Deceased First StateofFlo.rida,.,.P. ep. artm...... eo.t. of Health, V~tal S. tat. iStiCS~. 11- /~) APPLICATION FOR BURIAL - TRANSIT PERMIT ~~ ~ Middle Last Date Month of Moody Death Name of (If neither, give street address) Day Year (TYPE) Place of Death County revard Name of Medical ::ertifier Mary City, Town or location September 14, 2005 Rockledge Oscar Jerkins M.D. Hosp. or Inst. The Palace Medical Examiner X Physician Name of Funeral HomelDirect Disposal Address Establishment 24.19 S. Babcock St. STe. b :\.'ittonal Cremation Society Melbourne, FL 312901 KB 402 (321) 676-4100 Check . a. D The medical certification h~ been completed and signed. A completed certificate of death accompanies this Appropriate . application. Address 9 Orange Ave. Rockledge, FL 32955 Phone Number (321) 636-2421 Fla. Lic. No.lReg. No. Phone No. (Area Code) 80x b. [i] 1.01"; rhE' 11 P . war; contacted on September 15. 2005 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. .Jerkinl'! will complete and sign the medical certification of cause of death within 72 hours. c. D was contacted on He/she verified that , Medical Examiner, will complete and sign the Funeral Director/ ?irect 8isposer Date Signed , ~;)..-or BURIAL - TRANSIT PERMIT ::Jermission is hereby granted to dispose ofthis body. Permit No. 2005-402-113 6n A five (5) day extension of time for filing the death certificate (exclusive ofw6ekends) 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. ONo extension of time for filing the death certificate has been requested. Re istrar or ~.- Subregistrar Signatur Date Issued: 09/15/2005 Date Certificate Dije: 09/27/2005 AUTHORIZATION for CREMATION, DISSECTION, or BURIAl-AT-SEA Aj}proval Number: C05-09.,..139 Date September 20, 2005 i1f!edical Examiner, ,91lVe authoriz,~ion by telephone to NCS Funeral DireCtorlDirect Disposer. Date ;:haMedical 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. Dr. Sajid Qaiser Method of Disposition: CEMETERY OR CREMATORY .Place of Disposition Fountainhead Crematory ']SURIAL '.DSTORAGE Date of Disposition SEPTEMBER 22, 2005 DOTHER (Specify) }. . C(y-c!O -~\i~ p;;rmit must be endorsed by the Sexton or ~rs6~..jn-charg~ (or by the .Funef~1 Director/Direct Disposer when there is no Sexton) and .returned ,,/n-,in 10 days to the local County Health Department In .the county where dispOSItion occurred. --1 1x..J CREMATION Signature of Sexton ar Per'y:m-in-Charge ~ Lih 326. 8/97 (Obsoletes all previous ed~ions) (S!ock Number: 5740-000-0326-2) Distribution: White: Cemelel)' or Crematory Yellow: Funeral Director or Direct Disposei' Pink: Local RegisIrer -6-