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Home My WebLink About4-42-06 Pa~METERY Receipt No... .?. List Price $.. .J~~.,OO...... . 650.00 Net P81d $ .................. 11/17/89 ts 5 & 6 . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1k.42,Un.4 Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . NO. 1281 (Data above thll line for aty Reeord only) Robert Grove 5740 59th Dr.(Winter Bch.) Vero Beach,F1. 32967 Monument permitted. . . .. .. . . . . . . . .. . .. . . . . Cltitl1 of &fbastian <1!rmrtrry II rrb 1251 NO. THIS INDENTURE MADE TIlIa ....~7.th........... dAY of .....Nov.ember.......................... A. D.. 19..89.., between Ihe City of SeblLStlan, a municipal corporation alltlne under the Jaws of the State of Florida, a8 Grantor and ................ ...... .RQQe.t'.t..Gr.o:v~........ ..... ....... .......... ..... ......... ......................... ................ ...... 5740 59th Drive (Winter Beach) . . . . . . . . . . . . . . . . . . . . . . .Var; 0 . .:Baa en. 1 . . Fl.. . . . 329.61. . . . . . . . : . . . . . . . . . . . . . . . . . .. ............................................ of the County of .... ..l.t:l4;i,~.I).. R;i, Y.~~.................. anol State of ..... .f.lR:f:".i.Q.~..................................... .1 Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ " 9.~ 9. ~ RQ. . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargaiit, seU, release, convey and confirm unto the Grantee .~; ~ . .. heirs, legal representatives and assigns the foUowing property sitWl!ed in Sebastian, Indian River County, Florida, to-wit: . All of Lot(S)~ . .~ . ., , BIo~, .. .4? .. , UNIT .....~....... ,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 shaU 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 shaU 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 shaIl 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 attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. CITY OF SEBASTIAN, FLORIDA ,~i6~Y>1 QI J/J,,/J.~_ __ . Attest: -.-!Y4.{. ... .f.~ ( : . . .( I.~f:.<t;k.......... . .... .. . City Clerk /:0. "t. ~;-AL ~ . B)' ......~....:....~.T.~.......... Ma)'or Slgnl'd, Scaled and Delivered '.~./1. ... .~........:........ cp,/..r.: r.U.c.c....... ....... (~.C:-f:: .~~4-:... ! STATE OF FLORIDA (Grift! JIleal) .-\-~~" \ ." i ~ ~ ~ , '"::'\ " Q) e j:: \-7 "~ei!~?','~";;','?~' .. State of FlorIc:Ia, ertment of Health and Rehabilitative SerVI&tal Statistics APPUCATION FOR BURIAL - TRANSIT PERMIT ~~ /6 ~!J- LIt A. 1. Name of Deceased (Type or Print) First Gladys Mlcldle Maxine Last Grove DATE OF DEATH Month Day 02/24/91 Year 2. Place of Death County Indian River 3. Name of Medical Certifier Michael Zia.er M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Hoaes 5. Check a 0 Appro- priate Box City, Town or Location Medical Examiner Name of (If neither, give street address) Hosp. or Inst. 5740 59th Drive Address Phone Number 2300 5th Avenue Vero Beach Florida 32960 407 567-7111 Fla. Lic. No.1 Reg. No. Phone Number (Area Code) Vero Beach X Physician Address 916 17th Street P.A. Vero Beach Fl 32960 130 407 562-2325 The medical certification has been completed and signed. A completed certificate of death accompanies this application. b iii Maur991l was contacted on 02/2S/SH 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 M i chllp.l 1. i MMAr, M. n. 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 Sebastian Final Disposition: 7. Funeral Director/ Direct Dispo Indian River F.E. No.lReg. No. Removal from state Donation Date Signed B. BURIAL - TRANSIT PERMIT Permit No. 0130-91-0101 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 f~O"the death ~ertif~ica requested. -), Registrar or ~. Date ~ ~ I J Date Cert~L . Subregistrar Signature Issued:~!. Due: ~ C. AUTHORI~TlON for CREMATION, DISSECTION or BURIAL-AT-SEA l 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: o BURIAL o CREMATION o STORAGE o OTHER (Specify) 4 ,. ?~Q7: Place of Disposition Date of Disposition 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. HAS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Slock Number: 5740-000-0326-2) :1,