The URL can be used to link to this page

Home My WebLink About4-42-20COMMONWEALTH OF VIRGINIA DIVISION OF VITAL RECORDS DEPARTMENT OF HEALTH RICHMOND, VIRGINIA OUT-OF-STATE TRANSIT PERMIT AME �— T AGE EASED t ``-1a-',•\.� F ei °r o_" I _N", VIRGINIA DATE OF f Month D.y Yu l 'OR DEATH 1 r�TION TO WHICH 1C"y°f�°°"'YI Ftransport S TO BE SENTficate of Death having been filed as required by the laws of this State, or conditions Outlined in ons having been complied with, permission is herebgiven1too:uneral Director/Funeral Service Licensee Address s ort said deceased as stated above. DATE ) �aa ISSUED I REGISTRATIO SIGNATURE OF `N DISTRICT NO. REGISTRAR » CITY OF SEBASTIAN 10386 ADMINISTRATIVE SERVICES RECEIPT Name%SK(lnl((. / d� ❑Cash Date `/ �i b Check # `SI6 ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 0011501 3432-&g 01C. ( ° VAJ tr 4- 61 K 4;L LOT AP Total Pail i rt'als Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant ~ Lots 19,20 . . 61v 3/10/90 Block 42 PlUd by CEMETERY ReceIpt No. .... .. ...... .. . . Dated. . . ... ..... . . ... . ... ... .. ... .. Uni t 4 NO. List Price $ .~.Q9.: R9........ Net Paid $ . ~g9. : ~9.. .. . . .. Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Mrs. Virginia Ir~263 607 Wimbrow Dr. Sebastian,Fl.32958 Monument permitted. . . . . . . . . . .. . . . . . . . . . . . . John S. Irby interred 3/13/90 Lot 20 (Data above thll line lor C1t, Record 001,) OIitu of &rbustiun (ttrmrtrry IIrrb NO. 1263 THIS INDENTURE MADE TIaIa . J.(?~h............. day 01 .... .:M~.:t;"~h............................... A. D.. 18.9.9... betwern the City 01 S~baltlan, a municipal corporation existing under the Jaws 01 th~ State 01 Florida, al Grantor and .................. .... ..~~.~.~..Y~.;g;i;~~.~.. ;J;~1;>.y.............. ... ...... ........ ............. ........ ... ........................ 607 Wimbrow Dr. .............. .... ... ...Sebastian.,.El... 329.58.. ......... .:... ....... ......... ..................... ........... ............ 01 the County 01 ......~!?-~~.<;l!?-..~~.'!~~.................. an.l State 01 ....lf~~~.~4~....................................... u Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ ~.Q9.: R9. ., .. ... .. . ..... . 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 .,. h Ii!.~. heirs, legal representatives and assigns the fonowing property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(sjI..9~', Block, . . {+.Z. .. , 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 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 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 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 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 rust above written. Attes~~Jh:. .{)lIatt41~...... ~,. .C..-.... . City Clerk CITY OF SEBASTIAN, FLORIDA By ~/~I{..t:j-~....... Maror Signed, Sealed and Delivered In tb en~e.of. /"'~/ (. U '1'c[~ ........'.~. (QIitll JjeaJ) STA'rE OF Fl.onIDA 0 0 I"'" ,. z !. !. S- c:. Il) .. 3 CD CD '::T 9- 0 CD 9- ... 9- N al ~ CD -n c: III 0- c: ... ... !l ::3 !: 'f CD 0 ... c: !!. .. :t 0 3 , CD V 0J ~ ....0 \) ~ \) -I 3" CD '" - C) c) ~ ..... ~. ~ m;'<j;~',,"',:; t" \tj. " 0" ~ ~. ^ \.. /~'!i\?'Il"'.,:, ....~."..-.,.,.".,' -5 '$ . ,- Z ."Il 3 CD :\}. .. <'>;'~-!:Y']:\"r~.~;\IIIRtfi:;;'.2;:!~:';T'J:;.~ 'i - . ,,~>..,__,.,_____~~;>> 2:2b (j ~;2 1/1 .. State of Florida, De~ent of Health and Rehabnitatlve Services,. Statistics APPL:ICATlON FOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (Type or Print) First JOHN Middle Last DATE OF DEATH Month Day Year IRBY 3/9/90 2. Place of Death County INDIAN RIVER 3. Name of Medical Certifier City, Town or Location Medical Examiner Name of (If neither, give street address) Hasp. or I~t. HUMANA HOSPITAL-$EBASTIAN Address407_589_0879 Phone Number SEBASTIAN, FL 32958 Fla. Lie. No.lReg. No. Phone Number (Area Code) ROSELAND 4. Name of Funeral Homel Direct Disposer STRUNK FUNERAL HOME, 5. Check a 0 Appro- priate Box b S Physician 13875 US # 1 Address 1623 N. CENTRAL AVE. SEBASTIAN SEBASTIAN, FLORIDA 32958 1228 407-589-1000 The medical certification has been completed and signed. A completed certificate of death accompanies this application. LYDIE was contacted on 3/9/90 within 72 hours after death. Helshe verified that this death was from natural causes, that there was no accident nor other external cause of death, and that DR. MERCHANT will complete and sign the medical certification of cause of death. c 0 medical certification. was contacted on . He/she verified that , Medical Examiner, will complete and sign the 6. Place of SEBASTIAN Final Disposition: CEMETERY 7. Funeral Director I '{)jrect Dle!,e8Qf IND AN RIVER SEBASTIAN FL F.E. No.1 Reg. No. 1 72 Removal from state Donation Date Signed B. Permission is hereby granted to dispose of this body. o A five day exte~ion 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 flli the death certificate req ted. Y' Registrar or ( Subregistrar Signature Permit No. 1228-90-136 Date / / Issued: 3 9 90 Date Certificate Due: 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: fi BURIAL o CREMATION Signature of Sexton ) or Person-in-Charge ) o STORAGE o OTHER (Specify) ;:y, /. .tf:..~ 7' Place of Disposition Date of Disposition SEBASTIAN CEMETERY March 13, 1990 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) 1.