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Home My WebLink About4-41-04 < by CEMETERY R...;pt N~.. .~,,'!........ . D.... .... 'Y~.~ !.?9................ Ust Price S .4QO., 0.0........ Net Paid S .~~9.d~9..... .., Lots B1k. M. N B . IS Unit axunum o. una paces. . . . . . . . . . . . . . . . . 3,4 41 4 NO. (Data above this line for CIty Reeord only) Morris and/or Pauline 13366 Roseland Rd. P.O.Box 524 Roseland, Fl. 32957 1274 Capp Monument permitted. . . . . . . . . . . . . . . . . . . . . . . -,_.......~~...;...:;..~_. _. . -,-". -...-.-.-..-....... Cltitu nf &rbnstinn <1!rUtetrry I reb NO. 1274 THIS INDENTURE MADE TIlII 14th day of ...~~r..................................... A. D.. 19.~9... betwern the City of St'bllstlan, a municipal corporation existing under the laws of the State of Florida, 8S Grantor and Morris Capps and/or Pauline Capps . . , ' . . . . . . . . . . . . . .. . . . .. .. .. . 1'336'6' . Ro seTaria:' 'Rd'" ~.. 'P'; q:" 'Box' '5 2Zi . . .. . . . .. . . . . . . .. . . . .... ....... ........... .., ... Roseland Florida 32957 . , . . ........................................, ............................................ .,...,...................................... of the County of .. ~.1!.q..~~~. .~;i; Y~.J;'...................... an') State of ..f.l~H:::j..<;l.~......................................... u Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of S ..~ ~9... 9.Q . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, sell, release; convey and confmn unto the Grantee . ~h~J~ heirs, legal representatives and assigns the fonowing property situated in Sebastian, Indian River County, Florida, to-wit: An of Lot(s) . ~ ~~.. , Block, . . ~ ~. .. , 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. ,,I To Have and to Hold the same forever; provided that said property shan be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at aU 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 shan terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the rust 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 fust above written. CITY OF SEBASTIAN, FLORIDA Allal~." ../n.... (l~d~~ r "City ~k Br ~~.........:......... Sign~d, Sealed and Delivered In tile resence of I .....~4~.. ............... .' U ' /-_~Xat' (~~d~0~:.................................. (GIitu Jieal) r ---~--- -- -~ -------- ~ -~ Q) E j:: r~ \~..! '-"'- 1.:2 -~ ~ 'lo- ~ ... Q) '( ~- E> '" 0 :J: - ii :;) 0 ... ~ 'ii Q) c::: ... ";: :;) as :;) u.; ::E al '0 Q) ~ '0 '0 Q) E - (J Q) Q) E as -E:\- 0 '0 tii tii as ~- 'Z :;.. ::> ii'i ..J C C Z - '\\-- '-~r_":';-"::y~ /-.1'/ S1/ fli State of Florida, Dement of Health and Rehabilitative serVIC.1 Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (Type or Print) First PAULINE Middle Last CAPPS DATE OF DEATH Month Day 6/24/90 Year ROSELAND Name of Hosp. or Inst. (If neither, give street address) 2. Place of Death County INDIAN RIVER 3. Name of Medical Certifier NOOR MERCHANT M.D. 4. Name of Funeral Home/ Direct Disposer STRUNK FUNERAL HOMES 5. Check a 0 Appro- priate Box b ~ City, Town or Location HUMANA HOSPITAL-SEBASTIAN Medical Examiner Address Phone Number 7744 BAY STREET CENTER Physician SEBASTIAN, FLORIDA 32958 407-589-0879 Address Fla.lic. No.lReg. No. Phone Number (Area Code) 1623 N. CENTRAL AVE. SEBASTIAN SEBASTIAN FLORIDA 2 8 #1228 407-589-1000 The medical certification has been completed and signed. A completed certificate of death accompanies this application. LYDEE was contacted on 6/25/90 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 DR. MERCHANT will complete and sign the medical certification of cause of death. was contacted on . He/she verified that ,Medical Examiner, will complete and sign the c 0 medical certification. 6. Place of SEBASTIAN Final Disposition: CEMETERY 7. Funeral Director / Girect Di5150~er SEBASTIAN, FLA y: INDIAN RIVER F.E. No.1 Reg. No. //1672 Removal from state Donation Date Signed 6/25/90 B. BURIAL - TRANSIT PERMIT Permit NJ.228-90-345 Permission is hereby granted to dispose of this body. o A five day extension of time for filing the death certifipate (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 e death certificate requeste . Registrar or Subregistrar Signature Date Issued: 6/25/90 Date Certificate Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA 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 Signature of Sexton ) or Person-in-Charge ) o STORAGE o OTHER (Specify) ;(0 <]. ;J~?,. Place of Disposition Date of Disposition SEBASTIAN CEMETERY JUNE 27, 1990 Methods of Disposition: 11!1 BURIAL o CREMATION 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) .J: