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Home My WebLink About4-41-16 - . 7/19/90 PaId by CEMETERY Receipt No. . . . . .. . . . . . . . . . . Dated. . . . . . .. . . . . . . . . . . .. . . . .. . .. . . Lots 15, 16 Block 41 Unit 4 NO. Ust Price $. .4QQ... Q.Q....... Net Paid $ . .4~9... 9.Q....... Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Monument permitted...................... William L. Kutzler 1286 and/or Lillian B. Kutzler 658 S.W. Ervin Street (Data a~ve this line for City Reeord oDly) Sebastian, FL 32958 mitl! nf l'rbnstinu <1Jtmtttry Ittb '1286 NO. THIS INDENTURE MADE TIalI 19th day of ...-.!~~X.................................... A. 0., 19..~~., between the City of Sebastian, a municipal' eorporatlon exlsttng under the laws of the State of Florida, a. Grantor and William L. Kutzler and/or Lillian B. Kutzler ..................... '6'58 "s'~\r:"E'ivlii' .S.t:re.e't..... ........... ..... ............................. ....... ......... ............ . Sebastian fL 32958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . .. ............................................ ............................................ Indian River Florida of the County of ............................................. an-.l State of ....................................................... IS Grantee, WITNESSETH. 400.00 That the Grantor for and in consideration of the sum of $ .......................... 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 t.b.~ ix. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) 15.,.1.6, Block, . .41. ., ,UNIT ....!-l....... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 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 fust 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 SElJABTIAN, FWRIDA Attest I .lr:~t.~-I~:I)?7...{) (II a.t&!!~... (I City Clerk B, kr~. . ,.. Ma10r .. ..f./L--r....... (QIitu 'taJ) STATE. OF FLORIDA COl'NTY OF INDIAN RIVER 19th July 90 I HEUEDY CERTIFY, That on this.................. ..... .day of ..................................................., 19...., b~fllre me personally appeared .~.~..~f.J;Rny.~:r;~................................... and ~~~.~.t;'Y.T~ ..Q.'.ft?.+JR~?.~... ..... respt~etively Mayor and City Clerk of the City of Sebastlnn, H munlclpnl eorporatlon under the laws of the State of Florida to me known to be the Indi\'idulIls IInd officers described In and who exeeuh~d the fOfl'going CORveY'lllce to / William L. Kutzler and/or Lillian B. Kutzler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., and severall)' aeknowle(lged the execution thereof to be their free aet nnd (Iced as slIch officers thereunto duly authorized; and that the Offielal sell I of said corporatloiJ Is duly affixed thereto, Rnd the said cOllveyanee is the /let lInd deed of said corporaUon. WITNESS my sIgnature and official leal at Sebastian, in the County of IndIan River ond State of Florida, the day and 1ear last aforesaid. .~J'/" " (. . .~?td~~.Z~~.................. Not ry PublJe, State ;( F~:;;j)~i:;;. M eOIUlalsslon explrea, t1.tI~nry r-tl!:llic. ~ta'8 of Fltrldn A:1i ((lmr1l1::,;QI~ f::j:liras Jm1e 1 D, 1994 Bond~d rh,u Troy Fain. Insurance Inc. ~-------- Name w! ^ A.. ,:} /11'\ L. l!wV T'L L i&e. . U.nit 1 1.j I Block 10 . Lot Date of Burial I I ~3/9J l/~/ 'iJ # Ji Time !.. ~.: {)() r::1, (y') ~ Date of Mark-out Name of Funeral Hom~,,/>~.. ~(N L.. /<'/.. .... ..... I' ../' . i Authorized by .t',. a;i"-"'~-c:/t.. ,/ ,.' ," .... .... f; ",';/'! C/" ',/1 ~I .._u'.'_ _ _'_' .'_'~'____' _.__._.,.~._._._.,_u._-_ State of Florida, .nt of Health and Rehabilitative serviC&1 Statistics APPLICATION FOR BURIAL - mANSIT PERMIT J.. 15,..1t, 13 ~/ 111 A. 1. Name of Deceased (Type or Print) First "iUia. Middle Last Kutzler DATE OF DEATH Month Day 01/02/91 Year L. 2. Place of Death County Indian River 3. Name of Medical Certifier City, Town or location =r Medical Examiner Name of (If neither, give street address) Hosp. or Inst. 658 S." Erv in Street Address Sebastian Phone Number Kenneth Graff. M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral 5. Check Appro- priate Box XI Physician Address 1623 North Central Avenue Do_es. P.A. Sebastian. FI 32958 1228 (407)562-2325 a 0 The medical certification has been completed and signed. A completed eertificate of death accompanies this application. Lh~~ 200 E. Sheridan Road Melbourne. Florida 32901 (407)725-4500 Fla. lie. No./Reg. No. Phone Number (Area Code) b III was contacted on Ol/03/Ql 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 Kenneth Graff, M.D. 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/ DiAil8t tlisl5clMlr Indian River F.E. No./~. Removal from state Donation Date Signed B.- BURIAL - TRANSIT PERMIT Permit No. 1228-91-0001 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 for fili the death certificat quested. Registrar or Subregistrar Signature Date Issued: /-.3_~/ Date Certificate Due: C. AUTHORIZ~TlON 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. 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. CEMETERY OR CREMATORY . ? Place of D;sposilion .,.l'~-J &~~ o STORAGE Date of Disposition ~.,u ..s;. (991 o OTHER (Specify) /1"7 ~~7 Methods of Disposition: .81 BURIAL o CREMATION Signature of Sexton ) or Person-in-Charge ) HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2) "J.