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Home My WebLink About4-41-19 ~ ' Paid by CEMETERY Receipt No. . ..~ ~!. .. . . . . . . Dated. . !\1!.~~.~~. .? 1. . ~.~ ~~. . . . .. ~~ ~ ~ k 1 r i 18 , 19 , ~R List Price $.. .~P.Q...9.Q...... Maximum No. Burial Spaces ................. Uni t 4 Net Paid $ .. .~P.Q...9.q...... Monument permitted.......... ............. Ma t tie L. Snead 1290 and/or Isabel Johns 8135 Haven View Dr. (Data above this line for City Record only) Sebastian, Florida 32958 .--""- *-""" ~ .-. _ .-. ---.- --- mity of .&rbusthttt OIrmrtrry irtb '1290 NO. ,,", THIS INDENTURE MADE TIaIJ .....},~ h , , . , dRY of ... ..A1,1,g:4~~.. . . ... ... . . ............... ... A. D., 19.9.9... between the City of Sehustlan, a municipal corporation existing under the laws of the Statr. of Florida, os Grantor and Mattie L. Snead and/or Isabel Johns . , , . , , . . . .. .. . , . .. .. .. .. 8 i' )'5" Ha v'e ii' . V i'ew' . Dr' ~ .. .. .. .. .. . .. . . .. .. . .. .. .. .. . .. . ...,.................. ..R~.1?~.~.~~.~.Ib.. .f+,qr;;i,<;l.~. .~~.9.~~.....:....... .......... of tile County of .. .l,I:14;i, ~.I).. R,;i..y.e.r;. .. .. .. .. .. .. . .. .... an I State of ....... F.l.ox;i, da.. .. . .. .. . .. . .. . .. . . .. .. .. .. .. .. . .. . .. Granlee, WITNESSETH I T1101t the Grantor for and in consideration of the sum of $ ~.QR: .QP. . . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell. release, co'nvey and confirm unto the Grantee . ~.~~J ~ heirs, legal representatives and assigns the following propert! ;t~1e~ ~n Sebastian, Indian River County, Florida, to-wit: All of Lot(s) .19. f.2 Q Block, . . A!... ,UNIT .....~....... ,of Sebastian municipal cemetery as per Plat Number I 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 lIave and to Hold the same forever; provided that said property shall be used solely and exclusively for the Interment ~f 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 fallure of the owner of any property situated within said cemetery to ob- serve and comply with stich rules, regulations, re~olutions and ordinance~ 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 ~hall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this ln~trument 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 S~~nAB'rIAN, FLORIDA / -if .'. ) r r-./ Attest! -:.r. (l:l,lt:~t~~')~ll~' ~~;~f.. htf~~P f~ .~,:....-:,.. D /~ r---c- ~__~ _ '1 k:'V.L.,.. ---M~7' .-..............,.... RIgnr'd, Senlell IIml Delivered ._ In ~I.~~ Pte~c",:e ;~"-( /.::j; <)fF{d~~,6d?..................... . /.~" ." ,'.:." c 'JJ1~ . (A~.t~)~{.f(,~' (7\". 'i<' 1-.0::.,', ~:?~(:\-,.-;---...... STATE OI~ FJ.OnmA (OIil" ~rnl) Name Unit Block Lot IS I lJ- . ~. 1""" 0 If rl S . 1 ~/ I /1 Date of Mark-out '9 / I s-/1 T Date of Buri:1 4/ / fo,/9( Time . ~ ~ D D p. N1 /" ' Autho'riz~~_~ " l,: 5. ~- State of Florida, Depa.t of Health and Rehabilitative Services, Vit.atistics APPLlC N FOR BURIAL - TRANSIT PERMIT t./f 161/ IIi A. 1. Name of Deceased (Type or Print) First Bi 11 Middle Garner Last Johns DATE OF DEATH Month Day Year 04/13/97 2. Place of Death County Orange 3. Name of Medical Certifier City, Town or Location Medical Examiner Name of (If neither, give street address) Hosp. or Inst. Orlando Re ional Medical C t r Address Phone Number Or 1 ando Craig Deligdish, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes 5. Check a 0 Appro- priate Box X Physician Address 1623 North Central Avenue P.A. Sebastian Fl 32958 1228 407 56 - The medical certification has been completed and signed. A completed certificate of death accompanies this application. b :f] .JlIl ie was contacted on 04/14/97 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 Craig Del igdish, 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 Cemetery Final Disposition: 7. Funeral Director / Direct Disposer Removal from state B. BURIAL - TRANSIT PERMIT Permit No. 1228-97-0179 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 filing the death certificate requested. Fl~i...l.u or Subregistrar Signature Date Issued: ~//.31t!J7 Date Certifica~ I' Due: </. ,J ? 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: llfBURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition Date of Disposition ..;oL /_- Z~ ,{~#r o/...~1' 1(; I 19'i7 , Signature of Sexton ) or Person-in-Charge) ';LJ~..l t"'.k-.L 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) (Slack Number: 5740-000-0326-2) J.