HomeMy WebLinkAbout4-40-25
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Paid by CEMETERY Receipt No.. ..G9 7.......... ..dd.. ~ /.12-1 92............ ..... Lo t s ~. & 25
LitP' $ 1 "'00 .o(). M' N B ialS Block 40
s oce . '1 u . .. .. 8X1D1um o. ur paces................ Uni t 4
Net Paid $ .l.~ 200..00..... Monument permitted.......... ..... .........
.ois M. Blanchard interred 2/12/92 Lot 25
(Data above th.. line for CIty Record only)
NO.
1. (~,19
C!titv of &thustiun
Q!r~rtrry
m rrx.
'\1349
NO.
THIS INDENTURE ..ADE TIaII ....lZ.th........... day of ...F.e.b.ruar.y............................ A. D.. 19.9.?..,
between the City of Sebastian, a municipal corporation existing undcr the laws of the State of Florida, 08 Grantor and
Anthony Blanchard
........... .... ........ ........................ '705"L'antania ..Drive.... ........................ .... .......................
Barefoot Bay, Florida 32976
.... .......................................... ............................................ ...... .......... ............................
of the County of ..... .+p.4~~.~.. R~.Y.~~.................. an'J State of .. ..~.~q~J.4?'!-..................... ..................
u Grantee, WITNESSETH I
That the Grantor for and in consideration of the sum of $ . .1.,.2.00., QQ. ... . . ...... to it in hand paid, the receipt whereof is herewith ae-
knowledged, does by this instrument grant, bargaiit, sell, release, convey and confirm unto the Grantee.. hts.. heirs, legal representatives and assigns
the following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) .24 i-:lPlock, . . 40. .. , UNIT ... 4 . . . . . . .. ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, It 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 shaI1 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 u.m the same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the first part has alused this instrument to be executed irI 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 flIst above written.
CITY OF SEBASTIAN, FLORIDA
AtI"c;;!~,.Odatk~...
_.- - - . f . City Clerk
B1~~~":"'"
Mrr
Signed, Sealed and Dcllvered
In the Presence of.
(OIitU cSl!nl)
STA'rE OF FLORIDA
Name
to '/5'
r"J.
/:},,( ;:1;/ C H /1 jC' I).
Unit
J"~i
Block
"
"; '-~
Lot.
o/."J-
.
,-
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Date of Mark-out
:2//0/(1;;"
; I
Date of Burial
'~'I/~ Jq:J..
, , " ."
TiiTle I 0'0"0 A, IV1 '
Name of Fun.~,!,.~)j r~;{ K.~
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Autho",ed'W., jtJtJ;i!r{:' ,.:'#- ,1#.
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State of Florida, DepartmerAHealth and Rehabilitative Services, Vital SWICS
APPLlCATlOYfOR BURIAL - mANSIT PERMIT
J cJf, :25-
/8 1'0
LI 'i
A.
1. Name of
Deceased
(Type or Print)
First
Lois
Middle
Last
Blanchard
DATE
OF
DEATH
Month Day Year
02/08/92
Medical Examiner
Name of (If neither, give street address)
Hosp.or
Inst. Humana Hospital-Sebastian
Address Phone Number
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
City, Town or Location
Roseland
Ralph Geiger,M.D. hysician
4. Name of Funeral Home/ Address
Direct Disposer 1623 North Central Avenu
Strunk Funeral Homes P.A. Sebastian Fl 32968 1228 407 662-2326
5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box
13840 U.S.11
Sebastian, Florida 32968 407 388-0770
Fla. Lie. No.1 Reg. No. Phone Number (Area Code)
b Ox
f!;mly was contacted on 02/l0/92 within 72
hours after death. He/she verified ,that this death was from natural causes, that there was no accident
. nor other ext~~n~1 cause of death, and that Ralnh Geil!er.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.
Indian River
FE No.1 Reg. No.
Removal
from state Donation
Date Signed
6. Place of Sebastian
Final Disposition:
7. Funeral Director/
Di~('t Dispose!:
B.
BURIAL - TRANSIT PERMIT
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 filin e death certificate reques
Registrar or
Subregistrar Signature
Permit No.
1228-92-0071
Date CertifiC~ /."'" Y"')7
Due: r - / <>'- /t?
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
Methods of Disposition:
IiJ BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
I!.y, ?, ~~9<-'
Place of DispositiorSp-ha!":tai n Cp-mp-~p-ry
Date of Disposition Fp- hll r;:l ry 1 '- 1 q q '-
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.
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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