HomeMy WebLinkAbout4-40-38
~...s 37 &
Jck 40
Unit 4
38
-- 6sdi 1/29/91
Paid GYCEMETERY Receipt No........... (oJ'.', . Dated. .............................
List Price S.. . .&O.Q ...O.Q..... Maximum No. Burial Splices.,........... .... .
Net Paid S ... .~9.Q ... 9.Q . . . . . Monument permitted. . . .. . . . . . . . . . . . . . . . . . .
Lillian E. Blanchard and/or
Paul R. Blanchard; 100 Caladium Court
(Data aboye this line lor City Reeord only) Barefoot Bay, Fl. 32976
NO.
'1310
C!titD of l'rbastiau
<1!rmrtrry
mrrb
"1310
NO.
THIS INDENTURE MADE 'I1aII ... ..~.9.1:; h . .. .. .. '" day 01 ...... ~ ~.t:l.~~J::Y.. .. .. . .. .. .. .. .. .. . . .. .... A. D.. 19.. ~ ~..
between the City 01 Sebastian, a municipal corporation exlstln. under the laws 01 the State 01 Florida, 118 Grantor and
Lillian E. Blanchard and/or Paul R. Blanchard
. . . , . . . . . . .. . . . ... .. . . .. .... "'i 00 "C'aladi'um" Co'ur t . . . . . . ....... ... ... .. . .. . . .. . . .. . .. . . . . .. . . .. . . . . . . .... .. . ....... . .... ..
...,................. ..........:{J.~h~!.Q.q~ .:{J.~y". ..f..J,.RJ::i.Q~. .~.~.9lR........... ....................... ............... ......
01 the County 01 ...... .~.~~Y:~.~4.......................... an-J State 01 ...... .~~~~.~4~ ................. . ....... ...........
u Grantee, WITNESSETH.
That the Grantor for and in consideration of the sum of S .;.~ ~Q... 9.Q .. . .. . . . . .. .. . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargain, sell, release, convey and confum unto the Grantee.. t.11~.;!= heirs,legal representatives and assigns
the following property situated in Sebastian,lndian River County, Florida, to-wit:
All of Lot(s) ~. 7 ~ ~.8. Block, . .4 Q . .. ,UNIT ...4......... ,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, Fiorida.
To Have and to Hold the same forever; provided that said property shaU 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 fot the government and operation of said cemetery. The conditions, restrictions and requirements contained
in this instrument shall be covenants r~ing wilh the land. In the event of the faUure 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 fust above written.
(~~~",./ t In O' 'Ii- A JJ .. l. .
Attest! "a.t."~"",,, .......~~....
{J - City Clerk
CITY OF SEBASTIAN, FLORIDA
/~rr- ~~
B, .~.c:::.H..i.i~.7'............ .
Signed, Sealed and Delivered
~.~ the~.pr~sence ~'I
. ;;
, .. -<:J[' , . . ..
(t~.~
(QIUu ~eal)
ST ATE OF FLORIDA
""\1 '''-T'I'V 1"''0 T~TnT'" 1.:1' 4ft...."......
Nam!!l>o..~" L. -R '"f) I c. f",( hu r- J
Unit y
Block J../Q
Lot ~ fJ
v
Date of Mark-out
Date of Burial !..t J IV J ql
"
Name of Funeral Home
.:5/I{(/' V J.\ 'j
,) ,..
(/ 1" <'
Authorized by/;"'t. .\.14.< ......-TL.-. "'. .'11'... ~.."."((~-^ /..fi.
"/ .,,,," , . ,
(,../ ... ---..,\
----
Time
I j .. (.\0, r~.. /'..{ .
IB~]
State of Florida, Depart_ of Health and Rehabilitative Services, Vit.tistics
APPLlC~ FOR BURIAL - TRANSIT PERMIT
i- 3 7 fI.-(!!}
18 rjo
{j#
A.
1. Name of
Deceased
(Type or Print)
First
Paul
Middle
Last
Blanchard
DATE
OF
DEATH
Month Day
05/07/91
Year
R.
2. Place of Death
County
1 IHI i an Hi ver
City, Town or Location
3. Name of Medical
Certifier
George Mitchell,
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral
Medical Examiner
Name of (If neither, give street address)
Hasp. or
Inst. Humana Hosp i tal-Sebas t i an
Address
Phone Number
Roseland
M.D.
13855 US# 1
Sebastian, Florida 32958 .107 5..) :un
Fla. Lie. No.lReg. No. Phone Number (Area Code)
5. Check
Appro-
priate
Box
Physician
Address
1623 North Central Avenue
Homes, P.A. Sebastian, FI 32958 1228 407 562-
a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b ~
Lydee was contactM on 05/00/91 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 Geor~e Mitchell. 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/
piJeet Disl'ea8F
Indian River
FE No.1 Reg. No.
Removal
from state Donation
Date Signed
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228-91-0231
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 g the death certificate req sted.
-<R~l:l;"I, <on er
Subregistrar Signature
DateL::::' a V
Issued: to...I - C> ...
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
Methods of Disposition:
. BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition
Date of Disposition
5 A! 13 ~ -( r;.I1~
~//o./9J
Signature of Sexton )
or Person-in-Charge )
fi'~ 9'
I(AtJf.
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 retur~d within 10 days to the local HRS County Public Health Unit in the County where disposition occurred.
~w
HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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