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Home My WebLink About4-40-39 . ~ . ~S4 /' Paid by CEMETERY Receipt No..... v. .. _. 1 600.00 UstPrice S.. ..1........ ..... Net Paid S . J.t ~9.q: .9~... Lots.21, .. . Dated ... .\I.~?l~~................ )ck440 'u4dt Maximum No. Burial Spaces. _ . . . . . . . . . . . . . . . 22; 39, 40 NO. 1~U8 Monument permitted. . . . . . . . . . . . . . .. . . . . . . . 1/26/91 L 40 Donald.K. Vick and/or Dianne Melody S. Vick interred ot C B1shop (Data aboye thll Une lor CIty Reeord 001Y)130 . Valkaria Rd. Palm Bay, Fl. 32 C!titD of l'rbastiau <1!rmrtrry leeb NO. 1 1:, R THIS INDENTURE MADE 'I1aII ..... ..Z.5.th........ day 01 ... ..J.c:mv,aXy............................ A. D., 19.9.l.., between tile City 01 Sebutlan, a municipal corporation exist In. under the laws 01 the State 01 Florida, aa Grantor and ............................ .....:p.WH\~.<;1...~.... .YJ~~. .~n9:1.9.r;. .p.~.~.m1-~. .Y.~. .~~.~.~pp.............. ..................... ..................... ..... ...... J~.~~~~.ij~~~ltp~~.4t ).~.~Q9................. ............................................ of the County of .........B.r.ey.ar.d........................ an'J State 01 .......F.l.ox:ida.................................... u Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ .~. Lq 9.Q ... 9~ . . . . . . . . . . .. to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargaiit, sell, release, convey and confirm unto the Grantee . ~ h ~ J:;-. heirs, legal representatives and assigns the following proP:]. .'. .f't~~ in Sebastian, Indian River County, Florida, to-wit: ..' ~ 40' 4 4 AU of Lot(s) .. . .1.. ,Block,....Q... ,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. 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 shan 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, restr,ictions 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 iueb rules, regulations, resolutions and ,ordinances and the conditions of the deled 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 first above written. AI"."q>/~(JJ.:.t):t1~ - . . (j .. . City Clerk CITY OF SEBASTIAN, FLORIDA B'~H~"... (QIitu $eaJ) Name Unit Block Lot /) D // 'll/) 1(. (/1 '-t::. ()/ t;..T) -';/ y: I;; 1 1D 39'. Date of Mark-out Date of Burial ~ 7c.\ 7..//0/,- ) Time / Name of FuneraIH?'me L . i .. I Authorized by i . ~ ~ /Ir"<::'':''. ~...,,, .., .'.'. .,./ '. . tJAY!;S I ~ ... o o L11 L11 UJ OJ ... - .. o [J"J UJ - o n.J - L11 n.J - .. o [J"J r" ..c o o o - L11 n.J n.J OJ L11 ... CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Namejj;__~: ~~~~- ~ Date ~ /'$ pt4~ , . No. 001001 208001 001501322900 001501341920 001501 341910 001501341930 601010 343800 001501343805 ~~ nllla" Sales Tax GaIage Sales CoplesIBId Specs. LDCICode of Onllnances EIeclIon Qualifying Fees Cemetery Lois LolINlche . Block Cemetery Fees (.. ?/1JAI'4/eI ~ i::~ CJc1.C- 'I"'~IJ .f..~j 3316 o Ca.h ~5"'$'""3B Amount Paid . Unlt-:# JY 75:~,f) r '" TotalPaId /,J':110 Whit. - Dlpt. If Origin. Y lllow ... Finance . Pink. AppllcaDt I~ A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT /f-'1t)-JI 1. Name of First Middle Last Date Month Day Year Deceased of Donald Kenneth Vick Death July 8, 2005 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Palm Bay lnst. Life Care Center of Palm Bay 3. Name of Medical All C d M 0 Address 5305 Babcock St. NE Phone Number Certifier en on 0, . . o Medical Examiner ~ Physician Palm Bay I Florida 32905 676-9009 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No.lReg. No. Phone Number (Area Code) Establishment 1010 E. Palmetto Avenue Brownlie - Maxwell Funeral Home Melboume, Florida 32901 0000049 321/723-2345 5. Check a.. 0 Appropriate Box b. ~ Brevard Sebastian Cemetery c. 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Dr. Rossi was contacted on July 11, 2005 He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death, and that Dr. Condo will complete and sign the medical certification of cause of death within 72 hours. was contacted on He/she verified that , Medical Examiner, will complete and sign the 6. Funeral Director/ Direct Disposer F.E. No.lRea. No. 1948 Date Si!lned July 11,2005 D BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 406B004 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. No extension of time for filing the de Registrar or Subregistrar Signature Date Issued: July 11, 2005 Date Certificate Due: B. ~ C. AUTHORI TION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date , gave authorization by telephone to Medical Examiner, 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. Method of Disposition: CEMETERY OR CREMATORY Sebastian Cemetery Place of Disposition Sebastian, Florida D. ~ BURIAL D CREMATION Signature of Sexton or Person-in-Charge D STORAGE Date of Disposition D OTHER (Specify) } //J9- ~.49'- 7/tl/06' This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Director Disopser when there is no Sexton) and retumed within 10 days to the local County Health Department in the county where disposition occurred. DH 326, 8/97 (Obsoletes ell previous edRions) (Stock Number: 574O-OlXJ.0326..2) Distribution: Vvhite: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Lacel Registrer