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Home My WebLink About4-40-40 /ru:; by CEMETERY Receipt No. . . . . 9.~;. '. list Price S.. ~.2 f>.9R ...QQ... NetPaidS .).~~9.q:.9R... Lo,ts, 21, ... Dated... JJ~?l9.t........;...... ' '}Ck440 tJ~L1 t Maximum No. Burial Spaces. . .. . . .. . . . . .'. . . . 22; 39, 40 NO. Melody S. Vick interred Monument permitted. . . . . .. . . . . . . . . . . . . . . . . 1/26/91 Lot 40 Do~al~i~hO~iCk and/or Dianne (Data aboye tbla Une lor City Reeord ODlY)130 . Valkaria Rd. Palm Bay , Fl. 32 1~tJ8 C!titv of l'fbastiau <1!rmrtrry II rrb NO. 1,.'IR THIS INDENTURE MADB 'I1aII ...... .~.5 .th. .. .. ... day 01 .... .J.EJ.Jl\1.t;lXY..... '" .. ................... A. D.. 19.9.t., between the City 01 Sebastian, a municipal corporation exlstln. undcr the laws 01 the State 01 Florida, .a Grantor and .............................. ...J;>.Q1m~c;l..~.... .Y.tG~. :~n41.9.r;. .P~.~.m1~. .<;:.~. .~~.~.~~p.............. ...'.................. ...................... ....... ...J~.~~~~.~~~~~.t~~~.4~. ).~.~P9................. .,................... ............... ........ 01 the County 01 ....... ..B.:r.ey.ar.d........................ anJ State 01 ..... ..F.l.ox:ida......................... ~.......... u Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of S .~. ~ .~9.Q ...9~............ to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant. bargaiit, seD, release, convey and confmn unto the Grantee . ~ h ~:i: f. heirs, legal representatives and assigns the following proP1 t~; in Sebastian, Indian River County, Florida, to-wit: AU of Lot(s) . .9.:. .l.\Block, .. ;.Q... ,UNIT ...~......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the pubUc 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 shan be used solely and exclusively for the interment of the human dead and shall 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, restrictions and requirements contained in this instrument shall be coyenants 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 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. ~j j ,VL LJrI~ CITY OF SEBASTIAN, FLORIDA "'~.~~..... ~~ ~ Name IV> f- .L 0 n ! Unit "1 Block 10 10 Lot Date of Mark-out Date of Burial 5. I/'),~- / 91 II"'J/J 1'1 I N~me of Funeral Home . .13i!. () .\.0() ,IV) , .. jJ 'I .., :: \ .. fl.,!......... ..~ Au1hO"Z~9'(''V~~y , V I C /(. ~7 Time ~ 1. (.>0 r' /111 . Jt/1 1') X M) /I.. it . .. ;-",-.;, J. Melody Middle Si.nroons Last Vick j.. ~d ;g ~tJ !/1 DATE Month Day Year OF DEATH January 24, 1991 I~~ State of Florlda,.rtment of Health and Rehabilitative servi.~ital Statistics A CATION FOR BURIAL - TRANSIT PER A. 1. Name of Deceased (Type or Print) First Palm Bay Name of (If neither, give street address) Hosp. or Inst. 130 Valkaria Road Address 407-725-4500 Phone Number Sheridan Road, Melbourne, F1. 32901 Fla. Uc. No.lReg. No. Phone Number (Area Code) 2. Place of Death County Brevard 3. Name of Medical Certifier Robert C. Seelman, MD Physician 4. Name of Funeral Home/ ~'lfr E. Ba1metto 7\~en:ue Direct Disposer n Brownlie-Maxwell Funeral Home Melbourne, l~ 32901 0000049 407-723-2345 5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box City. Town or Location Medical Examiner 200 E. b gg Dr. Robert C. See;J.man. s Office was contacted on 1/25/91 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 he 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 Indian River F.E. No./Reg. No. 596 Removal from state Donation Date Signed Jan. 25 1991 6. Place of ~stian Final Disposition: 7. Funeral Director/ Direct Disposer B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. gg 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 certific r st. Registrar or Subregistrar Signature Permit No. 491C58 Date Issued: 1/25/91 Date Certificate Due: C. AUTHORIZATION for CREMATION, DISSECTION or aU RIAL -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: Kl BURIAL o CREMATION Signature of Sexton ) or Person-in-Charge ) o STORAGE o OTHER (Specify) /it; 9. ~7. Place of Disposition Date of Disposition Sebastian Cemetery Sebastian, Florida 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) (Slock Number: 5740-000-0326-2) 1.