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Home My WebLink About4-39-22 Paid by CEMETERY Receipt No..... ~.f:}Q.. List Price $ ..:t., .Q9.Q .'. OQ. .. Net Paid S .. ~ I.Q9.Q... 9.Q .. . ,Datt Lots 21,22 ... 7.1.~ !.~~. ..... ... .. ..... ~~~ 'l{ 4 3 Q NO. - Maxbnum No. Burial Spaces. . . . . . . . . . . . . . . . . "1334 Monument permitted. . . . . . . . . . . . . . . . . . . . . . . Lucy M. Pryor interred 7/5/91 Lot 22 (D.ta .bove this line for City Record only) Helen Pryor P.O. Box 1 Wabasso, Fl. 32970 otitv of &tbastian C1!rmrtrry Ir,ll ;1334 NO. THIS INDENTURE MADE TIaJa ....5. .to.... ....... ... d.y of .......... Jv.ly.... ........................ A. D.. 19.9J... between the City of Sebutl.... . municipal corporation alstin. under the I.ws of the State of Florida, .1 Grantor .nd . . . . .... .. .... ................................. >>~J..~.I).. r~.Y.Q;r:........:................. ............. ............................. P.O. Box 1 .... ......................................... . Wal>.E;l.~~~,.. f.;I.o.r.:L~a. .~.Z9. 7.0.... ............................................ of the County of .).t:l.4;l;~~..~;i;y~.~...................... .n:! State of ....~~~.~.~4~....................................... u Gr.ntee, WITNESSETH. That the Grantor for and In consideration of the sum of $ ..~ ,.QR9.'. 9.Q. . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, sell, release, convey and confirm unto the Grantee .. h~.:r; .. heirs, legal representatives and assigns the following property situated in Sebastian,lndlan River County, Florida, to-wit: All of Lot(s) ., J.. ,.%4 Block, . . .3.9. .. ,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 Circult Court of St. Lucie County of Florida; said land now lying and being In Indian River County, Florida. To Have and to Hoid the same forever; provided that said property shall 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. restri~ons and requirements contamed 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 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 first above written. Att",;~~..t)ffI.~ -- '-f'''''' Clt~ Clerk CITY OF SEBASTIAN, :FLORIDA 8, . /drz~........ bU- ';/ (QIitv -'tal) STATE OF FLORIDA COllN'fY OF INDIAN RIVER :1> I i 'Name L .t-\ C ~I ......... ') K" . r'R;i9.k 'Iill' \ '-\ ,Uoi~ ,;~ t 'alock ~'1 ,.4'!"'i'::<" Cot ';}.''d., . bate of Mark-out -lj;tj <1\ Date of Burial "'\.' .~ tl ql tl.,;;; _.' , ,,'.. Yr~v\n/I(~. . ~mFun.r.~A AUthorized b(7' '. .7 Time ;"'/',/).() I i' Vi " /0, f"" , (d.lt.....'.... i ~. ~~ \. " ,- ..,. ~ , '. ' , ',. . , ,--.'~ , i." . . 'r ~ ,'. .',i',::,,'I:'~'. ,/;,~;~~. ~~;_2 . _ .:'. Lots 21,22 .... by CEMETERY Roooipt No.. u. ~.~iL.. ". .n.......... u.~ m......... u..... ~~~~\ 39 LUt..... $.. J. ..QO.Q...O.Q... -N.."-................. U'u. Not.... $ . u~ ..O~Q... 9.0... ...n...... _..... u... u... u...... Lucy M. Pryor interred 7/5/91 Lot 22 (Data above thb lfne for City Record only) NO. "1334 Helen Pryor P.O. Box 1 Wabasso, Fl. 32970 "-----,-.- ....."'-........-.- -~'" "--,.. , - State of florida, Depart. of Health and Rehabilitative Services, Vi.tistics APPLICATION FOR BURIAL - mANSIT PERMIT t fJ.!1I-- ~.#J,i 13 3 .9' tI '-I 2. Place of Death County Indian River 3. Name of Medical Certifier Williu Panakos, M.D. Physician 4. Name of Funeral Home/ Address Direct Disposer 916 17th Street Strunk Funeral Hoaes, P.A. Vero Beach, Fl 32960 130 407 562-2325 5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box A. 1. Name of Deceased (Type or Print) First Lucy " Middle DATE OF DEATH Month Day 07/01/91 Year M. Last Pryor City, Town or Location Name of (If neither, give street address) Hosp. or Inst. Indian River MellOrial Hos ital Address Phone Number Vero Beach Medical Examiner 777 37th Street Vero Beach, Florida 32960 407567-4621 Fla. Lie. No.lReg. No. Phone Number (Area Code) b [J Juie was contacted on 07/01/91 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 Willia. Pan_os. 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 Ceaetery Final Disposition: 7. Funeral Director / Direct Dispo B. Removal from state Donation Date Signed Indian River F.E. No.1 Reg. No. BURIAL - TRANSIT PERMIT Permit No. 0130-91-0308 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. "esietl'6f or- Subregistrar Signature c. Signature or Medical Examiner, Date / / Issued: 7 1 91 ~~~ Certificate 7/6/91 AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA , 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. Methods of Disposition: ~ BURIAL o CREMATION Signature of Sexton ) or Person-in-Charge ) CEMETERY OR CREMATORY o STORAGE o OTHER (Specify) Place of Disposition Date. of Disposition S~bast~jn Cem~ery Julv 3.1991 r .1. (l t...... ...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) f~t""k NllmhAr' 5740.000-03:16-:1\ (\,0-.