HomeMy WebLinkAbout4-39-27
. . 698
~ by CEMETERY Receipt No. . . . . . . . . ..
List Price $.... .aOO...QO....
. 800.00
Net Paid $ ..................
. Dated...~/J~/.~~................ J ' 26 & 27
i.. ~k 39
Maximum No. Burial Spaces............. .... Uni t 4
NO.
Monument permitted. . . . . . . . . . . . . . . . . . . . . . .
1 :~ :5 0
C. Marion Fisher interred 2/13/92, Lot 26
(Data above this line for CUT Record oo1y)
O.titl1 nf l'rhustinn
Q!tmt!try
mttll
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. . MOo/' ,J
NO.
THIS INDENTURE MADB TIaIs ..13.th............. day of .. ..Februaz;y............................ A. D., 111..92..
between the City of Sebllltlan, a municipal corporation exl~tlng undcr the laws of the State of Florida, 88 Grantor and
Jean Fisher
.......,......,..,..,'....,. ... '.,. ....1.5'7..Pe.riwl'n'kt~. 'D':t:i:ve....' , ,...,.,.,....".....,..,.,..,..,.. .............. .......
Sebastian, Florida 32958
.............................................. ............................................ .0- ...... ...................................
of the County 0' .... ~~,4,:i,.fHJ. ..~;i. Y:~,:r;.................... an:! State 0' ..... .lrlQt:'.:i..da........ .............................
u Grantee, WITNESSETH I
That the. Grantor for and in consideration of the sum of $ .,. 800...00 . . . . . . . . . . . . . to it in band paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargalD, sell, release, convey and. confirm unto the Grantee . he l' . .. heirs, legal representatives and assigns
the foUowing property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) . ?~ ~~Block, . ~.~ . . .. ,UNIT .. ~. . . . . . . . .. ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; saki land now lying and being
in Indian River County, Florida. .
To Have and to Hold the same foreYer; 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 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 saki cemetery. The conditions, rest!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 saki 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.
CITY OF SEBASTIAN, FLORIDA
Al~.!./J?:.[)t.la,!k.~
. .!,,~ . City Clerk
By taE~.:;;~...:~....:.....
Tror
Slgn...d, Sealed llnd Delivered
In the .~resence of: ('\/ / / ~ _
:~.~............
(..~t{...:.'t&...................
STA'fE OF FI.ORIDA
.."..rr'ILT"'V' nD 'runT ~ v n'lV1Il'D
(QIitu JileaJ)
Name
C.-I P; rl ;..{
/'
AI
,c: . :~ II ::' ,;>
" j) . 1,- K....
Unit
Block '3 9'
'Lot ?-. t
Date of Mark-out
//2/1) /) O~
~ -'.
1,/3/;},OOD
I
Time
/1 J, ____ ,/')'
'ii,{ . /"./1 t.."" I ',/'
. I
.. l() fi-~)jL
-....
Date of Burial
.... . /'" ')1
Nam. e of Funeralt~ o.me~I)k:,?,tJ'ceJ ~ I. ~.E,...\i /1/1 i4 ;l
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State of Florida, Deparbnent of Health, Vital Statistics
APPUCA.FOR BURIAL - TRANSIT PERMIT
.
I-. Pl6 -02 7
t3 39'
111
DATE Month Day Year
OF
DEATH January 1, 2000
A.
1, Name of
Deceased
(Type or Print)
First
Jean
Middle
Kathryn
Hays
Last
Fisher
2. Place of Death
Coun%revard
City, Town or Location
Palm Bay
Name of (If neither, give street address)
~~f.p. or Bethesda Baptist Retirement Bane
3. Name of Medical
Certifier
Dr. Rizwi
4. Name of Funeral Home/
Direct Disposer 1010 E. Palmetto ave
Brownlie & Maxwell Funeral Halle lbourile, Fl.
5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box
Medical Examiner
Address
Phone Number
13885 US
Hwy 1
587 6844
Fla. Uc. No.1 Reg. No. Phone Number (Area Code)
0000049 321/723-2345
b ~
Dr. Rizwi's Ofice was contacted on 1/3/00 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.
was contacted on . He/she verified that
. Medical Examiner, will complete ;ind sign the
c 0
Indian River
Sebastian Cemetery
6. Place of
Final Disposition:
7. Funeral Director/
Direct Disposer
F.E. No.lReg. No.
1049
Removal
from. state Donation
Date Signed
1 3 00
B.
BURIAL - TRANSIT PERMIT
400F02
Permit No. XJDDIIIK
Permission is hereby granted to dispose of this body.
IJ 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 ~xtension of time for f~'li the deat~h ~rtifica requested.
RegIstrar or ./.4-.. Date 1/3/00
Sub' S' ~ Issued'.
registrar Ignature '
Date Certificate
Due:
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
Signature
or
Medical Examiner,
, 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.
CEMETERY OR CREMATORY
Signature of Sexton )
or Person-in-Charge )
o STORAGE
o OTHER (Specify)
;(~7' ,~t)jC)L
Place of Disposition
Date of Disposition
Sebastian, Fl
Sebastian Cemetery
/Iok
I ,
Methods of Disposition:
IX) BURIAL
o CREMATION
This permit must be endorsed by the Secton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton)
and returned within 10 days to the local County Health Department in the County where disposition occurred.
DH 326,10196 (Replaces HRS Form 326 which may b. us.d)
(Slock Number: 5740-000-0326-2)
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