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690 12/29/91
-... Pb.:d 'kjr CEMETERY Receipt No..... ...... .' .~.. Dated. ........ ........ . .......... ..
list Pnce $ .. ~.Q9. r QO.. ..... ". "daximum No. Burial Spaces................ .
800.00
Net Paid S .................. Monument permitted. . . . . . . . . . . . . . . . . . . . . . .
Lots 31 & 32
T'~')ck 39
",,'...J.t 4
NO.
1344
(Data aboye this line lor City Record oo1y)
Cltity of &tbusttun
(ttrmrtrry
i rrb
'....1 ~344
NO.
THIS INDENTURE MADE TIdI
30th
December 91
day 01 ............................................. A. D.. 19......,
between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
. . . . . . .. ... ... . ..... ............ ..... ............. . Jean. .Beuder t.. ............. . . . .. . .. ... . ........ ..... ........................
992 Tarpon Avenue
.................. ..... ....... ...... ...... ...Sebasti.an.,...F-lori-da. .32.9.58.. .......................... ... .... ... ........
01 the County 01 ...J: nd:ian ..R.i Y. ~r. .. . . .. .. .. . .. .. . .... an'] State 01 ... F1.o r i da.. .. .. . .. . .. . .. .. . .. .. .. .. .. .. .. .. .. .. . .
u Grantee, WITNESSETH.
That the Grantor for and in consideration of the sum of S . ?QR : QQ. . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ao-
knowledged, d~es by this instrument grant, bargam, sell, release, convey and conIum unto the Grantee .. ~.~~. .. heirs, legal representatives and assigns
tJle following property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(s) ?l ~~2~ DIode, ~. ~ . . . .. ,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 shall
be used, kept and maintained at aD times in accordance with ilie 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 covenants running with the land. In the event of the failure of the owner of any property si.tuated within said cemetery t.o ob-
serve and comply with Such rules, regulations, resolutions and ,ordinances and the co~tions of the dded 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 haa caused this instrument to be executed in ita name and on ita behalf by its Mayor and
attested by its City Clerk and ita corporate seal to be hereto affixed, the day and year first above written.
. ..rn...D~~.:
City Clerk
CITY OF SEBASTIAN', FLORIDA
~n- e-
B1 t?':.~""""'M?'~""
(QIitv ~eal)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
... .......'W2t'n" n'Dnm'l''D'V ........_.. _. &LI_
?nrl
.1_.... _..
Ta........ ft"''''r
,.....n.,
Name
U.)', \ \ '\(} H
F.
'-(:.e u cieRI""
Unit
,-j
Block
,3Cj
Lot.
J;(
1~I:rlI7/.
Date of Mark-out I I
f',)...} ':'\.\L y;
Oate of Burial ........ . .........../ .
I . .
~/f(.). N 1<:.;6 .. ./j
Name of Fun.eralt,;o..~.. e....... . . //. /._)~'-:;..,. /. :/.
Q" /7~
~' .~~', ": .~Af;' " ,_....?"
Authorized · /' ~:~ ",. / //
Time
/0" 0 0 A .11# . .
(ll~'
.... -".----.,..--.'.--- ~.:....._...__._.._'-.-..- -,-
690 12/29/91
Paid by CEMETERY Receipt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
List Price S .. ?QR r QQ....... Maximum No. Burial Spaces.................
Net Paid S .. ~.q~: ~9....... Monument permitted.......................
Lots 31 & 32
Block 39
Unit 4
NO.
1344
(Data above tbla line lor City Record only)
_v_~._~__.m--
State of Florida~ Dep&i~.' . ''';.He~i.h,.;~tB~ih.8bll.IU.. tWaS. e....'~J6..~. .S;:VIt8!,." $iieiV.:
" 'a '!IM<1:'1Q '\;)i,1i\MT~- i,ut" 1<.'1 ,~I( \:1 I
APPLI~~.. FOR BURIA'L""; TRANSit PERMIT -" ..j
(Type or Print)
First
)., '8~ 13 39tJ'I
A.
1. Name of
Deceased
William
'!'Middle.'
Frederick
Last
Beudert
DATE
OF
DEATH
Month
Day
Year
~ ~ . ~ ' ...~,
-', ~ .-.. ,
12/27!9~ I
2. Place of Death
County
Brevard
3. Name of Medical
Certifier
City, Town or Location
Name of (If nei!her, give street address)
Hosp. or: " : " '. ,; '''' ,.'
Inst.
4.
Medical Examiner
Address
Phone Number
. . 200
ij /f! " I::~d~
., ; i, 'i .'~\' ::_" ~ r,. i
..:r-..:
Strunk
5. Check
Appro-
priate
Box
~ m~icaI. certification, has ~een completed and sig~~.. ~) c~mp!~t~J c~t!f~~,e~.~f ~~~ accof!'panies
.:,!:t~lsapphcl\ltlon. ,', I ," . " " :1" ". .;;d' :0 (I..:"tl n:',,)!\:f"n
..( :';,F~ "':.".~ ,~'.-'"Iif''' l " :',"": .,....:'I:'.l,~!di5\f;/vt'!/.n fj :d
b l:i
8te,llaBie was contacte~ on 12/27/91 within 72
hours after death~ I:fe/s~ verified ~hat this death waS frolY' natural' cause~; that there was no accident
'" 'i"., .\ ~.(I , " ~ -.' ~, '~""I~()tl""'f.'l~'l'.,
nor other external cause of death, and that Barry' A I Mills; M.tl'." . ..' will complete
and sign the medical certification of cause of death. .,,,. c.,.!, 1 ., .
was contacted on . He/she verified that
, j Medical Examiner, will complete and sign the
... <d~~'- ~ i" ,.;.;:._~
c 0
medical certification.
6. Place of Seba.stian
Final Disposition:
7. Funeral Director/
l;)ifGd Dle~eeer
B.
BURIAL - TRANSIT PERMIT
Permit No.
1??R-Q1-0fifi4
Permission is hereby granled to dispose of this body. j' ,
o ^ five day exlension 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 tlme.limit.lf 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 liIi he death certificate request .
Registrar or
Subregistrar Signature
,~, ~:~~d: J~-,2-7_9 )
~~~Ce~'~~/_~
.
;;lr~,:~"~'l~"?~ i ~ If>;
C.
AUTHORIZATION for CREMAnON, DISSECTION' or BURIAL -AT-SEA
. ' , ' ,.. . .. ,'\'.1'
.",. ~:H~I': l ~i'~'jIf'tl ,~,.ju'J.",t" .>\J:'.~
Signature I 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. ,
~ ': i. f~' --'1"r .
, '
,.;.-....:,":..
D.
CEMETERY OR CREMATORY
Methods of Disposition:
I2Y BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition
Date of Disposition
_-i- "A~+:C1.'" ehnQ~o(~
\'1.- 30- q,
Signature of Sexton )
or Person-In-Charge )
,('~ 9-
/~7"
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 relumed within 10 days to the local HRS County Public Health Unit in the Counly where disposition occurred. Q (L
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) ., 'i
(Stock Number: 5740-000-0326-2)