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Home My WebLink About4-39-10 Pnid by CEMETERY Receipt No. . . .9 7.l. . . . . . Lots 9 ~ 10 5/29/91 Block: . Dated. . . . . . . . . . . . . . . . . . . . . . . . Utii t 4 NO. List.PriCe s .8QO.. QO........ Net Paid S ,a.Qo., QO........ Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Monument permitted. . . . . . . . . . . . . . . . . . . . . . . "1325 (Data above this line lor CIty Ileeord 0011') Dale K. & Elizabeth J. Alliso 454 Banyan St. Sebastian, Fl. 32958 O!itl1 af &rhustiun aIrmrtrry mrrb 1325 NO. THIS INDENTURE MADE'I1WI ......49.t..b.......... day of .......ijGlY.................................. A. 0.. 19.9.~... between the City of Sebastian, a munlelpal corporation existing under the law8 of the State of Florida, 88 Grantor alld ..."................................... ;I?~:J..~.. ~.... .~.I)41.9.:r;.. ;E;J...:J...~~R~.t.q...J:~. ..~,],;I)..~~m................ ................ 454 Banyan Street , .,..........".... .......,....,.,.......Sebastian.,. .F.I.orida..329.5B.,..... ................ ... ... .....,.... .... .... ..., of the County of .... ..+,I)4;i..~.I).. R;i..y.~;r:.................. an:l State 01 .... ..~~~;-.~4~..................................... II Grantee, WITNESSETH I That the Grantor for and in consideration of the sum of $ ~.QQ r QO.. . ....... . ..... . to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargam, seD. release, convey and confum unto the Grantee . t:.q.~.t[: heirs, legal representatives and assigns the following property situated in Sebastian,lndian River County, Florida, to-wit: All of Lot(s) .9. . ~. . 1, itock, . . .~ 9. .. ,UNIT ... A . . . . . . .. ,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 iand 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 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 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 Such rules, regulations, resolutions and ,ordinances and the conditions of the de'ed 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 fust part has caused this instrument to be executed in its name and on its behalf by its Mayor and !ttested by its City Clerk and its corporate seal to be hereto affIXed, the day and year fust above written. Au""t~~~m,.l)tI~ ' . !/r_, City Clerk CITY OF SEBASTIAN, FLORIDA Signl'd, Sealed und Delivered ~PreBence of: ( ~~~1?J*~... . ~l.... Jy&-:... .... ,... STATE OF FLORIDA COl'NTY OF fNnJ" N' R1V1P.R B,/tr~.......", /"a10r (QIitl,l ,;Seal) Nam F-' / . rjl ../ -; .1"I,'C~ I.~"" ,_.." &,!::!. d. _ - ,.....-- ,. ..) . fill.- o i),';' Unit ~I Block j~-\ ...'\ ,.~ ./ '/ Lot } /") ../ Name of Funeral Home /11' ,', , (... , ~ , ,~\(/:, , !*l~l,r'/:, Authorized by ,A, ..".,t.4,. "" ,~'o , ,'-"--1 //,'..,> I/"~ - '/1' \~_/ '\,/ I'e/ }/91 /oll'l!~J :5 -r; ,,( r/ /', Time :? co;:J fro') " / Date of Mark-out Date of Burial , Q.r- Lots 9 & 10 671 5/29/91 Block 39 Paid by CEMETERY Receipt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . Uti! t 4 List Price $ .8QO.. QO........ Maximum No. Burial Spaces................. Net Paid $ . 8.QO., QO........ Monument permitted....................... NO. "1325 (Data above dill line for City Record 001,) Dale K. & Elizabeth J. AI: 454 Banyon St. Sebastian, Fl. 32958 1-. 9^- /0 /3 39 Or [.~l State of Florida, DepartmeAHealth and Rehabilitative Services, Vitalsetics APPLlCATldl'PFOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (Type or Print) First El izabeth Middle Last Allison DATE OF DEATH Month Day 10/02/91 Year J, JPhysician Address Name of (If neither, give street address) Hosp. or Inst. 454 Ball~'an Street Address 7744 Bay Street Sebastian, Florida 32958 (407)589-0879 Fla. Lie. No.1 Reg. No. Phone Number (Area Code) Phone Number 2. Place of Death County Indian River 3. Name of Medical Certifier Noor Merchant. M,D, 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, P. A. (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 City, Town or Location Sebastian --l Medical Examiner b []{ T.i Y. ,I was contacted on 1 n,l n :.' ,I q 1 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 NoOl' Merchant, 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 Final Disposition: 7. Funeral Director / Difeet Disl'65er - Indian River FE No.l~. Removal from state Donation Date Signed B. BURIAL - TRANSIT PERMIT Permit No. 1228-91-0425 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 fir the death certifi ate re uested. Registrar or Subregistrar Signature Date Issued: /0 -' ;; 9'/ g~~~ CertifiC?{.L 7- 9 ( c. AUTHORIZATION for CREMATION, DISSECTION or BURIAL -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: Ul BURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition Sebastain Cemetery Date of Disposition October 4.1991 Signature of Sexton ) or Person-in-Charge ) ~ ~ 1. ~k<J"t 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. Qf~ HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) H'''',_ I ", 1, 'f'" ,"T"" '''''In f'~,.,p ",