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Home My WebLink About4-39-14 W-U.y Ul. ~tllU1t,uatl ~rmrtrrg II r r "" '1339 NO. THIS INDENTURE MADE TIaII 28th August 91 day of,.... ,..,..... ....................".,......... A. D.. 18....,., between the City of Sebutlan, .. municipal corporation exlatln, undcr the lawa ot the State of Florida, aa GrlUltor and . . .' . .. . .. ..... ........................, .ll;1.e.l;'~s.~,. J.>;i. t.inQ.....,.,................. . ...... .................,.".,.,........",. 321 N. Papaya Circle ....... ........... ...., .......,.,.......,BarefoQ.t..Bay.f ..F-L. -329.7.6.... ...... .....'.............. .,..,.....,. .,........., of the County of . ;r,J;1.4~~~ ..~~ y:~.:r;...... .. ............... an-] State of .. .:n,~+J4~. .......... .. ........ ....... ... .. ....... u Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of S .~). ?Q9. ~ R9.... . .. ... ... to it in hand paid, the receipt whereof is herewith ac- knowiedged, does by this instrument grant, bargaiD, seu, release, convey and confirm ~to the Grantee ~.~~. . . .. heirs, legai representatives and assigns the fonowing property situated in Sebastian, Indian River County, Florida, to-wit: An of Lot(s) t~~.\ ~ , Biock, . .~ 9. . .. ,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; sUI 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 tho 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 shan 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-iuch 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 shaD 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 ita Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year rust above written. Signed, Sealed und Delivered '~..~~.............. t:t5N~.....~~,............. CITY OF SEBASTIAN, FLORIDA ,...,_.,.--., //)7 ", '--. , By tA..(L...(:~...r.;~.;~:-:-:-:-:-~.,.,..., ,/. Auest~~..~....O~1I~... .. or.... '(j'~ City Clerk (QIitv $eal) STATE OF FLORIDA COl'NTY OF INDIAN RIVER 28th I HEUEDY CERTIFY, That on thll ....................... .day of August . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . of 91 18.., ., bl'(ore me personally appeared ~ ...? ~.. ~~.~y.~~.~....... ............... ........ ..... ... and ~~.~h~.Y~..~:, J? .'.~~.+~~~.~~... respl'ctively Mayor anel City Clerk of the City of Sebutlan, a municipal corporation under the laws of the State of Florida to me known to be the Indh'iduuls und officers described in and who executed the (or('80InB cORveyance to Theresa Pitino .0....... ..... ................................................................................ .......................................... . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . . . . .. and severally acknowledBed the execution thereof to be their free act aRd deed IS such officers thereunto duly authorlsed; and that the Official seal o( said corporation Is duly affixed thereto, and the said conveyance is the ad and deed of said corporation. WITNESS my slpature and official seal at Sebutlan, In the County of Indian Rlvt'l' and tate of Florida, the day and 1ear Name / 1) tilt' f}. [) I T'llf 0 f Unit ..../ Block 39 Lot Pi Date of Mark-out /1 ' 81!'t, -rif Date of Burial f: j" ,,:' /9' I :,; "'.5, , ,I' Time It, 0(;"" ;l.. iv!' Nam. of FU:~Co,;:J" ~ f' () 1".,. ' ''v, /-', ,,,/ fl.' -," \'It, j 1-/ Authorized b-V;~'1" /, i)c", '.' i', :"'-, :1:i'~ Lots 13&14 Paid by CEMETERY Receipt No. g.~?.......... . Dated . ~J ~~.~~.t................ .Block 39 . . 1 200.00 Unit 4 List Pnce $ . . .1. . . . . . . . . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Net Paid $ ..~! .~~9:. ?~.... Monument permitted....................... (Data above tbla line lor CJlf' Record only) ~ NO. 1339 State of Florida, Department of Health and Rehabilltatlve Services, Vital Statistics L /311- / ~ /3 3'1 !Ii APPLlCA. FOR BURIAL - mANSIT PERMIT . A. 1. Name of Deceased (Type or Print) First John Middle Anthony last Pitino DATE OF DEATH Month Day 08/16/91 Year 3. City, Town or Location Name of (If neither, give street address) Hosp. or Inst. Phone Number 2. Medical Examiner G 0 e 4. Name of Funeral Home/ Direct Disposer Physician Address 1623 N9rth Central Avenue 13855 \lS# 1 5. Check Appro- priate Box a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. b iJ Lyacc was contacted on 98/17/91 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 OE-o"'gP Mit{'he 11, D I 0, 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 Final Disposition: 7. Funeral Director/ Dip:>M ni~pnAAr F.E. No.lReg. No. Removal from state Donation Date Signed B. BURIAL - mANSIT PERMIT Permit No. 1228-91-0370 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. Registrar or Subregistrar Signature Date Issued: Date Certificate Due: 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 Signature of Sexton ) or Person-in-Charge ) o STORAGE o OTHER (Specify) ~i' f' .~~rr' Place of Disposition Date of Disposition ,! e Ii ~ er AI') e Ii. ~ 1- ~h,J ,/91 Methods of Disposition: . BURIAL o CREMATION 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) (Stock Number: 5740-000-0326-2) (AI~' L