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Home My WebLink About4-39-15B l PaidbYCEt.un;;~~~iptNO. .... ....... ..~ated... ~a~m~. ....... .... ..... ~~~C1IA List Pnce S . . .. . . .. .. . . .. .. . . Max1IIlum No. Burial Spa"", . .. . . . . . . . . .. . . . Uni t ~ 250.00 NO. Net Paid S Monument permilled . . . . . . . . . . . . . . . . . . . .. . . '.1523 (Data above thla Une 'or City Record ouly) Cl!ity pf &rhusttuu Q!tmtttry Ittll "1523 NO. THIS INDEN'fURE MADB TWa 13th d.y 0' .... ... ,FE!b~ry. 96 A. D~ 18....... bet...een Ihe ClIy 0' ll<>baatlan, a munieJpal corporation ....I.tln. under the I.w. 0' the State 0' Florhla, aa Grantor and ................................. . Sylvia. D.. . Doro thy. ................. 12860 82nd CT ""'.. ..... ........ ...................P..O.~.25.t. R0seland'J . Florida .32957. 0' the Collnty of....~~~.~~..Rl:y~~....................... ani State 0'.. ...~.}.Qr,i,Q~.................. .................. u Grantee, WITNBSSBTH, Tllat the Grantor for and in conllderation of the sum of S .. ??Q: RQ. . . . . . . . . . . . . .. . to it in hand paid. the receipt whereof is herewith ac- knowledged, does by this inllrument arant, baraaiil, sell, release, convey and confirm unto the Grantee . .~~F: . .. heirs, legal representatives and assigns the folJowiD& property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) . ~? ~ .. ,Block,. ~? . . .. ,UNIT .. ~. . . . . . . . .. ,of Sebastian municipal cemetery as per Plat Number I 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; said land now lying and beiD& in Indian River County, Florida. To Ilave and to Hold the llIl1Ie forever; provided that said property shall be used solely and exclullvely for the interment of Ihe human dead and shall be used, kept and maintained at all times in accordance with tho rules and rO(lulatloDl, ordinances and resolutioDl of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for tho government and operation of laid cemetery. The conditions, restrictions and requlremenll contained in this instrument shall be covenants runnina with the land. In the oyent of the failure of the owner of any property situated within laid cometery to ob- serve and comply with iuch rules, reaulations, rOlOlutions and ,ordinances and the conditioDl of the deed of conveyance thereof then the title of such owner in and to said property shaIJ terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the ftrst part has caused this instrument to be executed in its name and on its behalf by its Mayor and allested by its City Clerk and its corporate seal to be hereto affIXed, the day and year fIrSt above written. Atte,t, ,M~-(/IJ...{)ldd/~..... . . . . '/~;-" City Clerk m:1Z5~l Mayor (CllitU J&rllJ) STATE OF FLORIDA COUNTY OF INDIAN RtVBR I HlUlEBY CERTIFY. That OIl W. .... lJto............ ..duy 0' .. Febrnary............................... 18.96.. Arthur L. Firtion Kathryn M. O'Halloran be'ore me perlOnully appeared ...................................... and ....................................... re'p',etively Muyor and City Clerk 0' the City 0' Seba.Uan, a munlel..al corporation under the "',,'S 0' the State 0' Florida to me known to be the Individllhla hnd office.. de..rlbed In und wbo executed tile f'''''80Ins co_veYhnco to ..................................... ......... .~Y~X:j.A. ~,. .1:>!:!~A~hy............ ...... . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . .. . . . . .. and &rverally acknowledaed tbe execuUon thereo' to be their 'ree ad and deed .. lueh officers thereunto d,lIy ullthorlaed; and t....t the Offici.1 aehl of .ttld corllorhUon la dilly afflled thereto, and the laid conveyun.e is the lIet IInd .....01 0' laid corporation. , 1 WI'fNESS IDY Ilsnalllre and offlclal aeaI at Seha.tlan, 10 the the day and year 1..1 ",or...a1d. G)," UHDAM. ~ i~':. MY COMMI68IllN. CC 1711I4.-. . . EXI'lIlE8: _1'. I. "_ ......1llnl-,NIa_ V'. Name (;:,z () i:.} 'rI". ("'Y ~. ') Unit pi Block :;9 Lot 1-5- '" Ii ;(/I)~h , <:< //~/96 Time 2='. :"0 ,).- lJ . /'i/l . y Date of Mark-out Date of Burial ,.- I Name of Funer~ome ,_, ~1:, J- \' '-- --/} //'/' ~ --~~------ -.-- -/" / ,,/ l' ~ . ''0' Jda I~c:h Auth~ 1:.:,"r _-'::._ w'; .,'./ \ \_- \ \\. Q.IL. -.---....,-.-..----.-.... -"..__...-~....._._.__...._- _._'-~--._._,._--.._----,._,--- '.---.--.-.,.-.--.---. ~~'~'\V;aJ) ~~O'. ~i~L-+ ~~rL~%rJ "'\ ])eed# /693 [}/,O)q(P ~+ J6131~1(xdc.<Yl ~~4~ Iinr~iliviJ:U()r~ ;"le,-,-eJ dJIt}?&; l, - i "- - . . 877 2/12/96 Lot 15B Paid by CEMETERY ReceIpt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~OO ~~~ List Price $ .. . . . . . :. . . . . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . . . . . . Uni t 4 250.00 Net Paid $ .................. Monument permitted. . . . . . . . . . . . . . . . . . . . . . . NO. !~1523 (Data above this line lor City Reeord 0011) I. ~E SEBASTIAN CEdmRY CITY OF SEBASTIAN, FLORIDA '677 on this lei day f following described Cemetery Lot conditions as stated herein: Dollars (d~~ ~I FROM: , 19~ for the purchase of the Niaho(s);upon the terms and Description of Property: Cemetery Lot ~ ' ~ Purchase Price: Te~na;:w. OWl) This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: ?< ~n~ The City of Sebastian agrees the above named purchaser(s) above instrument. ed property to ns stated in the I .. . . City of Sebastian 1225 MAIN STREET [J SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 [J FAX (407) 589-5570 March 12, 1996 Sylvia D. Dorothy P.O. Box 25 Roseland, Florida 32957 Dear Mrs. Dorothy: Enclosed is Cemetery Deed No. 1523 for Lot 15(B), Block 39, Unit 4. Also enclosed is a form. Return for Transfers of Interest in Real Property. which must be filled out by you and completed by the office of the Clerk of~e Circuit Court when and if you have the deed recorded. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, P. O. Box 1028, Vera Beach, Florida 32960. S~m. Of/aM-1A- KathrynM. O'Halloran. CMC/AAE City Clerk KOH:lmg Enclosures (\wr-ftom\cemdeed. wpd) A. 1. Name of Deceased (Typ~_ or Print) First APPLlC.N FOR BURIAL - TRANSIT PERMIT Middle Last . ~ '15/3 /33j 03_ Day Year ._ ,,' Horida, Departrnent of Health and Hehab,hlallve .:>el,lt-aS, Vllal ;:,wusUt-s .=J 2 Place 'ofDeath C..ounty Indian River :f.-Name of Medical Certifier Harry City, Town or Location David DATE OF furothy DEATH Fen. 4, 1996 -"--- Name of (l'-neither, give street address) Hosp. or Inst. 12860 82nd Court Month RoselJ!.f!d __. N.ullal''tIlilBdFarooq.. M.D~ . __ Physician 4. Name of Funeral Home/ Address Direct Disposer 953 Old Dixie B-6 Indian Ri~~r~S!llations, Inc. Vero Beach, Fl. 32960. 1000OO235 407 _ 234-5961 5. Check II iii The medical certification ha5 been completed and signed. A completed certificate of dealh accompanies Appro- this application. prialo Box Medical Examiner 177 .37th Street V~ro .Beach, Florida 3296Qt;o10i-67-nn Fla. Lie. No./Reg. No. Phone Number (ArElii'codeY Address Phone Number b 0 was contacted on wilhin 72 hours after dealh. He/she verified that this death was from natural causes, that thore was no IIcc:id,mt nor olher external calise of death, and that ______._ will complete and sign the medical certification of calise of death. c 0 was contacted on ____ . He/she verified that .._~.' .--_ .-..__._.__..~________, Medical Examiner, will complete and sign the medical certification. ---'-I~ slate cemetery/ Gulf CrcnldUons cremat ry - name/county: Palm Beam.t'oWltl' Sign u e l.. F.E. No./Reg. No. 1/~ ...-..,--. KAOOOO235 nemoval ai-om state D~nation Date Signed 2-5-96 6. Place of Final Disposition: ~-_.- 7 Funeral Director/ , Direct Disposer V"----'-- "-.A) ------- 8. BURIAL - TRANSIT PERMIT Permit No~95-96-038 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 Vlould result from filinQ within the normal lime limit.tf the cerlificate cannot be filed within this extended time limit, a "Funeral Direclor/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. !:l No exlension of limn for fili~~. ~.'." th. certificate~eq ,t.ed.. _. .. ne(~slrar or -' ~l /' ra Date . -I _ .A7:..-;;;;/ Date Certificate Subregistrar Signature .. .;1 / .? 4:...;f.~,~~U~ V Issued: ~o.L...'::.z&e.. Due: SiQnature _ ___.., ___ ._. ..-- ,Medical Examiner Dale ___ :edical Examiner Frederick Hobin, ~f.D. ,gave authorization by telephone to Pau~_ Goodr!dge __ _' _0 ___._---,-'._. _ Funeral Director/Direcl Disposer. Date __....2::'_\.!..I."\-............... . The Medical Examlner's approval must be obtained belora. disposal by any of the above methods. A wait~ period of 48 hours allm death is required for all cremations. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEACremation ^uthorization No. (!~9t..I?..o-1-Or7 C. D. FOR FUNERAL DIRECTOR/DIRECT DISPOSER USE ONLY 1 Dnle l3uriI11-Tr,msif P()rrnit (pink copy) was filed with local Registrar: ----_, ______,_ _...__ 2. Date Temporary Certificate was tiled with Local Registrar: _ ____,. .... _. ______~_._____,_______ ____._ 3. Date complete Certificate wus filed with LOCi'll negistrar: __ ~___ __...____.___ .______ 4. Follow-Up Efforts & Activities (Note parties & dates contacted): -----,-- 5. Name and place 01 disposition: ______u__,_ 6 !"lInaml Director/Direct Disposer Report filed: Yes ___.__ No___._._ Date FilM: FUNERAL DIRECTOR/DIRECT DISPOSER COpy HHS F""r 3;>6. Fd.l 99 /ReplGces O~187 f?dilio" which may be lIsed) (Stoc~. NlImbN: 57.tO-OOO-032t).:?1 ~d.- J.. ~ .;dJ.uL--'~ 8-#7.t~ (~O 1"/ /99', Q~d