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Home My WebLink About4-38-07 \..- ~ Paid by CEMETERY Receipt No.... ?Q~......... Dated......4 /.?1. 9.~............... List Price s.. .1.,.(;)000,0(;)... . 1 , 000 . 00 Net Pa1d S .................. L s 6 & 7 Block 38 Maximum No. Burial Spaces. . . . . . . . . . . . . . . .. Uni t 4 NO. 1356 Monument permitted. . . .. . .. .. . . . .. . .. . .. . . (Data above thla Une for City Record oDly) Qtit1l nf &fbal1ttutt <ttrmrtrry m rrb NO. "1356 THIS INDENTURE MADE TIdI .... ..2nd.. ... ...... day 01 ... Apr.il................................. A. D.. 19.92.., between the City 01 Sebutlan, a municipal corporation alltln<< under the lawI of the Stete of Florida. al Grantor and Shirley & Eugene Mahalick . . . . . . . . .. . . . . . .. ... . .............. ........... . ... . 61"7'<:)" 9 8t'h" S t.t:"E!e t......... .. . . . .. .. .. .... . . .. ..... . ..................... Sebastian, Florida 32958 . ... ......................................... ............................................ . " .0. ...................................... of the Counl)< of .. ..;r.J;l.4;i,~J;\.~;i, ~~.:r;.................... an:1 State of ....... ?;L9.:r;.:i.4~.................................... .1 Grantee, WITNESSETH I That the Grantor for and In consideration of the sum of S . .1." 9g9. ~ ~9... ...... ... to it in hand paid, the receipt whereofis herewith ac- knowledged, does by this instrument grant, bargalit, eeD, release, convey and confum unto the Grantee. their heirs, legal representatives and assigns the foDowing property situated in Sebastian, Indian River County, Florida, to-wit: AD of Lot(s) . 9.~ t.. ,Block,. ~.~ . . .. ,UNIT ...!+......... ,of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat Book 2, at page 65 of the pubHc 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; proYided 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 the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or proYided 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- eeM and comply with such rules, regufations, 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 shail 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 behaif by its Mayor and attested by its City Clerk and its corporate eeal to be hereto affixed, the day and year first above written. TIAN, FLORID(l I J . ... ..... .... ~&.... AttS;.~ALl..}n....[)d~~... - . - --iT-"elty Clerk ~~-;:'p~:::.~"hi . ~(J~:::::::::::.:: (GIitu Jieal) STATE OF FLORIDA ...,.... n..TPI"V nD. "un'" .. ~ 'D""''D'D Name ; t;" <I r 'v x /7'. I ... ,__"" ::; /1'/'2' <, J Unit "'V Block i8 - . Lot 7 Date of Mark-out 1/t,1o :; II 9/c) '3 sJ;UI1 )::". Time // , <::' i:;> I';l Date of Burial Name of Funeral Home Authorized by ~it, f' YIA:1 , --"-,,,-,,",--_...~-.-._----,...-.--_.-..._---- _._-~-_...- Paid by CEMETERY Receipt No. " .?q,........ . Dated.. .. ..41.?/?~............... Lots 6 & 7 Block 38 Maximum No. Burial Spaces. . . . . . . . . . . . . . . .. Uni t 4 NO. Ust Price $.. .1.,.(;)000,0(;). .. . 1,000.00 Net PaId $ .................. Monument permitted. . . . . . . . . . . . . . . . . . . . . . . 1356 (Data above lids line tor Cll)< Record oDly) <D 0 ill en 10 H .... t- on 8 ~ <8 C\I .. l3 (Y) }!i Q ~ I z ~ ~ 'en ~~ l1.m ~w en en w, ==1- ~ ~Z~~l:(l ~cn....l~ ...I 0 :I: u. N ~Ol::zlfl a:o....u.:. w ~ ~15lfl Z ....10. ~ W 0>05: u. 0 ffi ~z > z~ ~Q a:<( I- en:I: en ~ o ,!Ill I I I I I I I I I I I I I I ~I I I ~l I- ,D , I ~ ~~ I'Y o W !;;c Q CITY OF SEBASTIAN CITY ClERK'S OFFICE RECEIPT ~l319 N... ~ ~A.J~ 0_ Date ~ / ~t:i/,Y~ AmoIll'ltPa 001001208001 001501322900 001501 341920 001501 341910 001501 362100 . 001501 362100 001501 362150 001501343800 601010343800 .. 001501 369400 - 001501369400 680800 220681 680800 220682 680800 2211683 LL o WII: >j!:~ ceo II: 1:1....0. a: o u. "II" ii1xnua.,. Sales Tax Garage Sales CopiesJBid Specs. LDClCode of Orcinances Community Center Rent Yacht Club Rent Non Taxable Rent Cemetery Lots Cemeteey Lots Lot/Niche . Block . Unit---:r .." t-r: tJO Interment Fee Weekend Service Yacht Club Security Deposit Community Center Security Deposit Riverview Park Security Deposit >f Total palcl7~ () ~ als WhIte - Dept. of Origin. y.IIDW - FIMllCI · Pink. Applicant C(())/PJ" State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT f -j8-o7 FLORIDA DEPARTMENT OF A. 1. Name of Deceased (TYPE) First Middle Last Date of Death (If neither, give street address) Month Day Year Shirley J Mahalick 01-03-03 2. Place of Death County Brevard 3. Name of Medical Certifier Muhammad Siddiqui, M. D . Medical Examiner Physician 4. Name of Funeral HomelDirect Disposal Address Establishment 1623 N. Central Avenue Strunk Funeral Home Sebastian, FL 32958 1228 (772) 589-1000 5. Check a. 0 The medical certification has been completed and signed. A completed certificete of death accompanies this Appropriate application. Box City, Town or Location Name of Hosp. or Inst. H.Q.M. of Palm Bay Palm Bay Address 937 Barefoot Boulevard Barefoot Ba , FL 32976 (772) 664-113119 Fla. Lic. No./Reg. No. Phone No. (Area Code) Phone Number b. ~ Victoria was contacted on 01/03/03 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Siddiqui will complete and sign the medical certification of cause of death within 72 hours. c.D was contacted on 6. Funeral Director/ Direct Disposer He/she verified that . Medical Examiner, will complete and sign the of death within 72 hours. F E. No./Reg. No. 1862 Date Signed 01/03/03 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-03-00011 o A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. ONO extension of time for filing the de~th certificate has been requested. !Mllie'Fer er . Subregistrar Signature Date Issued: 01/03/02 Date Certificate Due: 01/0903 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -SEA Approval Number: Date 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. Method of Disposition: ~ o STORAGE CEMETERY OR CREMATORY Place of Disposition 5r: J'J;" ~ ~ a" .AhL;;M~/' D. Date of Disposition .; / 9/0::3 . DCREMATION Signature of Sexton or Person-in-Charge DOTHER (Specify) } ~9'/~?' This permit must be endorsed by the Sexton or perso~-in-charge (or by the .Fune~1 Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local County He~ijtfPcounty where disposition occurred. Dc 11 Dillribution: White: Cemetery or Crematory DH 326, 8/97 (Obsoletes ell previous editions) Y!tllow: FlI'l8/lll mrector or Direct Disposer (Stock Number. 5740-000-0326-2) Pink: Local RegIStrar (j('