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Home My WebLink About4-38-16 I Paid by CEMETERY Receipt No. .....~....Dated....... !~.~~/?~.... ........ il~~k 1.17 800.00 Unit ~ LIst Price S . . 'SUO': lfO' . . . . . Maximum No. Burial Speces . . . . . . . . . . . . . . . . . Net PolcI S .................. Monument permitted . .. .. .. .. . . . . . . . . .. . .. . MO. l.l74 (D.ta .bo... tl... lIne 'or ell)' Reeord onl)') CltUv nt ., busthttt <ttftttftfty .tfb "1374 NO. THIS INDENTVIlE MADB N 11th d.y G' ...........~~~~':'.~........................ A. D..1'.~~., beh,-oon ,he CIty 0' &baatlan, . munletpal eorporatlon ..I.t"" under the law. 0' the St.te 0' Jl'lorld.. a. Grantor .nd Mr. James Maxwell . - -... -.... ............. ........... ................. .10.3.6. .F.o.s.ter..Road.................. ........ ......... .................. Sebastian, Florida 32958 ............................................. ............................................ ............................................ Indian River Florida 01 the Coan17 0' ............................................. .n1 Slale Gt ....................................................... II Grantee, WITNB88BTH, _ 800.00 That the Grantor lor .nd In conslcleratlon of the IIUft of S .;........................ to It In huul pekt, the receipt whereof Is herewith ae- know1edsed, doe. by this Instrument pant, barpIft. leD, release. ClOn...y and ClOnftrm unto the Grantee .ltJ ~ . .. heln.lepl repre_tatlves and asalpa the followlfts pro",y lltuated In Sebastlan, Indian IUver County, F1orkta, to-wlt: AD ofLol(S)\~!!t? ,BIoct... .~~... . UNIT . .4.......... . of Seballtlan munlclpel cemetery as per Plat Number I thereofreClOrcled In Plat Book 2. at \lIP 65 of the pubBe reeorcls In the ,oMce of the Clerk of the CIrcuit Court of 51. Lucie County of FIorlda; .Id land now l)'lna and bel,. In Indian River County, FlorldL To Hue and to Hold the sune forewr; proftlecl that sUt property shaD be useclllJlely and exclusively for the Interment of the human dead and shall be ullllcl. kept and maintained at aU timet In ac:ccmlanee with the rules and replatlclna. ordlnan_ and molutlon. of the CIty of geba1lt1an. Florida, hereto- fore. now and lmeafter adopted or proYIded 'or the ao-mnent and operation of solei cemetery. The condltions, restrlctlon. and requlrementa eontalned In this Instrument shaD be CXlftII8Rt'1'lIIIIlIne with the land. In the emrt of the failure of the o....er of any property situated within sUt cemetery to lib- - and ClOmply with iueh rules, replatlons, reaoIutlcln. and,orcllnance. and the con4ltlon. of the cleecI of ClOnoeyance thereof then the title of IIICh .....ner In and to laid property sIIaII terminate and the .me IhalI mIert to the City of Sebastian, FlorIda. IN WITNESS WHEREOF. The ..... perty of the lIrllt part has eauaecl thlt Instrument to be exeeuteclln It. name and on It. behalf by It. Mayor and ,,-,,"COy"""'" 1...-. -,....-............... ""... rl ......g/~J.m..Qd~ ~~;:: H~~~: . (I - CI17 Clerk ~.--/ / M or !II..."". Sealed and ~lInrod :~.t.he,~....~....... ~..~................ (GIltv "ea.) STATE 01' PUJRIDA COl'NTY OP INDIAN RIVER 11 th August 92 I HEREBY CERTIFY. Ttaat on th.. ....................... .day ot ..................................................., I....., before me penon.lly .ppeared ... ..~~~~~.~..~ ~.. ?~~eg.... _..................... and ~~.~~Hn..~!.. R .'.~.~.tl:9.r.~!L respedlvely Mayor and City C1ert. of the C117 0' &....tI.n. . munlell..1 rorporatlon under the I.... 0' the State of PlGrlda to me known '0 be lhe Indlvlduul. and olflee.. d...,rlbed In aDd who ""..uled the lOft'lOln, I!OIIv",an"" to Mr. James Maxwell . . . . .. . . . . .. .. . . . . . . . .. .. . .. .. .. .. .. .. . .. . .. . .. .. .. .. ... and .onrally ""knowledrcJ the nec:utlon thereo' 10 be their 'roe ad aDd deed II ,neh 010"".. t1",reunto duly .ulhorlaed I and that the Omel.1 ...1 0' ..Id eorporatlon It duly .mxed thereto, .nd the said eonnyanee I, the ad .nd deed 0' aaIcI corporation. WITNESS my ......ture .nd offlel.1 aeaI at Beba.tI.n. In Ihe County 0' Indl.n Rlvor .nd St.te of Jl'lorld.. the day ancl YO'e lilt 810.......... lJNIlIl II. u:JMII. ..., NlJD.IIIII"...... ~0lIIMlIIIIlIft...... 1t." CClWI'OO,*,* " Name fl /J ru ,t' (}. t1 tu<. W JE 1-1- Unit >.f Block 38 lIP Lot Date of, Mark-out f/,^ 7' l/ 6' ~>' "", ,(,.14 fj_ 'J t,,?_,:~' J ,~~' . ~'? Date of Bu rial. ' A uJ .. ,l',tif:)9 'i .:t. ::;::;i~;;;NK '~ Vi ,/'r'" 1/: 00 1"1, rn. Time "".' -,.. ....... ....'.::... ..'.,.....', .,. ,'-",'<', ". . ~.,--~~~'-' ,.,--,---- .---,,-.-.'-- --" /0-3(0 HJ.::>kr Kaui ~jaj\ rL Bt?q6~ ... ...~":"",::,:,;:,:_':_,,:''''';__,,,",::''''''':~';_'"!.....-'__ _;~'~~__~___,___",_,_._--"_,_,,,--, ~ ,__~_. ~;,,:""'_':'...c:';"_"':. ._, - . ~ /B7~ " J.J).fo I ~ t J 1 ~)ocJ_ -3~ Un; + 4 A O(\Q. C. rY\a..xweJ J ; n+-erred cg/'f Iq~ L.o+ J~ l., - '-- - J: t . . ~;;3 THE SEBASTIAN CEMETERY City of Sebastian Sebastian, Florida FROM: Dollars ($ ~tXJ ~ ) on this /;M. day of /l// Alh./VIl119 . for the purchase of the fOllowing described Cemetery Lot (~terms and condi tions as stated herein: Description of Property: Cemetery Lot(s)# I ~ i /7 Blockll l?'6 Purchase Price~~td jY Terms and' condi tions of sale: anitll 4 Dollars ($ )'ptJ,? ) 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 condi tions stated in the foregoing instrument: The Ci ty of Sebastian agrees to sell the above mentioned property to the above named purcbaser(s) on the terms and conditions stated in the above instrument. ~J~ ~ t of Sebas ~~o'f t!..~,P; . " . . . ,'1 y 0 ("..' " ~, iJ' r; ~ ~ ~ '~ (; /1 ~\ '~,,~ ,L,\.- . ,,. PFLIC~t<t. City of Sebastian POST OFFICE BOX 780127 a SEBASTIAN, FLORIDA 32978 TELEPHONE (407) 589-5330 a FAX (407) 589-5570 August 13, 1992 Mr. James Maxwell 1036 Foster Road Sebastian, Florida 32958 Dear Mr. Maxwell: Enclosed is Cemetery Deed No. 1374 for Cemetery Lots 16 & 17, Block 38, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the 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, 2145 14th Avenue, Vero Beach, Florida. We are enclosing two copies of Receipt No. 723 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience. Very truly yours, ~~Jn. [).;(fLlb,I~ Kat~~'~. O'Halloran City Clerk KMO:lml enclosure (\ws-form-cem.rec) I . . 7-23 THE SEBASTIAN CEMETERY Ci ty of Sebastian Sebastian, Florida RECEIPT IS HEREBY A~KfOHLEDGED OF THE SUM OF: 4<-J ~ ft-- Dollars ($?lm.!J- J FWJH, ~~~tIIjJt#J Jit~~~q~ on this /;M <fag of! ~ 19 . for the purchase of! the following described Cemeterg Lat(s) u the terms ,and conditions as stated herein: Description of Property: Cemeterg Lat(s)# I ~ t /7 Blocklf \;:j Purchase pr1ceqJ~ lid P' Terms and' conditions of sale: ani tll 4 Dollars ($ y~,? ) 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 condi tions stated in the foregoing instrument: ~~~ t/ / The City of Sebastian agrees to selL the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. ~Ji~ ~t of Sebas . ~ Jc( CtI-Ld n,/ wi ness ' - State of Florida, Departmeillil( Health and Rehabilitative Services, Vital SW' ics APPLICATI-=OR BURIAL - TRANSIT PERMIT I- I~/ 17 /c3 38 1/1 A. 1. Name of Deceased (Type or Print) First Anna Middle Camilla Last Maxwell DATE OF DEATH Month Day 08/06/92 Year 2. Place of Death County Indian River 3. Name of Medical Certifier City, Town or Location -.J Medical Examiner Name of (If neither, give street address) Hasp. or In~t. Hu.ana Hospital-Sebastian Address Phone Number Roseland Geor~e A. Mitchell, D.O. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral 5. Check Appro- priate Box XI Physician Address 1623 North Central Avenue Hoaes, P.A. Sebastian, FI 32958 1228 (407)562-232& a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. 13855 U.S.#! Sebastian, Florida 32958 (407)589-8992 Ra Lie. No./Reg. No. Phone Number (Area Code) b il P"'g was contacted on 08/07/92 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 George A. Mitchell, D.O. 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. Indian River F.E. No./Reg. No. 7 Removal from state Donation Date Signed 08 07 92 6. Place of Sebastian Final Disposition: 7. Funeral Director/ Direct Disposer B. BURIAL - TRANSIT PERMIT Permit No. 1228-92-0370 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 Registra of the County in which death occurred. o No extension of time for .. the death ~ficate ue RiW'~nr er ~ ~ Subregistrar Signatu ~~: ~"'l/~d- g:~Cert~;ft.}- 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: III BURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition <\~h ~ c:; t i ~ n r~m~t ~r y Date of Disposition A II 9 II c:; t 1 1 , 1 Q Q ? Signature of Sexton ) or Person-in-Charge) -L Lt",,;'" .1. (Jp",-" ~_ )' 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) J.