HomeMy WebLinkAbout4-38-22
~
Paid by CEMETEJl Y Rocelpt No. . . . 7. r
List Price S .. .. .~~9... 9.Q....
Net Paid S .... .aOQ.~o.o....
.... ..Datccl.... U.~~U.~?..... .......... Lots ?
Block
Maximum No. Burial S.._................ uni t 4
UonWDODt permitted. .. .. .. . .. . .. . .. . . . .. . .
" 22
NO.
1371
(Data aheva tIIJa IlAe to, at, Reeord DDIT)
cnUy pf &,bastian
Qttmtttry
Ittlt
"1371
NO.
1'H1S INDENTUIlB MADB 'J1oIa ......20th........, day ot ,.....,.........July...................... A.'D.. 1...9.2.,
between the City 01 Sehoatlaa, a IDualcJpal eorporalloa ealatln. IIIlder the law. of the Stat. of Florid.. .. Graalor ....a
Kim Crowe
",.,,'.', ,...,....,..,....,..........".."...", t2'3~' 'Cl'e~rIliO);\t' 'Str~e-t"""""''''''''''''''''''''''''''''''''''''''
"",,'.......,..... ......" ....., ........... ,." ~~J-?~~~.~.~~ 1., ,~.~~~~~~., ~.~,~?~.,"",.".,',.,"",..".."..,.,.."...,
01 the Couat)' ot .. .lnIU.a.o. .lU. v,e;r:..................... aa'J State 01 ...... ..f.l,QJ:!d,$,...............,.................,
.. Grantee, WITNBS8JI\TH,
That the Graolor for aod iD l:OIIIidacadoa of the IUID of S .. ~ QSl :. QQ . . . . . . . . . , . . . . to It In Iwul paid, the Illcelpt wberoaf b beIllwlth ac-
kDowlodaecl, dOli by this Inatrumoat put, barplia, aU, l"a, \:Onvey aod coDfiml unto tbe Owoteo . h~.~... belrs,lDpllllplOGltatiYes aod auJan.
the followlna property situated iD SebaIlIaa, IDCIlao Rmr County, Florida, to-wil:
All of Lot(s) . ~1.4~~1oc:k, . ~~.... ,UNIT..,.~........ . ofSebaatlan mWlidpal cemetery al pel Plat NWDber 1 theroofrocordod iDPlat
Book 1, at paaO 65 of the public ro_cIs iD the oftlce of tbe CIolk of the CIrcuit Court of St. Lucio CoUnty of Florida: .w Iaod oow IYIna and boIoa
In lndlao River County, Florida.
To Hava aod to Hold the samo forovor: proYidad that .w property iliaD be UIed solely aod oxc1lllivo1y for the iDtarmDat of the bumao dead and sbaU
be UIed, kept aod malDtaiDod at aU tImoIln accordaaco with the rWel aod lOlIu1atlous, ordlnaocea aad molutloos of the City of Sebaltlan, Florida, boroto-
fore, DOW aod boreafter adopted or provldad for tb8 lovoroment aod o!'Of8tlon of said cemetery, The llDAdltlons, fIlItrictlonl aod aequirolllOnta COIltalnod
In this lostlUDlODt iliaD be \:Ov_t. rllDlliDa with the Iaod. In the oveat 01 the failure of tbe 0_ of aoy property a1tuated witbln said cemetery to 0b-
serve and comply with iudl ruloa, l1lIulatloru, molutlooa and .0rdlDaoce. aod tho cond1tlona of the cIdod of conveyaoce tbDreof tben the title of IUcb oWllOr
In aod to IlIkI property IbaIl tormiDate aod the ..... sbaU revert to the City of Sebutlan, Florida.
IN WITNESS WHEREOF. The salol party of the Orst part hal caused tlolllostrumont to be oxocuteclln itllWllll aod on ill beba1f by ill Mayor and
attested by ill CIty Clerk aod ita corporato seal to be hereto afl1xe4, tbe clay aod year Orll above ..ritteD.
Alle.h'?:(ad:~.,IJi,.,DiIa~~
(J Clt)' aark
III,o.:d, Sealed a,aI Delivered
I. t(frelJlAtA:e 01,
?C~"'~~,..,."..,...,.,'
(/~~C~..,..,.........
(Glitll ,-eal)
STA'fB OF FI.QRlDA
COL'NTY OF INDIAN IlIVBR
I HBUBBY CERTIFY, TIlat .. t1lIa ...... 20 th...... , .. ,day ot ,..,..".. ...lul;y.. ,... ..... ....................., 1..92
belur. me pulOflally appeared ... ,~~!m~~.. R t.. .~~~~U.. ..... ............ , .. .. '.. &Ad ~~ ~,~,r;Y.n ..f:f, ~.. Q ~ ,J1:~~ ~.9.r;~~,
respccllvdy Mayor aod Clly Clerk 01 the C1t, 01 Scbeatlan, a IDlIIllell",1 eorl>oraUun under I'" Iawa of the State 01 Plorida to IIIe knowa
to b. the loollyiol..ula ulld olllcera delerlbed 1D and wbo a..,ut"d lbe foft',o;II, _ye)'_ 10
,.,....."....,........'...,.,... .....,'.......,. ,Kim, J:r:.o:we.............",.."..,...."..".."".....",... .........,....,..,.
. . .. , .. .. , .. .... .. .. ....' ......... ...... ....... ......... and leYerally ""kaowledlled lb. _.otlolo thereol 10 be their free act and deed
aa such olllee.. tbereuulu duly autborlaedt &Ad lbat the Olllclal _lot lIa1d c:orporatloll la dul)' a"bed thereto, and t'" aa1d eonveyauee
I, the ..et ....01 deed 01 laid c:orporatlDoa.
W l'fN ESS 18)' .Ipatun &Ad official .... at Scbeatlaa, iD tbo County ot Indian River IUIIl State 01
I..t duro:aald.
IJNOA.. I.OtISt.
No!lly Publlc.SIaIo 01 FIOllda
loti Colm",siDn expo- JUH 18,1llll4
COMM' CC 022744
Linda M. Lohsl
i
(
Name 1(' ,G." ././. r":
c
-, .
,,\/;:.:.:,///.1/)
Unit
i
Block
~, 6 '
J
Lot
"', r
...:. :<.
Date of Mark-out
~!ty. ..../... \; "?
/ . ,)
Date of Burial
/ .
.. {;'.//r/9:3
Time
II : (}() A. /YJ ,
Name of Funeral Ho
/~-
Authore.d
Paid by CEMETERY Receipt No... .l?Q........ Dated.....~ I.~~{.~?.............. 'Lots 21 & 22
.. 800 00 Block 38
List Pnce $ . . . . . . . . . .". . . . . . . . Maximum No.. Burial Spaces
. . . . . . . . . . . . . . . .Uni t 4
Net Paid $ .... .aOQ...oo.... Monument permitted.......................
NO.
'1371
(Data above this line tor at)' Record 001,)
[IB.~)
State of Florida, Department of Health and RehabHltative Services, Vital Statistics
APPlICA. FOR BURIAL - TRANSIT PERMIT .
l~di=~~ ...
A.
1. Name of
Deceased
(Type or Print)
First
Lucile
Year
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
Frederick Hobin M.D. M.E.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral HOIDes P.A. Sebastian 95
5, Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
Appro- this application.
priate
Box
Middle
Last
Strnad
DATE
OF
DEATH
c.
Month Day
06/12/93
City, Town or Location
Name of (If neither, give street address)
Hosp. or
Inst. Sebasti
Address
Phone Number
Roseland
Medical Examiner
Physician
Address
2500 S.
Fort Pi
b 0
was contacted on 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 will complete
and sign the medical certification of cause of death.
Helen
FrederIck HobIn, M,D.I M.E,
medical certification.
elDetery
c CJ
was contacted on 06/11/93 He/she verified that
, Medical Examiner, will complete and sign the
6.
7,
B,
Indian River
F.E. No.lReg. No,
1672
Removal
from state
Donation
Date Signed
06 11 93
BURIAL - TRANSIT PERMIT
1228-93-0284
Permit No.
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 filingh dea ertif";l' at req ed.
~or - ~/~~~~
Subregistrar Signature . Issued: (o-~ "'l~ Due:
C.
AUTHORIZA110N for CREMA110N, DISSEC110N 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.
Methods of Disposition:
. BURIAL
o CREMATION
Signature of Sexton )
or Person-in-Gharge )
CEMETERY OR CREMATORY
Place of Disposition 5-€AA<; rAN {J,/?"H'J;-. lZE17 I
Date of Disposition G // r / 9 ~
o STORAGE
o OTHER (Specify)
/~ i ~~0
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)
Q