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Paid b, CEMETERY ll00eJplNo...,....... . Dated , ... ?o.~/?~.,.........,.,. ~~~/a
LlstPrilJO S.. -40&;00,...,. MaxImum No,BIIriaI8pa_. ,.'......,."... ,uni t .".
Net Paid S .. .~~~,:?9.,..., Moo_l permitted,'.........,....,...".
NO.
.1370
(Data alIoYe tbIa \iac lo~ at,' Beconl oaIy)
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NO.
THIS INDENTUB& MADa....... ....l6.th........... d., 01 .......July............................... A. D~ 1...92.,
beh....n II.. Clly 01 Sebaatlaa, a D1l111lc1pal corporalloo eaIatlDf ....der the law. 01 the Stat" 01 Florlel.. u Graato. .....
Anthony Dell Donna
. .. . ................................................... '1'7" P~rk"1\venue""""'" ... .......... .............................
.................................. ........... ......... ~~.l?~~ ~~.~~.... .I!'.~~~~.~~.. ~~.~.~~.....................................
0' tbe CoualT of ......lnd..t~m..8.;l..y.~.L................ aa') 81ate 01 ...........n.9.J;';i,!\~................................
II GraNce, WITN&88&TJI.
Thai the OrlAlor for aad Ia OllIIIideradoa of tho sum of $ ,...~ ~9. ~ ~Q, . . , . . . , . . . . . to Ilia baacI paid, the receipt wllcreof Is llelewlth .0-
kaowledpcl, does by this lIut~al pult, bupIia, seu, release, coorey aad cooflrm 1ID10 the OrIUltee .. . ~.~!iI,. 1Ielrs,1ep1 repr_lalIv.. aDd .ulpl
the followiDe property silualed Ia SobaItlaa, IDdlaa lUrer CoualY, FIorlcla, lo-wit:
AU of Lol(l) , ~ ~ . .. ,Bloc:lt,." ~ ~ " ,UNIT ..~.."...," ,of Sebuliaa D1uaic1pal Clemetery al per Plat No'" 1 the_f re4lOlded Ia Pial
Boolt 2, at ..... 65 of the publicrocordlla the of8ce of the Clerk of the Circ:ult Court ofSt. LucleCouaty of FIorlcla; MId Iaad 1I0W l)'iIIaaad beiDc
in indian IUrer County, Florida.
To Hare aad 10 Hold the _ fomer; proYldecllbat MId property shaD bo used IOIelJ aad excluliYa\y for the IaterlllllDt of the IIwaaa dea4 aad sbaII
be used, kept aad aaalatalaed .t all dmea Ia IIClllOldaaco with the ruIea aad replatloas,ordiaaalln..... resoJutloru of the CIty of Sebutlaa, Florida, llareto-
fore, IIOW aad bereatler adopted or proYldecl for the lo_t aDd ......tIoa of MId cemetery, The oooditIoas, restrIcdoaa aad tequlrelDllall COAtaIaed
Ia thla laatrwaeat sbaII be co-It llIIIDIat with the Iud. Ia the ereJIt of the. failure of the oWller of lAy property situated withIa MId Clemetery to 011-
lI\rVe lAd com" with inch rulea, rep\atloot, reaotutloaa aad .ordlaaaoes aDd the colMlltloaa of the 4ded of COA"YlAce thereof then the liUe of IlICla owner
In lAd 10 laid property sbaII tennlaate aad the _ abaII reyert to the CIty of Sellalllan, Florida.
IN WITNESS WHEIlEOF, The saIcI part)' 01 the first part hal aaused this IaIlrumeat to be executed Ia Its_ aDd 00 its beheIf by III Mayor aad
aUelled by Its Clty Clerk and III corporat. seal to bo llereto aft1xed, the clay aad )'ear ftnt &bore nttea.
Att."~A'~ ~m.. ~.(tl4Jl;n~..
lNVIV"'~'1 City ~i.
Slpl.'d, Sealed ..11I Dellv.red
~r..:..~........,.
~~.{!~ I'-t<.,...........
(Citll ,$M1)
STA'fE OF FLORIDA
COUN'tY OF INDIAN BIVJ.
I HBUEDY CaRTIFY, Tllat OIl tIIIa ... ... .l.6.th... ... ... ....y of ...... .J.uly. ....... ... ..........................., It. .lJ~
be'u.e me penooalIy appeared..... .~~~~~.~..~~. .p.~~.~.~~......................... ..... .. ~~~.~.~r.~..~.... .~~~~~~.~.~~~
r..pectlveJy M.yor ..... CIty 0".. of the aty 01 Sebastla... . D1lJJ1ic\J..1 corpo.atloA 0....... tile law. 01 tile State 01 PIo.1da to ilia bow.
10 be Ibe bldlviduall ...... "fflce.. duerlbed Ia .nd wi... ellecuto:cl the '........101 euavcyeaa to
........................................ ...............:.. .A(J.t:hRI\Y. .>>~~!l.P.~~.Q~............................................
.. . .. .. . .. .. . .. . .. .. .. . .. .. .. .. .. . .. .. .. . .. . .. .. .. . .. ... ..... _".aIly ....oowledjrecl the _otloA thereol to be tIIelr lree act aad dc...&
.. ,",do o'lk:en thereulJlo dlJl, .utho~1aed I ..... tbat the Official ....1 0' ..Id co.potItlun Ia dlJly affbed tIlereto, ..... tile Mid CORVCY._
Is th1! llJlt ao4 dce4 0' aaIcI .,.......t\oIa.
WITN~ lOy .....111... .. otflelal .... at .....ttao, Ia the Coo
I.st .fu.raaIcI.
"'Il UIt&
...,..............
_O~ L.......... .,....
ClO'*'OO"-
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Name /11'1 / C ;-/ I 0 ,;,,;-,.
j) .,.,
J....,. [ 1 J... i} n", N /.l .
Unit
-4
BloCk
? Q
) lJ
Lot
~ ~..-
-'
Date of Burial
7'/I,A,').. ,
, t', - ,
,JI P,Jqt., ,
, /"
Time
('}
-1
;',) ()
j)' lV'.
Date of Mark-o,ut
Name of Funeraf Home
/'#/
J.
:J;eed:# /37D
~\~I An~n(D
6r1~k rfvenu.e.
c)~ia.J)J FL o;q.s~
101- 35
-:BId 8~
()iJ; + ,;
f}nJof)i 0 m. ))eJl ))~n nCL /()I&--red
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71/'8/r~
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. . 719 7/16/92 Lot 35
Paid by CEMETERY Receipt No",.,.."""",. Dated",,""""""""""""" Block 38
list Price $.. ,40&..00,..... Maximum No. Burial Spaces.......,.,.,...., Uni t 4
Net Paid $ .. ,~~~:.9.9."", Monument permitted",."".., ,.,..,...,..
NO,
1370
(Data above thls line for Clty Record ouIy)
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City of Sebastian
POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
July 22, 1992
Anthony Dell Donna
517 Park Avenue
Sebastian, Florida 32958
Dear Mr. Dell Donna:
Enclosed is Cemetery Deed No. 1370 for Lot 35, 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.
Very truly yours,
(~~rIJ. O,tlullY1 ~~
KathrynVM. O'Halloran
City Clerk
KMO: lml
enclosures
'1 '
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7/9
THE SEBASTIAN CEMETERY
City of Sebastian
Sebastian, Florida
($~.~
)
FROM:
.~~~~%'/
on this Ib dag ~ ~ , 19 901t'or the purchase of the following
described Cemeterg Lo~ terms and conditions as stated herein:
Description of Propertg:
Cemetery Lot{s)# ~ BlocJc# 3"l'uttit# 1-
Purchase pric : ' , ~d ~ DollarS($4tJ~, t1" )
Terms and' conditions of sale:
_~s/i5~~
This contract: shall be binding upon both parties, t:he seller and t:he purchaser, when
approved bg the owner of the propertg above described.
I, or we, agree to purchase the above described propertg on the terms and condi tions
stated in t:he foregoing inst:rument::
tV7 rfkO--.
The Ci tg of Sebast:ian agrees to sell the above mentioned propertg to the above named
purchaser (s) on the terms and condi tions stated in the above instrument.
~
@'~ (! ~.
Witness ~
'.l(ll~l
State of Florida, Departmeji&f Health and Rehabilitative Services, Vital SJlltlIcS
APPLICAnllPFOR BURIAL - TRANSIT PERMIT .
/...35
/?J 36'
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A.
1. Name of
Deceased
(Type or Print)
Rrst
Middle
Last
ANTONIO
M.
DKLLOONNA
Name of
Hasp. or
Inst.
July 16, 1992
(If neither, give street address)
DATE
OF
DEATH
Month
Day
Year
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
Noor Merchant, M.D. Physician
4. Name of Funeral Home/ Address
Direct Disposer Cox-Gifford 1950 20th Street
Funeral Home Vero Beach FL 32961 142 (407) 562-23&
a 0 The medical certification has been completed and signed. A completed certifICate of death accompanies
this application. -
City, Town or Location
Indian River Memorial Hospital
Address Phone Number
7744 Bay Street Suite #2 (407) 567-2332
Sebastian, Florida 32958
Aa Uc. No.1 Reg. No. Phone Number (Area Code)
Vero Beach
5. Check
Appro-
priate
Box
bOX looP tl8r~"''Pt. tL D _ was contacted on 07/1S/Q:Z 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 He 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.
In state cemetery/ Sebastian Cemetery
Bmatory - name/county: Indian River
'It F.E, No.lReg. No.
i 2S-3
6. Place of
Final Disposition:
7, Funeral Director/
Direct Disposer
Removal
from state Donation
Date Signed
,\-l -crt-
I
B. BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. ~ Permit No. 1423-174 -1992
o A five day extension of time for filing the death certificate (excluSive of weekends) has been requested and granted as undue hardship
would Jesuit 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 filecl with the Local Registrar of the County in which death occurred.
o No extension of time for filing the death ce .. ate requested.
Registrar or Date Date Certificate
Subregistrar Signature Issued: 01/16./92 Due:
C,
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
SignatuJe . 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:
. BURIAL
o CREMATION
Signature of Sexton )
or Person-in-Charge )
o STORAGE
o OTHER (Specify)
/11' ".r~7
Place of DispoSition
Date of Disposition
--' {1 -
S~J3A"51; AN ~JV')~/J.~",ej-
?/ n3/ 9.-a...
,
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 wheJe disposition occurred.
HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used)
(Stock Number: 5740-000-0326-2)
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