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Home My WebLink About4-37-34 / Paid by CEMETERY Receipt No. . . ??: Ust Price S.... .~.'. ~.q~ :~~. 1,200.00 NetPaldS .................. ...... . Dated .....~ !.~ !.?~................ Lots, ,34 Block -', Maxlmum No., Burial Spa_..... ........ ... 'Uni t 4 Monument permitted . .. .. .. .. . .. .. .. .. . . .. . NO. Lri'7 (D.t. .boYe IIIIa line lor Clt,. Reeonl oaly) ",-, <!lttv nf &thasthtu 'lJTt atrmrttry . r rb NO. THIS INDENTURB MADB nta 8th, d..,. of September ............................................. 92 A. D.. I......., bet...em lhe CIt, 01 S.bull.n, . lDunlelpal etn'Il'lratlon eal.tln, 'pnoler the la!" of the St.te 01 PIopldi. .. G....to. and nrs. ~va ~chumacner "",.,... ,.... ... ... ..... ...................... .12{f.7..N~. ..B.6J:ef.oQt..CiJ:~le."......... ..... ......... ..................... Barefoot Bay, FL 32976 ............................................. ............................................ ............................................ Indian River Florida 01 the County 01 ............................................. Ini Stlte of ....................................................... U Grantee, WtTNBS8BTH I TNt tho GrlOtor for and In consideration of the sum or S .. ^ I.~ ~9... 9.Q . . . . . . . . . . . to It In hand paid, the teceipt ..hereof I. heteWlth aD- knowledpd, d_ by thla InIlrument pant, barp!ft, ..0, retea.., convey and confirm unto the Grantee . .l?~;... helra,lepl repre_tatlv. and alii.... the followlns property a1tooted In Sebastian. Indian RInr Connty, FlorIda, to-wIt: AU or Lotbl ~.~ ~~~', Block, . .~ 7. . .. ,UNIT .. f4. . . . . . . . .. ,of SebaIllan munldpal cemetery as per Plat Number I thereor tecorded In Plat Book 2, at pap 65 of tho public racord.1n the office of the Clerk of the CIrcult Court ofSt. Lucie County of Florida: aid land no..l)'inKand belll8 In Indian River County, Florida. To Ha.. and to Hold tho _o'fo_: proYided that aid property shaObe used IDIeIy and exclusiftly for the Interment or the human dead and ...n be uaed, kept and maintained at aO tImea in accordance with the rule. and replattona, ordlnancea and _Iutlon. of the CIty of Seballlan, Florid.. hetelo- Ibte, now and hMufter adopted or proYIdad for tho IO-t and operation of aid cemetery. The conditions, rastrlctlon. and Jequlrementa contained In this InIlrument ...0 be _nil tUIIlIlna with the land. In the event of the faUute of the owner of IOY property lltuated within said cemetery to ob- _ and comply with inch rulea, raaulattona, reIOIuttonsand ,ordlnancea and the conditions of the deed of conyeyance thereof then the title of such owner In and to aid property shaO terminate and the ame shall teYert to the CIty of Seballlan, Florida. IN WITNESS WHEttEOP, The said partY of tho first put has caUlOd this Instrument to be oxecuted In It. _me and on It. behelf by It. Mayor and attelled by Ita CIty Clerk and It. corporato _I to be hereto atlIxecI, the day and year fInt abo... written. AIr! J~.. ..lrJ.....t!.71~~ 'Q~ City Clerk !ll~'~::' D.llye..d ~~"l;' lb.......................... ,... " ' ...~............. TE OP Fl.oRtDA COl'NTY OP INDIAN RIVBR 8 th September 92 t HBRBBY CBRTIFY, That 011 thlt ....................... .d.y n1 ,.................................................., I....., bel".., me pu"",ally ."....red . .~C?~~~~..~:. ..~.C?~~~.~.... ...,. ,.,... .........,.". and .~~~~~~..~:..R~.I;I.l!-g9.~.l!-!1. r.-"..dl...l, Mayor .nd City CI.... 01 the City of S"balllan,a mllnlel,.., eorftllr.llon under the I.w. 01 the State of P10rlda to me known 10 be t.... Indlyhlu.la and 01""".. deaerlbed In and ..ho eaoeutod the Ion-lOins e....ey.nee to . Mrs. Eva Schumacher ( (CIIitv '.al) ....................................................................................................................................... . .. . .. .. .. . .. .. .. . .. . .. . .. . .. .. .. .. . .. .. .. . .. .. .. .. .. .. . and aenrally ."..no..led..... the """""tlon the.....f to be th..l. free a'" and dNd II IUch ol"""p. thernnt.. dill, auth..rlaed I and that th. Of ""I. I .eal of ..Id "orporatlon II dul, affixed thu...o, and the ..Id eonnyal1l!1! I. the ..eI and d..... of ..Id eorporatlon. WITNESS...,. .I....tan and offlel.1 NIl at Sebaatlan, In the Cou lut do_ald. UftDA ".lOM& ,..., NlIID-8Imt of FIaI* lilt CllIIInlIalan!IIIIINI.JUN II.'. COMa... cc tlII7... Name rif, 0 1""1 .A '"\ 5 (/~ /I U #l[j ~ ( IIi(, e Unit Aj, BloCk -.{,; r L~ B 7.? ../ - j~i } , . ,--' C. kIT': J",/ "':I / )../ <: loT Date of Burial 9/:<'/9;( . 9/3/9~' Time / l) C)D /} , ;1'''1 . Date of Mark-out i Author~E._b j j, Paid by CEMETERY Receipt No. . . ?~~, . . . . . . . . . Dated list Price $ . , . . . ~ .'. ?~~ : ~9. Net Paid $ ,.... ~.'. ~.~~: .~? 9/8/92 .............................. 34 NO. Lots 33 & Block 37 Maximum No. Burial Spaces . . . . . , . . . . . . . . . . 'Uni t 4 Monument permitted. . . . . . . . . . . . . , , . . . . . . . . IJ:;'7 (Data above this Une for City Record only) [la~] Middle t. 331} 3315/ 3/ I ,(j 37 L/1 Month Day Year State of Florida, Department of Health and Rehabilitative Services, Vital Statistics APPUCATleOR BURIAL - TRANSIT PERMIT . A. (Type or Print) 1. Name of First Deceased Thomas 2. Place of Death County Indian River 3. Name of Medical Certifier Nasir R' wi M.D. 4. Name of Funeral Homel Direct Disposer 5. b Ck DATE OF DEATH Last Schumacher 08/28/1992 City, Town or Location Name of (If neither, give street address) Hasp. or Inst. H H umana os Address Roseland bastian Phone Number Medical Examiner Physician Address 1623 was contacted on 08/31/199!ithin 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 NA--qi r Ri !7.wi. M. n. 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. 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 LocaJ Registrar of the County in which death occurred. o No extension of time for fili death certificate request Registrar or Subregistrar Signature 6. Place of S~bastian Final DispositIon: 7. Funeral Director / DiRilGt 9i~;:jer B. C. Indian River F.E. No.1 Removal from state Donation Date Signed BURIAL - TRANSIT PERMIT Permit No. 1228-92-0404 ~:Y_3j_qL g:~Certif~~_ 4-~ 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. Methods of Disposition: IXl BURIAL o CREMATION Signature of Sexton ) or Person-in-Gharge ) CEMETERY OR CREMATORY o STORAGE o OTHER (Specify) i./ ,-~ ~ ~i" Place of DispoSitiOrDSebast i an Cemetery Date of Disposition Septemliler. 3. 1992 ,/ ,(." c- <...~ /~ . '" -y 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. HAS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2)