HomeMy WebLinkAbout4-36-02
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PIlei by CEMETERY Receipt No....~
LIst Price S...~ ,.'?99." 9.Q...
Net Paid S ...~ !.~ ~~.: ~.9...
......... Dated... .~/~.? /.~.~...............
NO.
Maximum No. Burial Spaces. . . . . . . . . . . . . . . . .
Monument permitted . . . . .. .. .. . .. . . . .. . . . . .
-'1507
(Dat. .boye lbll line for City Reeord ODI,)
CltUll nf &thustiuu
<!trmrtrry
IIrtb
NO.
1507
THIS INDENTURE MADe TIlIa
15th
d.y of
August
95
A. D. I.......,
bet,,'een the Cily of S.b..tl.... a mllnlelpa! torporallon eslltlne und.r the lawa of the Slate of Florid.. al Orl.nlor .nd
. . . . . . . . . . .. . . . . .. .. . . . . .. . . .. .... . ... .. .. .... Ba.l: bar.a.. E ,. . .Ti 1 t.on. ....... .. . . . .. . . . . . . . .. .. . . . . . . . .. .. . ....... .... . ....... . .
638 Braddock Street
..................... ........................ Sebast.ian,.. .Flor.ida. .3.2.958. ..............,........ .....................
of the CODnly of ......:J:.I).4;l,~I)...R;i.y.E:!.:t;.................. an'l Slate of ......J:'),~r.:t.4~.....................................
u Gr.ntee, WITNESSETH.
That the Grantor for and In condderadon of the sum of S ..... ~.t ?9~: .Q9... ...... to It In band palel, the receipt "';bereof II herewith ao-
knowledged, does by this Instrument grant, ba..aln, sell, rei...., convey and confirm unto the Grantee . h~;r: . .. heir..lepl representativOl Uld UdIPII
the followlnl propertyftuatedln Sebastlan,lndlan RIver COllnty, Florida, to-wit:
An of Lot(s)~ ,,2,... ~ ,Block, . ~.~. . .. ,UNIT ..~.......... ,of Sebastian munlclpal cemetery II per Plat Number I thereof recorded In Plat
Book 2, at pap 65 of lbe public record81n the .offlce of the Clerk oC the Circuit Court of St. Lucie County of Florida; ..lei land now Iylnland being
In IndlUl River County, FloridL
To Hive and to Hold the same forever; provlded that aald property shall be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintained at aU dmea In ac:eordance with the rules and regulations, ordlnanceJ Ind resolution. of the City oC Sebastian, Florlela, hereto-
fore. now and hereafter adopted or provlded Cor the goYMllment and operation of said cemetery. The condition., 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-
serve and comply wilb inch ru1ea, r....lation.. resoludons and ,ordinance. and the conditions of the deed oC conveyance thereof then the title of such owner
In and to said property shall terminate and the same shall revert to tbe City of Sebastian, FIorlela.
IN WITNESS WHEREOF, The said party of the first put has caused this Instrument to be executed In lis name and on its behalf by It I Mayor and
attested by Its City Clerk and Its corporate seal to be hereto affixed, lhe day and year fIr.t above written.
Allest%~~m.O/ltU~.~..
(7"~ . City Clerk
CITYD~~:r~~
B1....................~
M.,.or
Signed, Sealrd .nd DeUnred ~
In the 'preaence 01 I / .
~~.~uuuuuu
(GIitll Ji'tlll)
STATE OF PI.ORIDA
'COl'NTY OP INDIAN RIVBR
15th August 95
I HEREDY CERTIFY, That on lbla ........................ day of ..................................................., 19....,
brlllre me penonally approred ... ~~~.~.~!: ..~.:.. ~~.~.~~~.~........................ and ~~ ~.~~y.n. H.... .9. ~ H~J)..q~~~...
respr'ellv.'y Mayor ilnd City CI.rk of the City of Sebutlan, 8 munlcl,.al ro1'J1oratllln under the In's of tb. State 01 Plorlda to me known
10 be the '"dMd..nls .."d offlc,rs tleoc:rlbed In find who exeruled thc lor.goinl eo.y,ynnce 10
.... .. ... . .......... .. ........................ . . ~~.J;.I?Ar.~..:Pi .'. ..1:1,;1, !:.Qn.............. .. ......... ................................
Name
Unit
t4
.-, I
Block ,'''- \t)
Lot
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!..:A. t- i
H ") .'" --
"j. <:,- /,' '_~~' (i~,J ;:::....: i
r11(~ ,;t 111(0- .
[)
(f"
;-
1'1" ) f\ ~ ;,
Date of Mark-out .' / c" 6 ) (.JjQ.
Date .of Burial, ~11 Z. S~ Li)O
Name of Funeral Home FA,'n': ,1,/
Authorized by
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.' .1;
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f""(;.f'''-,-.)!<
Time
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J,
FLORID
A.
1. Name of
Deceased
(TYPE)
'.
.
t ;J/J
13 3~
!J1
l
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
First
Mil(garet
~
..
Middle
Palmer
Last
Date Month
of'~Y 17,
Death
(If rieither, give street address)
Day
2000
"'Year I
i
1
Fairfax
2. Place of Death
County
IDdian River
3. Name of Medical
Certifier David ~~tron, D.O.
Medical Examiner
4. Name of Funeral Home/Direct Disposal
Establishment
Indian River Cremat:lons, roo
5. Check a.
Appropriate
Box
b.D
c.o
City, Town or Location
Name of
Hasp, or
Inst.
Sebastian River Medical Ce:1ter
Rceeland
. Address
Phone Number
13230 U.S.tl'
sebastian, Florida HMA 32958.
561)589-68~8
Physician
Address
1937 Old D.ixie Hwy., #103
Vero Beach, ,norlda ,32960
Fla. Lie. No.lReg. No. Phone No, (Area Code)
KB0000285
561)234-5961
The medical certification has been completed and signed,' A completed certificate of death accompanies this l
application.
was contacted on . ,
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that win complete and sign the medical
certification of cause of death within 72 hours, . .
. was contacted on He/she verified that I
, Medical Examiner, will complete and sign th
6. Funeral Director/
Direct Disposer
7/fl'&rned
Permission is hereby granted to dispose of this body. Permit No. 195-00-134
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 I
been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section cf the death certificate within
72 hours.
:UlNo extension of time for filing the death certificate has been requested
Registrar' or
Subregistrar Signature
B.
C.
tion of caus~ of death within 72 hours,
~ ~~r~' No.
BURIAL - TRANSIT PERMIT
'Il'''
7/18/00
Date Certificate
Due:
~.,' .
, If. ,
,.~
(.
, AUTHORIZATION for CREMATION, DISS~CTION, or BURIAL-AT -SEA
Approval Number,
COO-l9-07- '2-0
Date
00
Medical Examiner, Frederick Hobin, M.D. , gave authorization by telephone to Paul GoOdridge
Funeral Director/Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waitin
required for all cremations.
D.
./.,.
,,1
FOR FUNERAL DIRECTOR/DIRECT DISPOSER USE ONLY
1. Date Burial-Transit Permit (pink copy) was filed with Local Registrar:
2. Date Temporary Certificate was filed with Local Registrar:
3. Date Permanent Certificate was filed with Local Registrar:
4. Follow-up efforts & activities (Note parties & dates contacted):
5. Name and place of disposilion: j
6. Funeral DirectorlOirect Disposer Report Filed:
s.