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Home My WebLink About4-36-18 --- ----- Paid by CEMETER Y Receipt No. . . . List Price $.. .~,~.'.<x>..... Net Paid $ .. .~!~:.~..... '........ Dated.... ..~(~.~(~!=!............... NO. Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Monument permitted. . . . . . . . . . . . . . . . . . . . . . . 1", ') , . .J i. " (Data above thla line for City Reeord only) atity uf f'l'bastiau (!t.rm.rtrry m r.r~ , 15;:~~) NO. THIS INDENTURE MADE TIoJI ..... 21st day oC ~larch 96 A. D., 19.. ...., between the City of St'bastlan, a municipal eorporatlon existing under the laws of the Stille of Florida, 01 Grantor and Reuel D. Brockway .............................. '108 '~in' .Stre-et.....................,.... .................. .............. .... .~.'7ba~.ti.~.~. .~l.~~.~?~. .~?~?~.........,.. DC Ihe County of .... ;(l').P,i,M. .Ri:'-[~;t; . . . . . . . . . . . . . . .. . .. . .,. ani Slale of . nQJ;;i,q.a. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . II Grantee, WITNESSETH. That the Grantor for and in considerltion of the sum of $ . .1, R<?9...Q9. . . .. . . . .. . . . . to it in hand paid, the receipt whereof Is herewith ac- knowlcdilCd. docs hy this instrument grant, bargain, sell, release, convey and confirm unto the Grantee . h;~. . .. heirs, legal representatives and assigns the follnwing property situated in Sebastian, Indian River County, Florida, to-wit: AU of Lotlsl? . ~. . ~~ Block, . ~~. . . .. ,UNIT ..4.......... ,of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat Book 2, at page 6S of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being In Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at aU times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, re.triction. and requirements contained in this Instrument shall be covenant. running with the land. In the event of the follure of the owner of any properiy situated within sold cemetery to ob. serve and comply with Such rules, regulation., resolutions and .ordinances and the condition. of the deed of conveyance thereof then the tllle of such owner in and to said property shall terminate and the same shall revert to the City of Seba.tlan, Florida. IN WITNESS WHEREOF, The .aid party of the first part has caused this instrument to be executed In it. name and on it. behalf by its Mayor and attested by it. City Clerk and it. corporate seal to be hereto affixed, the day and year fir.t above written. CITY OF SEnABTIAN, FLORIDA 1/; Attesi;--;;fQ.",: ,:':',/1!,-', . v ,.'\ .j l' /)7 . C! ./:1. ~Ud:1-!.1. ':~~ . , . . . . . . Clly Clerk By df,.,I.,~~ (~v4.~.~~~/-:.......... Mayor '";:-::-:-ff'''''' Signcd,.seiil91nml Dellverod In the .Pr"""",,e oC I (.-.:x.;;~L(' - / ~. . .:~~.. 'J' k-hV-.- /--./..J.-y..:yat........... 014...7,....,./?c~~~:--:-::...... (ClIilll %2111) STATE OF FJ.OnInA COl'NTY OF INDIAN RIVER 21st March 96 I HEIlEDY CERTIFY, That on thl. ....................... .do)' of ............................................, !9...., b,'Cure me pmonally aJlp...ed .. .l~~.~~..~.... qa~~~:l:~t...... ....... and Ka.~h!:Yrt. ~~ ..<?'.I;l~:!.;1,(;lJ::!!-r........ reR.w,:livl'/)' Mayor and Clly CI.,k of lhe City 0' S.b..lInn, n munlel"n' co'porall"n unde, lhe In's of the Stale of Flo,lda 10 m. known to btO the indh'idunls nm) uffkers tlescrihtOd In find who execlItc.d tlw tOff'goin! COHV(~ynnce to Reuel D. Brockway . . . . . . . . . . . . .. . . . . . .. . .. . ... .. . .. . . . . . . . . .. aud seve'IlIl)' acknowledged the .x.eutlon thereof to be lb.lr Cr.e aot nnd deed 8S such officers tht"reunto duly HlIthorlzcd; and th"t the Orfltial Be..1 of said corporation 'S duly affixed thereto, nnd the sBirl ennvt"ynnee is the net Ilnd deed oC ..Id corporation. / 'I I.st .C~~~;::d~SS my .Ign.~re. a:":cla, .eal at Seba.lIan, In t~e _~utl~.a,t!t!~.~ ~~:t_~~~ Of)F';:/da, tbe day and yea. li!1 ::~~~ - MY~~a:~~4' ,/~~~:~);i:)! }-!Jfr:~(~................... : . . exPIRES:""" IB.199ll ----- l'l"tary P"blle, Slat. yf ,j.{~~;.I. nt l.arge, \ 1,::...>..~_~llwv-"PuIllIc- My co,blDl..I"" 'Xplr~~1 \ Linda H. Galley " Name 1\ ~,~" II /~~ l -"'.: ." ,.' ..,/ ,;"~':: .~"'\ i /-,.,~. L ..~ ,~,;.i \ t /'1 Unit ,4 Block "':;. J ,:' (c Lot ~Q j (~.J ;j/I{ Date of Mark-out I ,-/ ii (' f /' . Date of Burial / "'-"/-'" I ~.,,,,;:, t ~ ,.~~.. ,,'" ..' Time .il' ~;:;:. 'j7i Name ~~_F_~n:_r,~~Oj5' .4 , '>St. -7' ,;)',1t Authoriz~d by .~r-~ .- '-,,~_._....~-- './" '","- ;..../ fl;"',.. '1'....:.. ," ,'.., .~:?l/{if~"'f , . . . 883 3/21/96 PaJd by CEMETERY ReceIpt No. , . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . Ust Price $ . . .!} 0?9...99. . . . . Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . . 1,000.00 Net PaJd $ .................. Monument permitted. . . . . . . . . . , . . . . . . . . . . . . (Data above this line tor City Record only) ,l....,~. s NO, · 1529 l~~] State of Florida, DepartrAof Health and Rehabilitative Services, Vital.sties APPLlCA~ FOR BURIAL - TRANSIT PERMIT t 17/([[) ,(? 3t Lt. If A. 1. Name of Deceased (Type or Print) First Middle Last DATE OF DEAtH Month Day Year Reuel Delmar Brockway Name of Hosp. or Inst. 8/2/97 M.D. Vero Beach W Medical Examiner 777 37th Street ~ Physician Vero Beach, Fl. 32960 561+5677"-Q006 Address Fla. Lic. No./Reg. No. Phone Number (Area Code) 1623 N. Central Ave. Sebastian, Fl. 32958 1228 561+589-1000 The medical certification has been completed and signed. A completed certificate of death accompanies this application. (If neither, give street address) I ndian River Memorial Hospital 37th Street, Vero Beach, R. Address Phone Number 2. Place of Death County I ndian River 3. Name of Medical Certifier Erol R. Atamer, 4. Name of Funeral Home/ Direct Disposer Strunk Funeral 5. Check Appro- priate Box City, Town or Location Home a 0 b ~ Shannon was contacted on 8/4/97 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 Erol R. A tamer, M.D. 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 6. Place of Sebastian Final Disposition: 7. Funeral Director/ Direct Disposer B. BURIAL - TRANSIT PERMIT 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 filing the death certificate requested. Permit No. 1228-97-0340 ~~~;~t. dl ~r Subregistrar Signature Date Issued: ~.j/"'71 Date Certificate Due: C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA , Medical Examiner Date Signature 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 o STORAGE o OTHER (Specify) k'~ l' r(~dJ' Place of Disposition Date of Disposition Sf!./?; J4. 5r;14~ eLK! ~1L;ey ~ to/7 I t.'J..,. . Signature of Sexton } or Person-in-Charge ) 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