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Home My WebLink About4-35-21 ., \, , " . . 851 4/3/95 Lot 21 PaId by CEMETERY Recelpl No.... ......... Dated.............................. BlOCk. Lisl Price $ .. ~.q9.: ~~.. .. ... Maximum No. Burial Spaces............. .. .Uni t Net Paid $ .. ?~? : ~?.. .. . .. 14~3 NO. Monument permitted. . . . . . . . .. . . . . . . . . . . . . . (Data above thli line lor CIty Record only) Q!itl1 of ~ebusttuu OIrmrtrry IIrrll 14 ~J8 NO. THIS INDENTURE MADE TIoIa """ .3rd . Ap r. i.l.. . . . . . . . .. .. . . . . . . . . .. A. D.. 19 9. ~ . ., day 01 belween the City 01 SebasUan. a munlclpal corporaUon e"isUng under the laws 01 lbe Slale 01 Florida. .S Grantor alld David Shearer .....,... ........ ....... ............544. 'PeteTson' 'STree.t........... ....... ......,... ... ... ... ............... ... Sebastian, Florida 32958 01 the County 01 JI)~;i,~.t:l.. R;i..y.~~..................... ani Slate 01 .. Fl,o.J;.i~a .. Grantee, WITNESSETH. That the Grantor for and in consideration of the sum of $ ... ~.q~: ~9... .. . .. .. .. .. to it in ~nli paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee .. . . . .~~. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) . .. .~ ~ ,Block,.... ~?. ,UNIT .....~....... ,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 Sl. Lucie Counly 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 all 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 tho government and operation of said cemetery. The conditions, restrictions and requiremenls contained in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situaled within said cemetery to ob- serve and comply with such rules, regulations, resolutions and ordinances and the conditions of lhe deed of conveyance thereof then lhe title of such owner in and to said property shall terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the frrst part has caused this instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affIXed, the day and year frrst above written. A..<..~t" )n{)J!tl!~......... City. Clerk CITY OF SEIlABTIAN.~ BY~""'~""""""""""""'" Mayor Signl'd, Sled alld Delivered r) l' A . 9)> sence~~./.. ;5.~~-::< '. Pu~<",-~~go/uu a::;~' OF FLORIDA COl'NTY OF INDIAN RIVER I HEREBY CERTIFY. That on thl. ........~XA..... ..dsy 01 ..AP.J::.:j.J................................19.9.?, Arthur L. Firtion Kathryn M. O'Halloran bt,ture me personally appeared ............................,......... and ....................................... respectively Mayor and City Clerk 01 the City 01 Sebastian, a municipal corfloration under the la~'s of thc Stale of Florida to me known to be lhe individuuls uno officl~rs described in llnd who execult:d the fon'going cOllveyance to (<lIit\! ~~1I1) ... .I?~yt.4.. ~~.~.lrr~r.................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. and severally acknowledgl>d lhe e"ecution thereol 10 be their free act and deed as such officers thereuulo duly aulhorizcd; and that the Of Ii cia I scal of saill corporation is duiy alfixed thereto, ond the said conveyancc is the net Ilud deed 01 said corporation. /) ... .,:.:.':t":_"".::re ... ~"". ... " ",...... ... ."'... ~/ 'ijl" ... ..., ... ,n, i "''='':1': C h"": ;i;;;~{!AL,;.~( u hh h h h h :' ....,~=.....~.!""'~NIIIo_ 1..lon e"Pire8lIfti:::, \ Linda M. Galley Name -:r; {! 12 ('t (;. j'v1cdloR Unit I '-I Block 3 .)'" Lot :?- 1 Date of Mark-out .:;;; - ;';' O.q :'J Date of Burial 3- 31 -.1:;"- Time I / .' c> t) .../fl, ,i~""j1 Name of Funeral Home J'rRi...{ ij K /j /e/ )'1//' Authorized by /; (/; ii ' l/-- ,J' I I - 3hatrlflJ:xurd 64.Lt'-f-.=P ~~n s+ ~af), rL 68160 'teed 141 t ~\0f96 Lo-I-01I,-olod3~, Uni+.f "je-ffi--~ G l1)a il'/)r~ - ; n~tYre.d 3/31/qj "- - '- P "db lU Y CEMETERY Receipt No. . . . . ~ ? ~ List Price $ 500.00 ........Dated.....4/3/95 L NotP.., S .. soei: 00....... _=NO.B:;~........ ... ......... Bf~c~\5 .................. paces............... .Uni t 4 Monument permitted NO. ..................... 14~8 (Data above this Ii ne tor City Record only) .> .E SEBASTIAN CEM~RY CITY OF SEBASTIAN, FLORIDA ~51 OF THE SUM OF: Dollars ($~~[). ~ ) FROM: on this 6 (ti day of following described Cemet y conditions as stated herein: , 19~ for the purchase of the Lot ~/Nl-.!u ,'.1) upon the terms and Description of Property: Cemetery LO~~i~} , / ~/ ~ Purchase pr~c~~d~ Terms and Condition of sale: Block 6=> Unit L Dollars ( $....~t/. f!Y) This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: The City of Sebastian agrees to sell the above mentioned property to the above named purchaser~o the terms and condi ons stated in the above instrument. /1 ~ Witness ~ ci ;/';)~~ . . City of Sebastian 1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 0 FAX (407) 589-5570 April 10, 1995 Mr. David Shearer 544 Peterson Street Sebastian, Florida 32958 Dear Mr. Shearer: Enclosed is Cemetery Deed No. 1498 for Lot 21, Block 35, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. If you wish to have this deed recorded you may do so at the office of the Clerk of the Circuit Court, 2000 16th Avenue, Vero Beach, Florida, 32960. We are enclosing two copies of Receipt No. 851 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience. V~U1Y yours, ~m. O'l/~~. Kathryn M. O'Halloran City Clerk KMO:lmg enclosure (\ws-form-cem.rec) '-E SEBASTIAN CEMARY CITY OF SEBASTIAN, FLORIDA O:tJ I OF THE SUM OF: Dollars ($~~~, ~ ) FROM: on this G r;J. day OL following described Cemet y conditions as stated herein: , 19~ for the purchase of the Lot f;sPY/Nl-ha ,'ji) upon the terms and Description of Property: Cemetery LO~IBi-'-~ M. Purchase Prl.ce..:.... _~~ Terms and Condition of sale: Block \5:5 Unit L Dollars ($....~().;5Y) This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoi~ instrument: , -.fiJ~~H~ The City of Sebastian agrees to sell the above mentioned property to the above named purchaser~o the terms and condi 'ons stated in the above instrument. //] ~ Ci v!L Y /}~~~ ,witness [lll~] State of Florida, Departme~ Health and Rehabilitative Services, Vital S.'stics APPLICATI-=OR BURIAL - TRANSIT PERMIT 1- .lJ--;<; A. 1. Name of Deceased (Type or Print) First Jeffrey Middle Glenn Last Mallory DATE OF DEATH Month Day 03/26/95 Year 2. Place of Death County Indian River 3. Name of Medical Certifier Frederick P. Hobin 4. Name of Funeral Home/ Direct Disposer City, Town or Location Sebastian Name of (If neither, give street address) Hosp. or Inst. 2 Phone Number Medical Examiner M.D. M.E. Physician Address 1623 North Central Avenue P.A. Sebasti n 9 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Fort Strunk 6. Check Appro- priate Box Funeral Homes a 0 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. Hel~n Fre erick P. Hobin, M.D.,M.E. was contacted on 03/29/95. He/she verified that , Medical Examiner, will complete and sign the c rn medical certification. 6. Place of Sebast ian Cemetery Final Disposition: 7. Funeral Director / Direct Disposer Indian River F.E. No.1 Reg. No. 1672 Removal from state Donation Date Signed 03/29/95 B. BURIAL - TRANSIT PERMIT Permit No. 1228-95-0179 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. R. ~ e..-- eglstrar or - / Subregistrar Signature --' D I ~ ~ Date Issued: 3_ 2;: '1s- Date Certificate Due: C. 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. CEMETERY OR CREMATORY Methods of Disposition: !sa BURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition Date of Disposition ~<;!"Q;' ~A7d~2t J; #/a/lr.1. .31, /1?r , Signature of Sexton ) or Person-in-Charge ) J-'Lv'-I... !J If?/~J- _/ This permit must be endorsed by the. Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no S(J) 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)