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Home My WebLink About4-35-32 I nnn --- . P~9 11/3/94. Lots 3' & 32 Paid by CEMETERY Receipt No.... ........ D.ted.............................. 1 000 00 Block LIst Price S...}...... ~....... M.ximum No. Burial Spaces. .............. Uni t 4 Net Paid $ ..~ !.?~?:~.?.. Monument permitted... :.. ..... .......: .... NO. 14'16 (Data aboye this line lor C117 Reeord only) atitl1 of &rbusthlU fI14',6 <!Irmttrry 111 trlk NO. THIS INDENTURE MADE 'I1a1I 3rd d.y 01 November 94 A. D. I.......f beh,'een Ihe CI17 01 SebutJan, a munlelpal eorporatlon alatins under the law. 01 the State 01 Florida, a. Grantor and ......................oo.oo.oo....... Nanc.y. Diam.ond. .&.. Tho.maa ..C.o.1.l.\l.l1l...........oo................................. 437 Seagrass Avenue .......oo.........oo.. .....oo ........ .51ebast.ian tOO li'lo.r.ida. -3295.13.......... ...oo...............oo.........oo........... Indian River Florida 01 the Coanl1 0' ............oo............oo.....oo.......... an'l State 0' ..oo.........................oo..oo.........,.......... u Grantee, WITNESSETH I Tbat the Grantor for and in lXlnslderatlon of the sum of S ...~ t.9~9.'. 9.9........... to It in hand paid, the receipt whereofts herewlth.c- knowledged, does' by thlllnltrument grant, b.rpiit, sell. relealle, oonvey and oonflrm unto the Grantee ~.l,1~~.:t;. heIra, Iepl repreaentativea and .sslgns the followiDfl property situated In Seb.stlan, Indian Rtver County, Florid., to-wit: AU of Lot(l) ~.~ ~.~f, Block, ~.~..... ,UNIT...~......... ,of Seb.stlan municipal cemetery as per Plat Number 1 thereofreoorded in Plat Book 2, at pqe 6S of the public records In the offlce of the Clerk of the Circuit Court of St. Lucie County of Florid.: IIId land now lylDfI and being In Indian RIver County, Florida. To Have .nd to Hold the same forever; proYlded that said property shaD be used solely and exclusively for the interment of the human dead .nd shall be used, kept and maintained .t an tImes in .ccoidance with the rules and resuIatlons, ordinances and resolutions of the CIty of Sebastian. Florida, hereto- fore, now and hereafter adopted or proYlded for the government and operation of said cemetery. The lXlndltlons, restrictions and requirements contained In this instrument shall be oovenants 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 with inch rules, replations, resolutions .nd .ordlnances and the oonditlons of the deled of lXlnveyance thereof then the title of such owner In and to said property sh.n tennlnate .nd the lime sh.1l revert to the City of Seb.stlan, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this Instrument to be executed in Its n.me and on its behalf by its M.yor and attested by Its City Clerk and its oorporate oeal to be hereto affixed, the d.y .ndyear Orst above written. "-71aJ W1 (), I / ,J II. AUe.lI .fM/f(.~I.I./..... . . .l1au.a-.~....... If CI17 Clerk ';:.~~~~~~~ L ..~.)./(.V~~. =:,O'm-;(~ MaJOr (QIitv ji;eal) STATE 01' FI..ORIDA COUNTY OF INDIAN RIVER 94 3rd November I HEREBY CERTIFY, That on thla .... ,.. ...........oo... .day 0' ..... ... '" ..oo..oo...........................oo.oo., I....., Arthur L.Firtion Kathryn M. O'Halloran belore me penonally appe.red .oo...oo.....oo.....oo...........oo........................ and ...........oo........ .. . . .. .. . .. .. . .. .. r..p."Ctlvely Mayor and City Clerk 01 the City 0' Se.....tI.n, a munlellml eor""r.t1on under the I..... 01 the Stale 01 Plorida to me known 10 be Ihe Individual. "lid oWcers deserlb...d In and ",ho eu"uled the forrgolnl cuany.n.,., to .. ........oooo....................... )\~1H~Y. ool)ialJ\Qn~ ..~.. :th9.QI.l)~ ..C.oUv,QI..... ......oo................................. . . . .. .. oo .. . oo . . .. . . oo oo . . . .. oo . .. . . .. . .. .. .. .. .. .. oo ... and oeverally aeknowledrd the exeeutlon thereol to be their Iree aet and deed .. sIIch otneers thereunto duly autborbed; and that the OW,,'al oeol 01 oaid corporation I. duly aflJxed thereIn, ond the said conveyance Is the Het and deed of said eorporatlon. WITNESS my olgnature .nd ofll"I.I _I at Sebaotlan, In the lut aforesaid. G)~n UNOAM.8AllEY 0: . ." COMMI8lIIIII' ec 3m24 EllPIIIElI: ... II. t_ .....lIIIlI...., NIle t.--.n Linda M. Galley Name 'Tfi~'_) rn as :s: /'1,.. i' i..-O I \ LA ,'Y"\ Unit i.....r Block 3cJ lot '"') /"''l. .);;0<. ... Date of Mark-out Time' l (J .,~ () C.J1 ,tf'j1' l')>l Date of Burial .~ -", ,/ / /-. /I~' Name of Fl..!nf:lral(Home/' Ji--, O.k'" lr.~_/ C::' /'fE() . .... ""-....J-< ....,. l / l,.... <"" _/.,..'./i~,_,. _ .,.1,..:/ j,Y/if'1,(".J(i,,.!(.?,, . . " Authorized by .J'/' / .i("'lf ""f...' t,/',.- ,.I' , .' 0",,,.1 1/ , {' / ~ i 7. lA. NAME OF DECEDENT-FIRST (GIVEN) Thomas SA. CITY OF DEATH Burbank I lC. LAST (FAMILY) I Collum I 58. COUNTY OF DEAlH-OUTSIDE CALIF., I ENTER STATELos Angeles J. 3~ 3 d /3 35 1/ APPLICATION eo PERMIT FOR DISPOSITION OF .N REMAINS USE BLACK INK ONLY-MAKE NO ERASURES, WHITEOUTS OR OTHER ALTERATIONS I lB. MIDDLE I Joseph 4. SEX 7A. TYPED NAME AND ADDRESS OF CAUFORNA-RlNERAl. DIRECTOR OR PERSON ACTING AS SUCH I 7B. CALIF. LICENSE NUMBER Scovern Mortuary I -IF APPLICABLE 1434 W. Kenneth Road, Glendale, CA 91201 : FD394 1'llOfeb! acIlIIIalIdIt as __ IhIt IIle ~ cislXJsiIion slated herein is one of IIle disposj\ioos authorized by SecIion 1031S ol1llt HaIIIl .. and _ autIlorized 10 SecIion 7100 oIlIle HeaIIlI and Sale Code. ~~s"~~M~Sc~av:l ~=" ~ ~ 9A. AMOUNT OF FEE PAlO I 9B. DATE PERMIT ISSUED, 9C. SIGNATURE OF LOCAL REGISTRAR ISSUING PERMIT AND IS THE AUTHORITY FOR THE DISPOSITION SPECIF1ED I 02/23/1999 I ~~R~:ci:~~~~ ::-:'PE::r'&llESIIl..-WIIIPO$ILOOISa:Wcu-. $7.00 I 1Ni~ . I ~FAX AUTH#273/l664l 90. ADDRESS OF REGISTRAR OF DISTRICT OF DEATH- 19E. ADDRESS OF REGISTRAR OF DISTRICT OF DISPOSmOM- IF DEATH OCCUIIRED IN CAUFORNIA I IF DISPOSITION IS TO OCCUR IN ANOTHER DISTRICT IN CAUFORNIA 313 N. Figueroa Street, Room L-l : Los Angeles, CA 91201 I 10. AUTHORIZED DISPOSITION(S) ctECK APPLICABlE ITEMS D A. BURIAL (INCLUDES ENTOMBMENT) D B. CREMATION DC. DlsposmON OF CREMATED REMAINS onlER THAN IN A CEMETERY D D. SCIENTIFIC USE AQUIOWlEDGIIENT Of APl'I.ICAlIT PERMIT At<< CHANGE IN DISP05 TION REQUIIlfS A NEW PERMIT TO SHOW FINAL DISPOSITION. FOR CORONER'S USE ONLY BURIAL D E. TEMPORARY ENVAULTMENT D F. DISINTERMENT D G. SHIP IN TO CAliFORNIA []I H. TRANSIT TO OUTSIDE OF CAliFORNIA D I. DISPOSITION PENDING-AEMAINS LOCATED AT (Name and Address) llA. NAME AND ADDRESS OF B:~fm CEMETERY . .LI I llB. DATE BURIED F (J , ......":'\\",\ ~~ It.~~ ~ n ;:)f'1 rn :ll w t: w ..... ~ o :::i a.. a.. -< ..... ..... -< W I- W ..... a.. :ll o o CREMATION 13A. NAME AND ADDRESS OF CAlIFORNIA FACILITY RECEIVING REMAINS SCIENTIFIC USE 14A. NAME AND ADDRESS IN RECEIVING STATE OR COUNTRY WHERE 14B. DATE SHIPPED I REMAINS OR CREMATED REMAINS ARE TO BE SHIPPED COX Gifford Funeral Home, 1950 20th St. I I Vero Beach, FL 32960 I ~ SCATTERING AT SEA 15A. ADDRESS, NEAREST POINT ON SHORElINE, OR OTHER DESCRIPTION SUF. 15B. DATE OF 15C. SIGNATURE OF PERSON IN OR FIClENT TO IDEHTIFY FINAL PlACE AJI) CA ~ OF DISPOSITION . DISPOSITION: CHARGE OF DISPosmON DISPosmON OTHER I IN A CEMETERY I I ~ ~ OF THE PERMIT ACCOMPANIES THE REMAINS TO THE STATED PLACE OF DISPOSITION. THE PERSON IN CHARGE OF DISPOSITION IS RESPONSIBLE FOR COMPLETING AND FORWARDING THE PERMIT WITHIN 10 DAYS OF DISPOSITION TO THE REGISTRAR OF THE DISTRICT IN WHICH DISPOSITION OCCURRED OR THE DISTRICT -NEAREST THE POINT WHERE THE CREMATED REMAINS WERE SCATTERED AT SEA. THE LOCAL REGISTRAR MAY DESTROY ANY ORIGINAL OR DUPLICATE PERMIT AFTER ONE YEAR FROM ISSUE DATE. TRANSIT 150. lICl:NSE NUMBER I OF CREMATED RE. I MAINS DISPOSER I -IF APPlICABIf COPY 1 - STATE OF CALIFORNIA. DEPARTMENT OF HEAlTH SERVICES, OFFICE OF STATE REGISTRAR VS 9 (REV. 6/91) J