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!'sId by CEMETERY R.ceipt No.....p '-">
List Price S....~ 1.9~9.'. 9.9..
N.tPaldS ....~!.~~?:~.?.
....... D.t.d.... .~n.?!.?5............... Lots 3'-
Block
M.xlmum No. Burial Spaces.. . .. . .. ... .. .. .Uni t 4
~ 36
NO.
Monument permitted. .. ........ ........ ... .
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(Data aboy. thl. IIn. 'or Clt, Reeord onl,)
(!J:Uu nf &rhulIthtU
Q!tmtttry
II ttb
,1485
NO.
THIS INDENTURE MADE TIIII
17th
........ day 0'
March
95
A. D~ I'.......
bet,....n 'h. City 0' S.bastl.n, a municipal corporation <x1.Un, undcr the J.w. 0' th. Stat. 0' Florid.. .. Orantor .nd
Mrs. Melba Bishop
..................... ............... ......... '4-81' 'Candle' .Avenue.................................................. ......
Sebatsian, Florida 32958
.......................................... ............................................ ............................................
0' the Count, 0' ....... ;J;~9-.:t~~ ..~;i, Y~,J;.. .... ..... " .... .n'.1 SI.t. 0' ..........~;I, ~.~.~~~.. .. .. .. .. .. .. .. ..... .. .... .. . .. .
u Or.ntee, WITNESSETH I
That th. Grantor for and In consld.ration of the sum of S . ~ 1.Q9.9:. 9.Q . ...... . . .. . . to It ~ hand paid, the receipt whereof Is h.rewlth.o-
knowledged. do.. by this Instrument grant, blrlaiil, ..U, r.I..... oonvey .nd oonfIrm unto the Gr.nt.e .... '7!... h.Irs,1epl representatives and .aslps
the foUowlng prop.rty situated In S.b.stlan, Indian RIver County, Florid., to-wlt:
AU of Lot(s) .~? ~ ~ ~ Bloclc. . . ~. ~ . .. ,UNIT ...~......... ,of Sebastian municipal cem.t.ry .s per Plat Number 1 thereof recorded In Plat
Book 2, .t Pili. 6S of the pubUc records In the oroce of the Clerk of the Circuit Court of SL Luc:ie County of Florida: said land now lying and being
In Indian River County, Florida.
To H.y. .nd to Hold the same fore_; proYlded th.t said prop.rty shaU be used solely and .xcluslvely for th.lnt.rment ofthe human dead .nd shall
be used, k.pt and maintained .t .U t11lle11n .ccordance with the rul.. .nd regulations, ordinances .nd resolution. of the City of Sebastian, Florid., hereto.
fore, now .nd hereafter .dopted or pronded for the governm.nt and oper.tlon of said cemetery. The oondltlons, r.strIct1on. and requlr.ment. contained
In thl. Instrument .haU be oovenant. running with the land. In the event of the failure of the own.r of .ny property situated within said cemet.ry to ob.
serve and oomply with iueb rul.., regulations, resolution..nd ordinance. and the condition. of the deed of conveyance thereof then th. title of such owner
In .nd to said property shall termln.t. and the same shall r.vert to th. City of S.b.stlan, Florida.
IN WITNESS WHEREOF. The said p.rty of the first part has caused thl.lnstrument to be .x.cuted In Its n.me and on It. behalf by It. Mayor .nd
.tt..ted by It. City Clerk and It. corpor.te ...1 to b. h.reto affixed, the d.y .nd year first above written.
Atl.st~~.JrJ. ..~ 11..~.......,..
City C1.rk
~~,~'Z~n
M.,or
Rlgnrd, Sealed .nd Dellnred
In the "".n.r 0':. . .~............., (GritV JiJ~al)
I L.....;)~.
STATE OF FLORIDA
COl'NTY OF INDIAN RIVER
I HEltEDY CERTIFY, That on thl. ..........~l~~........d.y 0' .................!:f.~~~.l.t........................... ...~.~.
Arthur L. Firtion Kathryn M. O'Halloran
brror. m. per.on.lly appearrd ........................................................... .nd ..",..................................
r..p,"'Uv.ly M.yor .nd City Clerk 0' the City 0' S.ba.ti.n, a munlel".1 eorporatlon und.r the In', 0' the Stat. 0' Florida to m. known
10 be the Indlvldu.l. ,,"d officers tI...rl....... In ond who .x.euled the fOft'lIVlng coav.y.ncr to
....................,.............................. ~~.~.:.. ~~.~.~~. .~.;.~h<?.I?...............,............,.............,...........
. . . . .. . . . .. . .. .. . . . . . .. .. . . .. .. . . .. . . . . . .. .. . . . . .. . .. . .. .nd ..yrrally acknowledged the .xecutlon thereo' to be their 'r.. .et ond dred
II .nch office.. th.r.ullto duly .uthorlled; and that the Official ...1 of ..Id corporation I. dul, .,"x.d therrto, ....d the ..Id ronY'fanc.
I. the /let .nd d.ed 0' said corporation.
WITNESS 10' .Ign.ture .nd offlcl.1 aeaI at S.ba.Uan, In th.
1..1 afor...ld.
Q) l.lNOA M. 8AUEY
0; ; MY CCIMBllIlN , CC 371724
EllI'lIEB: ..... '" ,.
, ........"... ...., NIl 0IdIIMlIIlI
Linda M. Galley
5 ec 1/ r j fell h II /I '-J! d II 0 ',II fI! t tl t.. See. b Q , k
STRUNK FONERAL HOMES PA
CASH ADVANCE ACCOUNT~SEBAS;'AN
11161TTH ST.
VEROBEACH, FL 32lI60
PH. 561-562C2325
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Indiao ~ NalID.al Bank. _JIlN..-
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 2 6 1 7
RECEIPT
N...~7-.4 ~o_
Date . ~ '. ;Z; ;I;;~
No.. ..' Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 " Copies/Bid Specs.
001501 341910 LDClCode of Ordinances
001501341930 Election Qualilying Fees
601010343800 Cemetery Lois
LotINlche Block
,Unit
- %:tJd
001501 343805
Cemetery Fees
/f.E~ ~d, .
I.Ifj ,$1<; LJ5
t2t
Total Paid z.....cPr"
Whit. - DIlpt. of Origin. Y.low - Fin.nc. . Pink. Applic.nt
Dr II e t n, ;Is. riI
4184
DATE
. 63-12061e70
01
'1 (.t:)0
DOLLARS fn
=-
---
o 10r:~~"br--~-~ ~
Name
/;1 i
( hi Ie it ::)
w:
--t.
) 1 .f:;:~ t~. /)" ;....~
, j., ~ l"~
I
Unit ~
Block 3<:r
-,,"'~. ,
Lot ..jl(;
f
Date of Mark-out
/
31 ),:;-/9')'
I
Date of Burial
/, /' r
/j ., ,}.,,-
~ 7/ 1(,:' . 7,)
Time
;'.'00
,,{'J... /?}...
'"
, ..<,r';,/"
Name of Fune~al Home f-Jt K {,j J"vt( · :i
. . ><~/. " :J(; ';/1 (
Authorized ~y;"'-1/ 7c " t/--( f.~, .,
-.' //
f . ,:2( .._{
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.,_, ,c,_..", ,3".
[1I1.~]
State of Florida, Depart.t of Health and Rehabilitative Services, Vita.tistics
APPLlC N FOR BURIAL - TRANSIT PERMIT
,?- 30'/310
/0 3S
vi
A.
1. Name of
Deceased
(Type or Print)
First
Charles
Middle
'" Wash:ington~,rc
Last
'B i shop, 111....
DATE Month Day
OF
DEAll'f' "-.03/14/95
Year
Sebastian"
Name of (If neither, give street address)
Hosp. or
Inst.
-",~ 48~'Candle-'Avenue
Address
Phone Number
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
City, Town or Location
"Thomas A.Netter M.D.
4. Name of Funeral Home/
Direct Disposer
.. Strunk,.Funeral.' Homes-
5. Check a 0
Appro-
priate
Box
13840 U.S.# 1-- "'
::.. .. ..,Sebast ian-'F l-onda'"'..a2~58 ....,. 4 589-~2---'
Fla. Lie. No.1 Reg. No. Phone Number (Area Code)
1623 North<-Cen~ral-Avenue"--
, p .A.--~.- "'Sebast iart'i"-F-l-32958- -.--,,- ....:,..~22&-,....,-- . 562-i-3~S-~'
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b. lJ: .. S~e .---...---..---- -- --. ., was-contaete&oo,- --<Bf14j.Q5--wit.~in 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 tha\.... Thomas' A. .-Net.ter-o 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
medical certification.
6. Place of..Sebas-ti-an' €emeteTY
Final Disposition:
7. Funeral Director/
Direct Disposer
'," Indian",Rive-l"- '"
F.E. No.lReg. No.
.,
Removal
from state Donation
Date Signed
..........-.-.....---
B.
BURIAL - TRANSIT PERMIT
Permit No.
t228-9:5-0148
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.
Registrar or . r - ~
Subregistrar Signature . I),. ,-
Date 3 II/. L7 ~ Date Certif~te., f'r'
Issued: - - 7 .J Due: _ A,O- v
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT-SEA
Signature
or
Medical Examiner,
, Medical Examiner
Date
, 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
Signature of Sexton )
or Person-in-Charge)
o STORAGE
o OTHER (Specify)
<'1' 9' j(~,
Place of Disposition Si!./3A:S 7:11 y{ _ C /!, 1J't,,~ter .
Date of Disposition ~ // '" I <i ~
Methods of Disposition:
. BURIAL
o CREMATION
This permit must be endorsed by the Sexton or person-in-charge (or by tile 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)
(Slack Number: 5740-000-0326-2)
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