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Home My WebLink About4-35-37 ---- Paid by CEMETERY Receipt No..... .~..~....... . Dated ...Y ~.~ !?~............... '~~~~k - 35 list Price S .. ... ~ .'. 9.q~ : ~9. Maximum No. Burial Spa.,."... ..... ..... . .llni t 4 , 1,000.00 Net Paid S .................. Monument permitted....................... .. 38 NO. 1.1k5 (Data above thla line 'or CI\J Reeord only) QJ:itu of l'rhulIthtu Q!tmtttry II ttb ,1485 NO. THIS INDENTURE MADE TIIII ..........1 3,th.. ... day of ...-1 AP'\l,~.I;y' . .. ...... ., .. .......... .. .. ... A. D~ l'.~?'..o b.t.....n III. City 0' Seb...tlan. a mUDlclpal corporetlon exlatill, lIDder the laws 0' tbe State 0' Florid.. aa Oraator alld Mary E. Brock .............. ..... ..... ............... ......... .p; 0', "Box' .7-804&9....................................... .... ........... ...... Sebastian, Florida 32978 ............................................. ............................................ ............................................ of tha CollDty 0' ...;t;p.9,:!-!m..~Jx~;-..................... aD'J State ,0' ...~~.<?;r:~c;l.~........................................ u Orantee, WITNBSSETH. That the Grantor for and In conlideratloD of the sum of $ .~.! ~9~ .. .9~ . . . . . . . . . . . . 10 It ~ hand paid, the receipt wbereofls herewith ao- kDowlllqed, does by this iIIstrumeDt paIIt, b....m, sell, retea.., ooDvey and confirm unto the Grantee .. . .~ ~ .. heirs, legal representatives and aasIp. the foUowln& property situated In Sebastian, Indian River County, Florida, to-wlt: AU of LoI(s) .~ ?~~.8, Bloclc, .. ~.~... ,UNIT...~......... ,of Sebastian munlc:ipal cemetery as per Plat Number I thereof recorded In Plat Book 2, at PIlle 6S of the publlc records ill the of lIce of the Clllrk of the CIrcuit Court of St. Luc:ie ColIDty of Florida; said land now IYin& and being In Indian River COlIDty, Florida. To Have and to Hold the IIlIR10 forever; provided that said property shaU be used solllly and exclusively for the Interment of the bWIWI dead and shall be used, kepi and maintained at all times In accordance with the rules and regulatlo.... ordlnan.,.s and resolutions of the City of Sebastian, Florida, hereto- fore, now and bereafter adopted or provided for the go_mnent and operation of aid cemetery. The conditions. restrictions and requlremenll contained In this Instrument shall be cov_ts runnlnl with thD land. In tbo event of the fallwe of lhe owner of any property sltualed within said cemetery to ob- oerve and comply wltb iucb rules, regulations, reaolutlona and .ordlnances and the oondlt1ona of the deed of conveyance tboreof then the title of such owner In and to said property shall terminate and the same shall re_t to the City of Sebastian, Florida. IN WITNESS WHEREOF, 1'110 said party of the first part has c:aused this Instrument to be executed In Its name and on Its behalf by Its Mayor and attested by III City Clerk and Its corporate.... to be bereto affixed, tbo day and year first above wrllten. Att'~4-r- m...Ot!a..~...,.. (j Clly Clerk CITYO~7~ B, ...,........,.,.........',............. . . . . . . . .. . Ma,or Signed, Sealed 1I,Id D.Uv.r.d tln the P. ceOf~ .. . .... . ...................... . /. ...Y:.. /.~....... ~A'rE OF FLORIDA COUN'fY OF INDIAN RIVBR I JlEIlEBY CERTIFY. That oa thla ... J.:},1;h........... ..dey of .... J.1i1.l}.~HI:rY...................................o I'.~ '~o Arthur L. Firtion Kathryn M. O'Halloran befure Ole pcraonaUy appeared .......................................,..........."...,.. and ........................ . .. .. . . . . . . . . .. resp,'eli.ely Mayur and City Clerk of the City 0' Sebaatlan, e munlcll'ol corllor.t1un under the In's 0' the State 0' Florida to me known 10 b. lb. llldlvldunla ond uW..r. aIeoa:r1..... In ond wbo exe.uted th. 'on.golnl cuavey.nce to Mary E. Brock (alilll ~.al) ...............................................................................................,....................................... .. .. . . .. . .. .. .. .. .. .. .. .. . . .. .. .. . . . .. . .. . . . . . . . . ; . . . .., and severally ...knowledl~-u the """"UtlOl' thereof to be their 'ree act and dced a. sucla oWce.. th.r.unto duly .uthor1aed I and that t1ae Official ..el 0' .eld .orpuratlun i. duly eWxed th.reto, and the acid cOllveye.... is the oel ond <ked of aaId corporation. WITNESS my sllnature arad otfldal aeaI at S.baatlan, In the last cfur..ald. RIV~eand at Florid.. the day and ,ca. ..... ..~..... .\.. . .. ....tiLt...........,..... r L; 2~)' ery PubUc. State of rlda at La.,.. J-- _~t ,>~ , ~ 72 , COIIIIIIlaaIon expl~1 "-' /~' l' I Linda M. Galley ('/lJJ ~(f /~ Name :..:.; /:////) / ',) /' ,IVI ( \ ";.{: ,:::-, {~:.', /~':" Z. '\, l! 1':~'~5 Unit .ti, / Block ,,"'~ I~~ -,.......... ,J:) Lot -.<~ -7 -.. Date of Mark-out ,. // /. /'. II '('Y., I f ~,' l t.. ~ I)' Time ; ,.',,' d if Date of Burial Name of Funeral Home ....-.---..." ..'~ " I ,_, f~ --<,'~ /" /~ ~..( .'/ t J -..... I Authorized by .,./~-,'".+, Q.F- r :Brode /. YY6r~ f. -:PO -SVX '7~o~~q ~ehi-5+i an tL wq 70 I Lo.b 3'7/0f,bloc1c:s5, u.n;# ~h11/-". 71! /Ju.d ~;tz; 37- d"-- /-/;l~OrP J)~ )JO, l'-/f{5 " ~ \..., - '- - . . 837 1/12/95 Lots 37 & 38 PaId by CEMETERY Receipt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B 1 0 C k 3 5 List Price $... "~'" 9.q~: ~9. Maximum No. Burial Spaces.............. .11ni t 4 . 1,000.00 Net PaId $ .................. Monument permitted. , . . . . . . . . . . . . . . . . . . . . . NO. 1Arr= ,.,i").) (Data above this line for City Jl,eeord only) R.: JA~U~, ~~o~ llm...u:.. ~ I r:6 11-< "B ~ ~,. 31 , ~ ,,. 1112.1 0,- S~ c:...-- ~~~- ~ " ~~ tS'~ ~\J "k ~ ~ ~O~ ~~>-~~ ~~~1-"~ ~ ~~~ ~ Y-1, ~ 7a ~~.,,~Q Vo '9~ "'& .. . Jl ~8 .~, '" HI Us Q') Q ... LO 7 () CEI M 0 '" ~ en C\J . a: CITY OF SEBASTIAN 0348 V) <( CITY CLERK'S OFFICE ...J (( ...J RECEIPT 0 -~~Af~ ~~Jl{lAjJ a ~ Name o Cash rl Date /-/.y-cJ,7 .(Check # ~rJ{ )7 0 Amount Paid il3 ,,; - W " ~ - . ." a .0 .:: ci ~ -;:::, . . ~ ~ 0 z ... ..: <C .j: <CU) .; a:<c ." ~m ::- ."U)W 4 ~ .WU) ~:i":' ~ CD .::oz ~lQ :::c:>>~...J!'3 1 ...IOCllu.N J: -ID :: <CCJ\;:13'9 : II:CJ ... U5 u; :W<ClDlDlll ,;;zwa;o:i il3:>>CJ a:o.. II.z ~ (/) ~<C z> :>>Q II:<C I-::c U)U) <C CJ u. o Wa: >-J:w 1-0 <(0 a: 0..1- 0 VB u":>fRW/fJ'a'fA"Ii)O ~ 3~ ~ 8~t!l 5a~~ COO 01 ilCD. . 2ilb =::~! ~ ~ liL~ lIIi", i - a: o u.. A.1.3.:lVS Qil NVIOI:IVna tlJ o ru o .. - t'- lS1 o ru ... o t'- tlJ' o .. - ~ []'" lS1 o ru o o 001001 208001 001501322900 001501 341920 001501 341910 001501 362100 001501 362100 001501 362150 001501 343800 601010343800 001501 369400 001501369400 680800 220681 680800 220682 680800 220683 Sales Tax Garage Sales Copies/Bid Specs LDC/Code of Ordinances Community Center Rent Yacht Club Rent Non Taxable Rent Cemetery Lots Cemetery Lots LoVNiche ~ '37 . Block :3 t)' ,Unit Ii- Interment Fee Weekend Service .6~O~1\ Yacht Club Security Deposit /~r:M Community Center Security Deposit Riverview Park Security Deposit iL T""PoW I ~D. M t/ Initials White - Dept. of Origin. Yellow - Fill8nce . Pink _ Applicant FLORIDA DEPARTMENT OF State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (TYPE) James Brock Date of Death (If neither, give street address) Month Day Year First Middle Last Martin Jan. 9 2002 Melbourne Name of Hosp. or Inst. Holmes Regional Medical Center 2. Place of Death County B rev a rd 3. Name of Medical Certifier City, Town or Location 4. Name of Funeral Home/OiI;eet B;"l'utictl"" Establishment Strunk Funeral Home a. D Physician Address Address 1750 Cedar Street Rockledge , FL 1623 N. Central Ave. Sebastian, FL Phone Number Paul Vasallo, M. E. Medical Examiner 321-633-1981 Fla. Lic. No./Reg. No. Phone No. (Area Code) 1228 561-589-1000 5. Check Appropriate Box The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. D was contacted on He/she verified that this death was from natural causes, that there was no accident nor other extemal cause of death, and that will complete and sign the medical certification of cause of death within 72 hours. Johnny Dr. Vasa was contacted on 1 /11 /02 . He/she verified that , Medical Examiner, will complete and sign the c. ~ ~ireat Di~fJvo;)crr eath within 72 hours. F.E. No./Reg. No. 1862 Date Signed 1 /10/02 6. Funeral Director/ B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-02-0018 DA five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. D No extension of time for filing the death certificate has been requested. n.g;.;tlIClI VI ......... Date Issued: 1 / 1 0 / 02 Date Certificate Due: 1 /15/02 Subregistrar Signature C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Approval Number: Date 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. Method of Disposition: CEMETERY OR CREMATORY Place of Disposition Sebastian Cemetery D. ~BURIAL DCREMATION Signature of Sexton or Person-In-Charge o STORAGE o OTHER (Specify) } ,;(jJ 'l "r ~i!~)(/, Date of Disposition / //;( /O';l-/ , , 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 County Health Department in the county where disposition occurred. DH 326, 8/97 (Obsoletes all previous editions) (Stock Number: 5740.000-0326-2) Distribution: Whrte: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: local Registrar