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Paid by CEMETERY Receipt No....~ ?Q......... Dated..... ~n I.?~............... Lo ts 11 & 12
Lisl Price S .. .. ~.~ ?9~: .Q9.. Maximum No. Bwial Spaces... .............. ~~~il .., 4
, 1,500.00
Net Paid $ .................. Monument permitted. . . .. .. . . . . . . .. . . . . . . . .
NO.
14 ~::J'/
(Data above thl. line lor City IUcord only)
((tUy of &ebulItiun
,1487
Q!.rmrtery
It r ell
NO.
THIS INDENTURE MADE 'I1oIa
3rd
day of
April
95
A. D., 18,.....,
b.l.....n lh. City of Sebastian, a municipal corporation eai.Uns under the law. 01 the Stat. of Florida, AI Grantor and
.".,.,..,.............,............... .....Tame,s,.W... .Play.er,,.. .Jr.......,..,
9985 88th Street
, .. .. .. , .. , .. .... . ........ .. ........... .. VerQ.. Bea.c;:h.,.. ,F.lot'i,da.. 32.96:], . . . . .. , .... , , , . .. , .. . .... . .. ... .. . .... .. ..
01 Ihe County 0' . J,I).4;i..~.~.. R;i..v,~;t:...................... an-J State 0' ....... ..li'lp.t'.i.cla..................................
Ii Grantee, WITNESSETH.
That the Grllltor for and in consideration of the sum of S .. J.~ ?Q~: .QQ. . . . . .. . . . . 10 it in hand paid. the receipt whereor Is herewith ac-
knowledged, does by this instrument grant, bal\l.m. seD, release, convey and conrirm Unto the Grantee. . h~ ~ .. heirs, 1e8l1 repre..nlatives and assigns
the foDowing property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lol(s) .~ ~.~ ~.2, Block, .. . .. ;3.~ ,UNIT .....4....... ,of Sebastian municipal cemetery as per Plat Number 1 thereor recorded in Plat
Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court or 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 shaD be used solely and exclusively for the interment of the hUmlll dead and shall
be used, kept and maintained at aD times in accordance with the rules and regulatioJIJI, ordinances and resolutions of the City of Sebastian, Florida, hereto-
rore, now and hereafter adopted or provided for the government and operation of said cemetery. The cOnditions, restrictions and requirements contained
in this instrument shaD be covenants 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 Such ruJes, regulations, resolutions and ordinances and the conditions of the dcred or conveYlllce thereor then the title of such owner
in and to said property shaD terminate and the same shail revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party or the fust part has elused this instrument 10 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 afflXed, the day and year fust above written.
~~w )J1 !J:d-eI-L
AtI..t1 .",."..,. ~.. , , , , , , , ...... ...........~.,....
City Clerk
d and DellVeren
,.~ L./)./!{~.f.~.~...~.,.,.
TL~...~.............
~~-;~ OF FLORIDA
COl'NTY OF INDIAN RIVER
CITYO~~
B~"""""""""'"'''''''''''' .
MaJor
((([ill! "stili)
April 95
I IIElllmy CEIlTIFY, That on this ...................... ..day 01 ............................................, 18....,
bdllre 111. personally appeared... A~.~~~~.. ~.... .~.~~t,~.,?~.."................... andK.l:!-l::h;"Y~..~:.. Q .'.tI.~.U9.J;.l').~.
resp",etivdy M~y()r ~nd City Clerk 01 the City 01 S.bullan, a lRunlcll,~1 corJlorntlon umler the laws of thc State of l'lorida to m. known
lo be the indh'iLluuls um) offlccn ueacribed in Mild who executed the fur(.going cUMveyunce to
3rd
....".,.,....,......... .......... ............ ..J.~I1I~l;l.. N.,., .~.l.FlY:~.t... .J.t........ ...."......,.....,.,............."...........
, . . . . , .. . .. . . . , . . , . . . , . . . . , . . . . ...... .. . . ... ... . . , . .. and severally ~eknowledgt'd thc execution thereof 10 be their fr.. .ct and d.ed
.. sneh offic... th.reunto duly ~uthori&ed; and th..t the Official s.al of saitl eorpul'11l1un Is duly affix.... ..r.tu, and the said conveyane.
is tbe /let and d..d uf said corporation.
[ ~..... - .-
. j~'/!I"~. LINDA M. lWJ.EY
j'i~:'l MY COIHSSlOH.' CC 81&724
W- . i EXPIAES: June 18, 1888
~~... _ThNIIol&IyNllc--...
Ida, the d.y and Jear
WITNESS IRY signature and official seal at SebasUan, in the
1..1 .fo,esaid.
Name51\M 1'::. S , \., ').
(j J... A u. '(.12-
I \
i
" ,,)
I. C /GEM A I ;is
'I I, ,fS
Unit J./
Block '3'1
Lot 1"--
Date of Burial
(w,:TH ~ I~
(:tIt /9-,
~ J
/::z / I / 9 '-r
.
F ,," ,.,. \
" A \~, i" ,/\
., .. ""-" ~~,~- /
Date of Mark-out
Time /1 ;0-0 A
......-~' - '"
Name of Funaral HOll'lE{' ./ / t:::" ". hi K
,.'., "
..,,<../--.") ,
.' ~~.
Authorized by , -'
/
::r
.
Paid by CEMETERY Receipt No....~ ?Q........ . Dated.. .. . ~!.~ I.~?... . .. .......... La t s 11 & 12
.. 1,500.00 .' Block 34
List Pnce $ ...,.............. Maxunum No. Burial Spaces -...... -......... Uni t 4
Net Paid $ .... ~.'. ??~ ~ .~?. Monument permitted...................... .
NO.
14~7
(Data above this line for City Record only)
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as 'c 0 '0 - 1ii '5
as III
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rm kJ. 'f.l..o, r ~ oJ /t If! ~)i:tJ1 /;).
[lP.~1
State of Florida, Departm.f Health and Rehabilitative Services, Vital .stics
APPLlCAT FOR BURIAL - TRANSIT PERMIT
), III / ~-
(33i
tl1
A.
1. Name of
Deceased
(Type or Print)
First
James
Middle
Warren
Last
Player, Sr.
DATE
OF
DEATH
Month Day
03/26/95
Year
2. Place of Death
County
Brevard
3. Name of Medical
Certifier
Timoth S. Truitt
4. Name of Funeral Home/
Direct Disposer
City. Town or Location
edical Examiner
Name of (If neither. give street address)
Hosp. or
Inst. P 1 Ba C .
a m ommunlt
Address
ital
Phone Number
Palm Ba
M.D.
5270 Babcock St. N.E.
Palm Ba Florida 32905 407 724-9496
Fla. Lic. No./Reg. No. Phone Number (Area Code)
1623 North Central Avenue
P.A. Sebastian FI 32958 1228 407 562-2325
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
--- .
(l)~. /.~/?/
hours after death. He/she verified that this deat
nor other external cause of death, and that
and sign the medical certification of cause of death.
9f. Ti'lii it
Tj'I_llJ 3. L ~t.., un.
was contacted on J.~ ~-:ithin 72
from natural causes, that there was no accident
will complete
Strunk
5. Check
Appro-
priate
Box
Funeral Homes
a 0
b 0
c Ci
was contacted on 03/27/95. He/she verified that
. M$d;,,'!1 e:^....,,;I..!r. will complete and sign the
medical certification.
6. Place of Sebast ian
Final Disposition:
7. Funeral Director /
Direct Disposer
Indian River
F.E. No./Reg. No.
1672
Removal
from state Donation
Date Signed
03/27/95
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 th death certificate requested.
Registrar or ~
Subregistrar Signature
Permit No.
1228-95-0176
Date ~ t:::i_ Date Certificate
Issued: .../ _ '2 7_ (:) Due:
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.
Methods of Disposition:
. BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
CEMETERY OR CREMATORY
Place of Disposition S E.~ 4"5 11 -4 ~ C /E..Jv"'I Jt: U ,If!. 'f -
Date of Disposition -3 /30 /1 -r-
Signature of Sexton )
or Person-in-Charge)
/~ ,.
~~7'
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)
:T.