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Paid by CEMETERY Receipt No.. .~.3Q
List Price $..~ }.9~9. '. ~9....
Net Paid $ ..~ !.?~?:. ??....
........Dated..J/~)/.9.L.............. Lots ~':l & 34
Block
Maximum No. Burial Spaces................ .Uni t ..
NO.
~
Monument permitted. . . .. .. . . .. . .. . .. . . .. . .
"1487
(D.t. .boYe tbll line for Clt'.' Reeon;l ouly)
mUll nf l'tbastian
<1!rmrtrry
I r ria
'1487
NO.
THIS INDENTURE MADE 'I1dI
26th
.... ... d.y of ......... ~ ~.t.t.~~:r-:r........................ A. D~ "..~.~.,
bet...een Ihe City of Seb..tI.... . launlelpal corpor.tlon alltln. under the 1._ of tbe St.te of Florid.. II Gr.ntor .nd
Mrs. Mildred U. O'Grady
....................... ....... ........l}'62. 'G~!'o'tgl!"Stre'e.t......................................... ......... ............
.................. ..... ...... ............ ..~.el>lis.~.~li~,..n?~.~~li J~?~.~..... ....................... .....................
of Ibe Connt, of .....Indi.an..Ri:vex:................... .nl SI.te of ......F.1.orida.....................................
u Gr.ntee, WITNESSETH I
That the Grantor for and In consideration of the sum of S .\ J.QQ9. '. 9.Q.. .. .. . . .. .. . to It in hand paid, the receipt wbereof is herewltb.c>-
knowledged, does by this instrument grant, b.qain, ..D, releue, convey and confirm unto the Grantee . h~.t;. .. heirs, lopl repreaent.tlvN and lnigaS
the foUowlnl property situated in Seb.stian,lndlan RIver County, Floridl, to-wit:
An of Lot(,) ~ ~ ~.~~ , Block, . . J.4. .. ,UNIT ....4........ ,of Sebastian munidpal cemetery IS per Plat Number 1 tbereof recorded In Plat
Book 2, at pqe 65 of tbe pubUe records in the of lice of tbe Clerk of the Circuit Court of St. Lude County of Florid.; .Id land now lyins Ind beiDB
In Indian River County, Florid..
To Hive .nd to Hold the .me forever; proYided th.t said property shan be u...s solely and exelualftly for tbe interment of tbe humID dead .nd shall
be uled, kept and m.intaiJled It an tillllll in .ccordance with the rule. and resulatlons, ordlnlnces .nd resolutionl of the City of Sebastian, Florldl, hereto-
fore, now and bereafter adopted Or proYided for tbe government and operation of .Id cemetery. The condition.. restrictions Ind requirement' conlalned
in tbla instrument ,hall be covenants runninl with the land. In the event of the failure of the owner of any property situated within .Id cemetery to ob-
serve and comply with inch rule.. regulation.. relOlutiona and ordinanc:e, and the conditions of the dl!ed of conveyance thereof then the title of such owner
in IDd to .id property shan terminate .nd the .me shall revert to the City of Sebastian, Fiorld..
IN WITNESS WHEREOF, The said party of the first put has caused this Instrument 10 be executed in it, name and on its behalf by Its Mayor and
attested by Its City Clerk and Its corporate ..al to be hereto affixed, tbe day and year first above written.
Attest:
..~C;;)JJ:2=H...H....HH
C'TYi:!i?S ;Z~~:Z:~1..
M.,or
~~~. ~:::'~HHPHHPH (C.._I
~ ..2/.Jf~..........
STATE OF FLORIDA
COl'N'fY OF INDIAN RIVER
I HEllImy CERTIFY, Th.t on tbla .....~.~~~.............d.y of ..........~~.I?-~!":~X.............................. I~.~..
befure me person.Uy .p~9l9!I ..... A~~.~~~ ..J;...~ ..r~.J;'.~;l,9.t:I........................ and l:!~p.y..~!.. MM.<?.................
relprcUv.ly M.yor In(~ti1Clerk of tbe Clt, of Sebastian, a municipal eor""ratlon under tbl! I.... of tbe St.t. of Florida to me known
10 be the Individual I "ud offle... described In and wbo aerutlod tbe forrlJOinl eORvey.nee 10
.............. ............. ................MrS... .Mildr.ed. .li.. .Q!.G.rady........................... ........ .................
. . . . . .. .. . .. .. . . .. .. . . .. .. . . . . .. . . .. .. .. .. .. .. .. .. . . . ... .nd ,nerally aeknowledard tbe exerutlOl' thereof 10 be their free ..1 and .leed
u such officers ther.unto duly autborlsed; .nd tb.t tbe Orn.lal .eal of 1.ld corporation II duly af"X~edh.re and lb. ..Id .onyef.nee
I. Ibe He! und deed of said corporation.
WITNESS my Ilpltun! and offlcl.1 _I .t Seb.ltl.... in tbe unly of Ja~1 , Rlyer as;' F~~ Ihe d., and yea,
lut "'or....d. 't!lt:..-ti
(/"ftA. UNllA M. BALlEY / /, . ?/ .
~ ::.=1:- ~i ~~::{e7;;i~t.~<~(:{~~
Name
QeKP.4..5.:>
F.
-) .. /,'" ,.., ".
r l.1((:I';\".l"
'{
Unit
Ll
Block
? \../
.~J ~
Lot
':';:,1./
Date of Mark-out ',: .',,' (!
Date of Burial
\ i ,<.'
~ i .~:"I i
Co); "'"
Ii ",
Time
t /~,i,
..,."...... ;/.
Name of Funeral Home
:~,,"l.- .,"--', '-. .. - t
......,.,,' l~..,,",) '{'-" .,:.:.,
"" ......./ ,..'
Authoriz.El? bY~..~:;:<:_(-:--;(/ ,
\,-
,;(;:;,. /,1./
" "'C'
;{':"';:':l <(
[l;.l.~]
State of Florida, Depart"llt. of Health and Rehabilitative Services, Vita.tistics
APPLlCA_ FOR BURIAL - TRANSIT PERMIT
L 331 3L-/
/3 3/;'
VII
A.
1. Name of
Deceased
(Type or Print)
First
Gerald
Middle
Francis
Last
O'Grady
Month Day
01/16/1995
Year
DATE
OF
DEATH
2. Place of Death
County
Indian River
City, Town or Location
Roseland
Name of (If neither, give street address)
Hosp. or
Inst. Sebast ian River Medical Center
T- Medical Examiner Address Phone Number
7744 Bay St. Suite 2
*1 Physician Sebastian, Florida 32958 (407)589-0879
Address Fla. Uc. No.1 Reg. No. Phone Number (Area Code)
1623 North Central Avenue
P.A. Sebastian, FI 32958 1228 (407}562-2325
3. Name of Medical
Certifier
N. Noor Merchant, M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes,
5. Check a 0
Appro-
priate
Box b tI
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
Pam was contacted on 01/18/1995within 72
hours after death. He/she verified that this.death was. .fromJ!1atural causes, that there was no accident
N. Noor Mercuant, M.V. '11 It
nor other external cause of death, and that WI comp e e
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
7.
Indian River
F.E. No.lReg. No.
1672
Removal
from state Donation
Date Signed
01/18/1995
6.
B.
BURIAL - TRANSIT PERMIT
1228-95-0043
Permit No.
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 t'}f\ death certificate requested.
Registrar or AJl.A. AD'" AI 7---;'- ___ . IDsasueted.. /_/~_ rS Date Certificate.;l~ 7~-
Subregistrar Signature ~ ~ 0 ,~, - 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.
CEMETERY OR CREMATORY
Methods of Disposition:
JI BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition - ~ .h-7r;'~1"
Date of Disposition (j4A'>~ a-'d-
/
~~:J:
c9" . I 9 / S-
.
Signature of Sexton )
or Person-in-Gharge) .-yf1~';:" .9. 1'./-1
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)