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Home My WebLink About4-34-36 ~ ~ Paid by CEMETERY Receipt No. .. List Price S...~ l.q9.q...~.q... 1,000.00 NetPaidS .................. .~..... ..Dated.... ..~t.~ !.?~ ............... Lots & 36 Block" ,j4 Maximum No. Bwial Spaces. .. .. ... . . . .. ... Uni t 4 NO. Monument permitted. . . .. . . . . .. . . . . . . .. .. . . 1483 (Data above thla line 'or City Record ooly) Q!itt! of &tbastian .1483 O!emetery m eeb NO. THIS INDENTURE MADE 'l1oIs 8th day of March 95 A. D., 18....... between the City of SebAstian, a wunlclpal corporation .,.I.tlns undcr the laws of tbe State of Florida, aa Graotor alld Mrs. Opal Clemons , . . . . . .. . . . . .. . . .. ... . . . . . . . .. .... . . . P ; '0' ~. . BO'X' '11'2' . .. . . . . ... . . . . . . . . .. ,............................ ............... ... R.?~~~~.~.~.... X~.~~~.~.<;i. }??~? of lhe Collnty 0' ". ):.I)!:U-.c;I.Q..R:j..V~J::.................... ao'l Slate a' . Flor.i.da......................................... .. Granlee. WITNESSETH. That tbe Grantor for and in consideration of the sum of S .. J.~ 9.Q~ :.qP........... to it in hand paid, tbe receipt whereof Is berewltb ac- knowledged, does by this Instrumeot grant, barg.u., sell, release, convey and confirm unto the Grantee .I] ~ l? . .. heirs, legal representatives and assigns Ihe following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot(s) .~ ?~ ~ 6, Block, . . ;3.4. .. ,UNIT .....4......, ,of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat Book 2, at page 6S of the public records in tbe ofllce of tbe Clerk of the Circuit Court of St. Lucie County of Florida; said land now lying and being in Indian River County, Florida. To llave and to Hold the same forever; provided tbat said property shall be used solely and exclusively for tbe interment of tbe buman dead and shall be used, kept and maintained at all times In accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and bereafter adopted or prOVided for the government and operation of said cemetery. Tbe conditions, restrictions and requirements contained In tbia instrument shall be covenants running with the iand. In the event of the failwe of the owner of any property situated within said cemetery to ob- serve and comply witb ;uclt rules, regulations, resolutions and ordinances and the conditions of tbe de'ed of conveyance thereof then the title of such owner in and to said property shaIIlerminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the fust part has caused tbia instrument to 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 affIXed, the day and year fust above written. Att.~~. !nl)J!tU.L!:-t!.~:'=........ tl . . City Clerk Dr ~~ ..........: .... MaJor 1i1llnCdt alld Dcllvered In tb rt!lien e 011 . ~.. :'. .~............... L~~HHHH (Qlite ~~lll) STATE OF FI.OIUDA COUNTY OF INDIAN RIVER March 95 18.. ... 8th I HEIlEBY CEBTII>Y, That on this... .......... ..... ..... .day Of . .................................................., bdure me per.onally appeared A~.~!!-~~...~.~..f.~.~.~~.?x;t.......................... and K~.~~~X.~..~:..~.'.~~.~~?~.~~.. respectively Mayor an<l City Clerk of tbe City of Sebastian, a municipal c:orporatloll under lhe Ian of the State of Florida to me kllown to be the indivicJuuls un&) officeu deiicrib&:d In und who ex.ecutL-d the lot('guilll CONveyance to ............................................... }1J::~.... QP';;1,J,... Qlli!Jl.l~HH'........................................................ . . . . . . . .. . .. . . . . . . . . . . . . . .. . . . .. . . . ... ... . .. ... .... . .. .. and severally acknowledll,'d the .xecutlon thereof 10 be Ihelr free ad and deed lIS .such olticers thereunto duly liuthorbed i and that the Offici.J 5eul of IiMid corpotH.liun I>> duly ullixt'd tbt'rcto. And the IMid cunv~)'unc~ is tho lid IIl1d <I..d of ...Id corporation. W ITN ESS my slgoalure and official Ileal at SebaaUan, In 1..1 uforC8aid. v UNDA M. llALLEY MY COIoWISSIlIII' CC 315124 EllPUlES: Juns la. 1_ lIandsd 'Il1N -,........ UIldoNolIn fm] State of Florida, Department of Health and Rehabilitative Services, V_Statistics APPLelON FOR BURIAL - TRANSIT PERMIT L. 3-5-/3t; /0 .3~ Vi A. 1 . Name of Deceased (Type or Print) First Jason Middle Last Clemons DATE OF DEATH Month Day 02127/95 Year 2. Place of Death County Brevard 3. Name of Medical Certifier City, Town or Location Thomas J. Kline, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, 5. Check a 0 Appro- priate Box o Medical Examiner rxJ Physician Address Name of (If neither, give street address) Hosp. or Inst. H 1 R' I Md' 1 C o mes eglOna e lea enter Address Phone Number 95 Bulldog Blvd. Melbourne, Florida 32901 (407)722-1811 Fla. Lie. No.1 Reg. No. Phone Number (Area Code) Me 1 bourne 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. b Ea T<:atD)' was contacted on 02/2'7,195 within 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 that Thomas J. K 1 i ne. 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 6. Place of Sebas t ian Final Disposition: 7. Funeral Director/ Direct Disposer medical certification. Indian River F.E. No.1 Reg. No. Removal from state Donation Date Signed , B. BURIAL - TRANSIT PERMIT Pe 't N 1228-95-0115 ~ssion is hereby granted to dispose of this bOdy. rml o. lJd"'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 ---I . __ _ Date "'1_" ~_ a_D Duaet~. Certifica_te n _ 0,..- Subregistrar Signature - ..c;.r--,- Issued: t:::I'(, "~7~ ~ ~ 7-0:. 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: IiJ BURIAL o CREMATION o STORAGE o OTHER (Specify) CEMETERY OR CREMATORY Place of Disposition .JIL~k~-.. d_..~)' Date of Disposition '-n?",_ ('.J. .:z, / ~ "1 ~ . Signature of Sexton ) or Person-in-Charge ) .4rL,,~., t?.eo L I This permit must be endorsed by the Sexton or person-,ln-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 COfJnty where disposition occurred. HRS Form 326. Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2) J. Name ;~... //p) '_' C: j. ,I../"', / ~:' /1"'" () ,~.,.' f\ ".r - . ,." ,/ Unit Block . ~:,! Lot re. : ;; (<.";' Date of Mark-out ,/ / ." <- . '? .' / :'~f .:,;""'_.. Date of Burial ,; /2\ / 'Or' ,;, " -."'t ~., . , J , ,. Time Na.!:,!e.~!!.u~ral HOIJ'8J~/0:~ '.' \ "'\. / /': . / " : / . \, ,,~.-.....- 1 / ' . ;'f " Auth~r~~Qy ~,.I'.cPj< ./~.c;;. ;'?'t /' / . I \..- .,> I~""- ,'- . Paid by CEMETERY Receipt No. .... ~~.~...... .Dated..... ~t.~!.?~............... Lots 35 & 36 .. 1,000.00 .' . Block 34 List Pnce $ . . . . . . . . . . . . . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . .. . . . Uni t 4 Net Paid $ .. ~ ~.~~.9:.?~... Monument permitted....................... (Data above this line tor City Reeord oDly) ., ~ NO. 1483