HomeMy WebLinkAbout4-33-06
~
Paid by CEMETERY Rece\pt No. . . . . ?~
1,000.OU
List Price $..................
1,000.00
Net Paid $ ..................
..... Dated....~ /.~.~?~.................
Lots 5
Block _
Maximum No. Burial Spaces.. .. .. .. .. .. . .. . . Un it 4
<;
NO.
"14.13
Monument permitted. . . .. .. . .. .. . .. . .. . .. . .
/'
(Data abo... thl. line for City Rec:ord only)
QUty nf l'r bustiun
'14.10
ClLemetery
m eell
NO.
THIS INDENTURE MADE TlIII
4th
day of
August
93
A. D~ 19.......
bet...een Ihe City of Sebaltla... a munlelpal corporation exlllln, under the lawI of the State of Ftorlda, .. Grantor and
Mr. Joseph S. Bendix
........................ ........ ......... '1318"6" 76t'h' . Court .. .................................... .......................
....................... ........... ........... ~~b.a.~.~~~.~.!.. ~~.?r:~~l!I.. .~~??~.. ..........................................
of Ihe County of .. ..+n.4;i..l;l.~.. R:J..v.~~..... .. ............. an'l St.te 01 ..... r.J..9.r; ;i,9,l;l......... ....... .... ..................
u G..nt.... WITNESSETH I
That the Grantor for and in consideradon of the sum of $ . ~ 1.q~<?.. 9.q...... ." .. .to it in .hand paid, the receipt whereoC is herewith ac-
knowledged, does by this instrument grant, bargaiir, seU, release, con..ey and confirm unto the Grantee .~?: l? . .. heirs, legal representatiyes and assigns
the following property situated in Sebastian, Indian RIver County, Florida, to-wit:
AU of Lot(s) .~ ~.l?. ,Block,.}}... ,UNIT ...~......... ,0C Sebastian municipal cemetery as per Piat Number I thereof recorded in Plat
Book 2, at page 65 of the public reoords in the office oC the Clerk of the Circuit Court of 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 shaU be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintained at aU dmes in accordance with the rules and reguiatlons, ordinances and resolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafter adopted or provided for the government and operation of said cemetery, The conditions, restrictions and requirements contained
in this instrument shaU be covenants running with the land. In the ....nt of the failure of the owner of any property situated within said cemetery \0 ob-
serve and comply with such rules, regula dons, resolutions and .ordinances and the conditions of the deed of conveyance thereof then the title of such owner
in and to said property shaU terminate and the same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the fust part has caused this instrument to be execnted 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.
AlteS~~lM.AJ.m. .O'l!!at.k.~.....
. . (j -, City Clerk
(GIillz ~eal)
TATE OF FLORIDA
COl'NTY OF INDIAN RIVER
4th
I HEREny CERTIFY, That on thl. ....................... .day of
August
93
It... ..
b,'f.ore me penonally appeand .~?ry~~~...~.'...P.9~~~.1............................. and .~!'lt.l:1.~y.~..t:f.~..~~.~~~~.9?:~~
".p,'rliyely Mayor and City Clerk of the City of SebA.tlan, a munl"ll'al corporation und.r the In's of thc State of Florid. to me kllown
to be the Individuul. ILl..) officers described In ond who rxecu"~d the for('guing CORvryance to
Mr. Joseph S. Bendix
.......................................................................................................................................
. . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . ... .. . . .. ... . ... ... .. and .....rlllly acknowled,ro the execullon ther""f to be th.lr free aet and deed
OS slI"h offleer. thereullto duly Bulhorbed; and lh.t the OfflelBI seal of .ald eorpuralioll I. duly affixed thereto, alld the said Clloytyanee
Is the net and deed of ..Id eorporalion.
WITNESS my .Ignature and offlelal .eal .t
18&1 afore.ald.
UNDA II. LOt&
NoIBry,....... 01 AIIIIII
.., CGmmIIaIon ~JUN '1,111&
COMM' CC ClI27.-
(
Name
L () . (..f.. IS 1(- oF
-r:
I) /. j,/ /) I 1<
Unit
4/
!
Block
<!;,.. ;iI"-
<: <'
_1 ,..;;
Lot
?,
Date of Mark-out
", I ~ /'"" &.,
/"'1' " '''('?
d' ,,r.,. "'.
~ " .._~
Date of Burial
C",/
A /
......... I
,
/-1,- "
" r' s...,
, I".... <....
" I j /
Time
j ,r
;1
.{) D
/~ .. /f
Name of Fune~1 Hom,e
, ,
,- :~-.~~;~~'-~~~
Autho rize(l1Yt:<"/',i:>:f
5, r7::: V 1//('
jJ, -\:>y.':':i;;.,;,J '
J
,
[lD.~]
State of Florida, DepartmtIPof Health and Rehabilitative Services, Vita,listiCs
APPLICATION FOR BURIAL - TRANSIT PERMIT
J~, 5 I G-
:l -;.7-,
I,) ,j ,:.?
Ii t-I
A.
1. Name of
Deceased
(Type or Print)
First
Louise
Middle
Last
Bendix
DATE
OF
DEATH
Month Day
07/31/93
Year
J.
2, Place of Death
County
Indian River
3. Name of Medical
Certifier
City, Town or Location
Vera Beach
Name of (If neither, give street address)
Hosp. or
Inst.
Medical Examiner
~oor Merchant M.D.
4. Name of Funeral Home/
Direct Disposer
Physician
Address
77.14 B~y St.
2
Strunk
5. Check
Appro-
priate
Box
1623 Nqrth Central Avenue
Funeral Homes P.A. .?
a 0 The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b Q
Liz was contacted on 08/02/~J 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 Moor Mercbaut, bit 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 Sebastian
Final Disposition:
7, Funeral Director/
[)il eGt t:)is~t'\"~
tery /
- name/county:
Removal
from state Donation
Date Signed
')
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 e death certificate request
Registrar or
Subregistrar Signature
Permit No. 1 ?2R-9~-()~fi7
Date <7.,; q.7
Issued: ~' . {J
Date Certificate
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:
rn BURIAL
o CREMATION
o STORAGE
o OTHER (Specify)
Place of Disposition
Date of Disposition
...JE 6f'1sT: ",,, (} e""fe "e~'f
(.1....7.':> r
'y
:j- ,/93
,
Signature of Sexton )
or Person-in-Charge )
./ ^ Q l/j~rZ) ~.
I~/ / ~U T
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.
T
HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used)
7