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Home My WebLink About4-33-13 Paid by CEMETERY Receipt No.. .~........ Dated.. .?t.~?/?~................ ~l~~k 1. 14 List Price $ .. ~.~ ~.9~: .q~.... Maxlmum No. Burial Spaces............... .Uni t 4 Net Paid $ .. ~.~ ~.?~: .~~.... NO. Monument permitted. . . .. . .. .. . . . . .. . . . . . . . 1458 ~ , (Data abo.e thl. \Ine for City Reco.d only) CltUy It! &tbastiau <1!rmrtrry I1trb NO. 1458 THIS INDENTURE MADE 'ftlI ..... 24th dAY of ..........' June 94 A. D. I........ bet.....n Ihe City of Sebastian, a munlelpal eo.po.aUon ..lsUnll under the law. of the State of Fio.lda, al Oranto. and ,...".,..,'....................... ...... ,Mr... .Wl.l.l.i.alJl.I?~9.V.QM;........., 674 Periwinkle Drive ..................... .......... ......... ,Sebastian,.. .Flor.ida. .3.2.958 ....................................... of tbe County of ,...J;n<,i.t~n..~J:'[~r..................... ani Slate 0' ............fIW:;l,d.~............................... II Onnte.. WITNESSETH I Thst the Grantor for and In consideration of the sum of $ '" ~ .'. ~.q9. : ~~. . . . . . . . . . . to It Ir\. hpnd paid, the receipt whereof Is herewith ac- knowledged, does by this Instrument grant, bargain, selt, release, convey and confirm unto the Grantee. . ~.:I:-~. .. heirs, legal representatives and assigns the following property situated in Sebastian. Indian River County, Florida, to-wit: All of Lot(s) :to ~.~ ~.4, Block. .. . .~~.. ,UNIT ... ~. . . . . .. .. ,of Sebastlsn municipal cemetery as per Plat Number I thereof recorded in Plal Book 2, at page 65 of the public records In the office of 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 sold property shall be used solely and exclusively for the Interment of the human 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 hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements contained In this Instrument shalt 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 rules, regulations, resolutions and ordinances snd the conditions of the deed of conveyance thereof then the title of such owner in and to said property shalt terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has Clused this 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 first above written. All'~l~~ In{)/I~~~~...... I City C1e.k C'T:,O~~ Mayo. IInd Ddlve..d nc Oftt: .,.~.................... z(4~ (<lIitu ".al) STATE OF FLORtnA COl'NTY OF INDIAN RIVER I HEltEBY CERTIFY, That on tbl. 24th . day of June 94 I'.. .., Arthur L, Firtion Kathryn M, O'Halloran brlore Ole personally appeAred ...................,.................. and ....................................... ".p,'elivdy Mayor and Clly Clerk of the City of SehAsliAn, a municipal eorporftllon under tbe In's of tbe State of Flo.lda to me known to bt' the Indh'idultls Bm) orticers described In ftod who execull~d the forc'golng cORve)'ftnCe to Mr. WIlliam Provost , .. . . . . . . . . . . .. .. .. .. . .. .. .. . . .. .. .. . .. .. .. .. .. .... and .ev.rally aeknowl.dllro tbe .xecullon th.....f to be tb.l. fr.. ad and d.ed IS slleh olllee.. th..euntu duly authorlZcd; and that the Olflclll .eui of said corporation Is duly Ifflxed ther.to, And the said eonv'y"nce Is the net and deed 01 sold eorporaUon. UNoA M. GALLEY MY COMMISSION , CC 375724 EXPIlIES: Juno 11. ll1ll1 _1lw-,PlItIIIc'-- WITNESS IRst IIfofeeald. Linda M. Galley Name f:l',rll/\/;'- /(. l~, ) L/''''''o r: ,. Unit ,/0:/ I Block ~,:') .:) Lot .;./, ! ,..,J Date of Mark-out .' / ' , ! . J / /) ,.,"j / " " Date of Burial / I, ./., .,,.l ,,'';'- '"I :. ,....;.1 l \.' , . .,- ~ Time Name of Funeral Hom~ ~~) ;' :',' i," ,i /' ,,"~ .. "r~ .. /i ,,' Authorizedl:ly,:::';t .. )<;,.:;/,i.3l2f", .'" I,A .'! I<'/~'" LtJ', 11 ian1 '-~jlJ;U;(1 k)eJ Dr ~htdioJ)J KL (3$08 L~ /5 *,)1+ -SJV{!f (33 WJJ+ I.f ;Jor~:.j( <f?DVV5./- - I~lerred {p1}1p I~~ tJ);/!,t2/YJ !I~VlJs/ /I]terrtti !f)/1.:5'117 . i _eO '.." t .i......~ " 3. '" }):'JrJ )Jo. )460 LDt /3 LLJ -f 1-</ "- - . . 809 6/24/94 Lots 13 & 14 PaId by CEMETERY ReceIpt No. . . . . . . . . . . . . . . . . Dated. . . . . . . . . .. . . . . .. . . . . . . . . . . . . . B 1 0 C k 3 3 L. P' $ 1,000.00 M' N B . IS U . t 4 1St nce ........,......... axunurn o. una paces..............,. ill 1,000.00 Net Paid! .. ~,..... ........ ',' u);Jlt&/Yi r~ Monument permitted. . . . . . . . . . . . . . . . . . . . . . . (Data above this line lor City Record only) NO. 1458 . . . ~{)g THE SEBASTIAN CEMETERY CITY OF SEBASTIAN SEBASTIAN, FLORIDA ~CEIPT FROM: HEREBY ACKNOWLEDGED OF THE SUM OF: tP~ (S / t.1jcJ~ ) for the purchase of the terms and conditions as Description of Property: Cemetery Lot ( s) /.5 i /,/' Block Purchase priceJ.n~M..-----r1 ~ ,,33 Unit "I- Dollars (s/t1M.ft-) Terms and Condition of sale: This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in. the foregoing instrtmlent: The City of Sebastian agrees to sell the above mentioned property to the above named purchaser ( s) on the terms and conditio stated in. the above instrtmlent. . . . ...,",y 0 , " "', "" [;~ A ~ ~~ - ,~ ""0", 4 S '1 ~.."Q ~ o~ PfLlCP.~ ,s . City of Sebastian 1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 0 FAX (407) 589-5570 June 30, 1994 Mr. William Provost 674 periwinkle Drive Sebastian, Florida 32958 Dear Mr. Provost: Enclosed is Cemetery Deed No, 1458 for Cemetery Lots 13 and 14, Block 33, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Florida Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. If you wish to have this deed recorded you may do so at the office of the Clerk of the Circuit Court, 2145 14th Avenue, Vero Beach, Florida. We are enclosing two copies of Receipt No. 8098 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self-addressed envelope is provided for your convenience, Kathryn M, O'Halloran City Clerk KMO:lmg enclosure (\ws-form-cem.rec) . . ~Qg THE SEBASTIAN CEMETERY CITY OF SEBASTIAN SEBASTIAN, FLORIDA ~CEIPT FROM: HEREBY ACKNOWLEDGED OF THE SUM OF: ~() ( S / ,JJuft" ) for the purchase of the terms and conditions as Description of Property: Cemetery Lot(s) J3 -1// Block Purchase pric~----;J;;;M..-Y1 ~ 33 Unit 4- Dollars (S /t1Jtl,ft- ) Terms and Condition of sa1.e: This contract sha1.1 be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the cfO::;oing inst~t~ _ J /~~' ~~i-~~/d~ The City of Sebastian agrees to sell the above mentioned property to the above named purchaser ( s) on the terms and conditio stated in the above instrument. [In~] State of Florida, Depar8t of Health and Rehabilitative Services, Vi.tistics APPLlC!t5N FOR BURIAL - TRANSIT PERMIT ~ "''7 /q j..... IJ; 13 2'3 (' ;1-/ L ! A. 1. Name of Deceased (Type or Print) First Norma Middle Last Provost DATE OF DEATH Month Day 06/12/94 Year Rae 2, Place of Death County Indian River City, Town or Location Vero Beach Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial Hospital W Medical Examiner M Physician Address 1623 North Central Avenue Homes, P.A. Sebastian, FI 32958 1228 (407)562-2325 a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Address 7744 Bay Street,Suite 2 Sebastian, Florida 32958 (407)589-0879 Fla. Lie. No.1 Reg. No. Phone Number (Area Code) Phone Number 3. Name of Medical Certifier Noor Merchant, M.D. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral 5, Check Appro- priate Box b ~ Liz was contacted on 06/14/94 within 72 hours after death, He/she verified that this ~eath 1I:s fr~m nptur~ ~uses, that there was no accident nor other external cause of death, and that oar ere ant, . V. 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 Cemerty Final Disposition: 7. Funeral Director/ QjrQf"t Diiposer Indian river FE No.1 Reg. No. 1672 Removal from state Donation Date Signed 06/14/94 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 fil~'n he death certificate requested. Registrar or . ~ ~I Date -1- , /.7."</' Date Certificate Subregistrar Signature IL. r J Issued: Due: Permit No. 1228-94-0282 C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature , Medical Examiner Date or 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. D, CEMETERY OR CREMATORY Methods of Disposition: . BURIAL o CREMATION o STORAGE o OTHER (Specify) Place of Disposition Date of Disposition "5If.AA~r:A- ~ c!""L~ E rLIC,J tc / / (~ /7 <f . I Signature of Sexton ) . or Person-in-Charge ) /-{17" iA7 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) 5