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Home My WebLink About4-33-17 Paid by CEMETERY Receipt No... ~9..... .D.ted..."." ~U !.~~,..,..,...,. Ust Price S .~~9... 9.q........ Maximum No. Burial Spaces,................ 500.00 Net Pald S .................. ?ntj~~ Lot 1. Block Unit 4 NO. Monument permIttecl.. . . . . .. .. . .. .. . . .. .. . . 1450 (D.ta ....... thla line lor Qtr Reeord DB"') C!!ttv of &,haJlttatt Irtb 1450 Gtrmttrry NO. 8th THIS INDENTURE MADS 'I1lIa ...................... day 01 March 94 A. D1 .1....... behl'een tile CIty 01 Reheatlan, . ..unlelpaJ eorporatlon ""Iat.... under the Iawa 01 the St.te or Florid.. .a Orantor .nd Bong Sun Lorino , '" . ...... ............................. '1550' Have-r-ford' t.ane............. ....,....................................... ".,,'................ ......................~e~a,t.~~~~.~..~~. .~~~~.~... .......... ",.,..".............. ..................... or the ColIntr 01 ,Jm~$,~.l,l.. R~.Y.~~...................... .ni St.te 01 .......... n.9.1;.~~!!............... .................. u O~antee, WITN8888TH, That the Grantor for and In considentlon of the sum of S ..,........ ~ ~9. ~ ~q, , . . . . to It in hand paid. the receipt whereof Is herewith .c- knowledged, dooa by thla Inlt~ gnInt, borplft. leU, re..... conwey and conftrm unto the Gr.ntee ~!!, ~. . ., heln,,,,,1 repreent.t1.. and ........ the followintI property dtuated in Sehaalloll, Indlan River County, florida. t01llt: An of Lot(s) .~ 7. . .. . Block. . . ~,~ , ., . UNIT ,..~...,..... . of Seb.allan municipal cemetery .a per Plat Number 1 thereof recorded In Plat Book 2, at page 6S of the pubHc recorda In the ,omce of the Clerk of the Clreult Court of St. LucIe County of florid.; aald IancI now lyina and bel,. In Indian River County. FloridL To Hue .nd to Hold the ..me fomer; proYlded that aald property ....n be uaed IOlely and exclualYely for the Inlerment of the human dead and aban be used. kept and maintained .t .n timea in .ccorda1lce with the ralea and replatlons, ordlna_ .nd resulutlcma of the CIty of Seballlan, Florid.. hereto- fore. now .nd hereafter adopted or proYldecl for the IU-t and operation of aald cemetery, The concIItlon.. restrlc:tlona and requirements contained In thla inatrument abaft be co_nts rurmIna with the land. In the ewent of the failure of the o_er of any property sltuatecl within said cemetery to ob- _ and comply with iuch rules, replatlon.. reaohatlons and ,ordinance. and the conditions of the deled of conwyance thereof then the title of such owner In .nd to ..Id property ahaII termin.te and the ..me sha1I rewrt to the City of Sehaltlan, Florida. IN WITNESS WHEREOF. The said party of the Oral put haa caused this inatrument to be eaecuted in It. n.me and on Its beholC by Its Mayor Ind .ttested by ita City Clerk and Its corponte lOll to be hereto affixed, the day and year ftnt abow writ. / ,."f~~c~~.,................ ed .nd Dell... d ..~.. ... .~.~:~.<.~ 0< ...:....... STATE OF FI DA COUNTY OF IN IAN R1VBR I HEREBY CERTIFY. That on thl. .......~J::h...........day 01 .........M!!.l;~h.................................. 119~, Lonnie R. Powell Kathryn M. O'Halloran brlllre me peraon.lly .ppe.red ...........................,..........,.""....,.,'."..,. and .................. .. .. .. . .. . .. .. .. .. .. . ....p".Uy.ly Mayor .nd City Clerk of the C1tr 01 Sebaatl.n, . munlrll..1 eo.....r.tlon under the ..... of the St.te 01 Florida to me ._ 10 be the Indl.iduala and offIeen deac:rlbed in .nd who exeeutrcl the ro.....ln. _...,.a.ee to Bong Sun Lorino (Gritv ~rlll) . . . ' , ' . . . . . . . . . . . . ' .. . .. . .. . . . . . .. .. . .. .. .. . .. . .. .. .. ... .nd aeyerally .e1mowledrrcl the execution thereol to be their lree .d .nd deed a. aueh ollie... thel'l!llhto duly lulhorIoecl; and that the Olllel.1 ....1 of laid eorporatlon Ia duly .1II"eel .nd the laid _...,.._ la the art .nd deed 01 lalel eorporation. WITNESS my alm.hI... and oIlIdal IS! .t Seboatl.n. In the I.at aloreaaJd. Q) lIIMM. MI.1.EY '" . tI/'f ClIIIlIlIIllft, llCII4I17 EllI'lRES ~. .. It, "" -----.., Name Pe /0. J;O ~ E, ioi?, It) 0 Unit Blpck 3.3 lot 17 Date ot Mark-out ";.;/7/1 ~/ F , Oateot Burial '"Ji''' i.~ ~ tfi..~ :;!"f I '~I Time / J. ()() ,1. l/'l# 01' ,Name ot Funer" Home t:6.;t,- " ",-~~~:;=;1~,~l AuthORz.' ~.- f;/ ,_')t./<, ,',,</,-{ , .. ", / f''''-; t......./ -' 1'.' (Jr, f/,)i"? ~;. /) _;2>o'1( &n 1650 ,.:b.ver~D~ LJ.j ~~ F"~~~~ . .' -, IX -. .._.. ."-.---- _..~._--,._-,-, --.-.-.,-..----- :Deed No I~ J() I- /7 ~d.. .3'3 ttnif 4- Vda~"DE, LDrr no ;()-Icrfed 3J~)91- I \.. '- ... Paid by CEMETERY Receipt No. .. ~9.~........ . Dated. ...... . 'Arlo !.~~............ List Price $ .~~9... 9.q........ . 500.00 Net PaId $ .................. ?nj~c!/~ Maximum No. Burial Spaces. . . . . . . . . . . . . . . . . Lot 17 Block 33 Unit 4 NO. Monument permitted. . . . . . . . . . . . . . . . . . . . . . . 14.50 (Data above this line for City Rec:ord only) ... . . ~()I TIlE, SEBASTIMl CEMrl'ERY CITY OF SEBASTW SEBASTIAN, FLORIDA Dollars (~f)~ ) FROM: on this 7 day of following described Cemete stated herein: Description of Property: Cemet:erg Lot:~, _ j '$1 J ; ~4BIOc:1c Purchase PriC:a.:.~~ for the purchase of the e terms and cQnditions as 33 Unit ~ Dollars ($6/JIJ~ ~ rerms and Condi.tion of sale: ~))O . c2Jo rl1is con'tract sb.al.l. 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 c:ondi.tions stated i..r1 the foregoi.11g i.11strtmzent: j~n~~~ ~ ac~~ ~ rhe City of Sebastian agrees to sell. the above lIZent ned property to the above named. purcl1aser( s) on e terms and cond ons stated in. the above instrtmzent. ~ .. . ,'1y 0 "'" " ~. \ \I' 'J . ~ ~, ?" /./ < , 1 <, , . ; ()r: Pf LlC.e..N. City of Sebastian 1225 MAIN STREET C SEBASTIAN, FLORIDA 32958 TELEPHONE (407) 589-5330 C FAX (407) 589-5570 March 16, 1994 Bong Sun Lorino 1550 Haverford Lane Sebastian, Florida 32958 Dear Mrs. Lorino: Enclosed is Cemetery Deed No. 1450 for Lot 17, 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. Kathryn M. O'Halloran City Clerk KMO:lmg enclosures A. 1, Name of Deceased (Type or Print) First Middle Last ~ /7 /j 33 t/ ~ Month Day Year I.~] State of Florida, Departeof Health and Rehabilitative Services, Vitaeistics APPLICATION FOR BURIAL - TRANSIT PERMIT 2. Place of Death County Indian River 3. Name of Medical Certifier Taher Husainy, M. D. Physician 4. Name of Funeral Home/ Address Direct Disposer Cox-Gifford 1950 20th Street Funeral Home Vero Beach FL 32961 ""- 36 a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. Sebastian Medical Examiner LORINO Name of Hosp. Of Inst. March 02. 1994 (If neither, give street address) DATE OF DEATH PELAGIO E. City, Town Of Location Residence Address 2300 5th Avenue Vero Beach Flori ?960 Fla. Lic. No./Reg. No. Phone Number (Area Code) Phone Number (407) 567-7111 5. Check Appro- priate Box bOX 'i'~~r Uaaain,y U.D. was contacted on 0:3 '01 'S4 within 72 hours after death. He/she wrified that this death was from natural causes, that the~ w's no accident nor other external cause of death, and that H will complete t: 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 Final Disposition: 7. Funeral Director / Direct Disposer Burial Removal o from state 0 Donation Date Signed ...? -:;J - 7 Bj;' BURIAL - TRANSIT PERMIT . rmission is hereby granted to dispose of this body. ' Permit No. 142~-14 -1994 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 Difector/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. o No extension of time fOf filing the death certificate requested. Registrar or Subregistrar Signature Date Issued: 0:3/01194 Date ~~ficat~ .... _ I Due:~ C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature , Medical Examiner Date or Medical Examiner, , gave authorization by telephone fo Funeral Director/Direct Disposef. 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 .Jd_..7,;",-. ;ZA'Y(i1::;'J Date of Disposition "1niJJ.A"~ B ,q r;.y I I Signature of Sexton ) or Person-in-Charge ) ~';"'.J.. r.J~ , This permit must be endorsed by the Sexton or person-in-charge (Of 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 occur fed. HRS Form 326, Feb 89 (Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2) y