HomeMy WebLinkAbout4-33-34
~
. 7P~ 12/13/93
PaId by CEMETERY Receipt No.... )........ Dated.......,.......,..............
List Price $ .~~~.q:.9~...... Moximum No. Burial Spaces. ....... .........
Net Paid $ .~~?~ :.?~...,.. Monument permitted...,..........,........
Lot
Bl
Un~l.
33 &
33
4
34
NO.
1437
(Data obon thl. line for CJty Ikc>>,d ooly)
Cl! Ull of &t bustiutt
<!Itmtltry
m t tb
'1437
NO.
THIS INDENTURE MADE TIoJa
13th
dRY 01
December
93
A. D~ II......,
betwern Ihe Clly of Sebaltlon, a munlelpal eorporaUoo eal.Untr under the law. of thr StRte of Florid.. as Grantor ond
....................... ........ .l:IJ::1'! ,..Anni.e.. Mae.. Mann... .... .............
850 George Street
................... ..... ......... .Sebastian,.. Flo.:dda ..3295.8........... .....................................
01 the County of .... ..~I1~i..~I1..~,:j.y~~................... ao'l Stote of .............. n..Q.:t;';i,9"l;I.............................
u G,antee, WITNESSETH,
That the Grantor for and in consideration of the sum of $ ... ~.~ ~9.q: .q~.. ......... to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargain, oeU, relea!lll, convey and confirm unto the Grantee.. ~<<;!.~.. heirs, legal repreoentatives and assigns
the foUowing property situated in Sebastian, Indian River County, Florida, to-wit:
All of Lot(l) ,~~.~ ~~ Block, .~~. . ... ,UNIT ..~....,..... ,of Sebastian municipal cemetery as per Plat Number I thereof recorded In Plat
Book 2, at page 6S of the public records in the office of the Clerk of the Circuit Court of St. Lucie County of Florida; soid land now lying and being
in Indian River County, Florida.
',,-
To Have and to Hold the some forever: provided that said property shaU be used solely and exclusively for the Interment of the human dead and shall
be used, kept and malntoined 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 sold cemetery. The conditions, restrictions and requirements contained
in this instrument shaU be covenants running with the land. In the event of the failure of the owner of any property sltuoted within said cemetery to ob-
oerve and comply with ;uch rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner
In and to soid property shaU terminate and the some shaU revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed In its name and on Its behalf by its Mayor and
attested by its City Clerk and Its corporate oeal to be hereto affixed, the day and year first above written.
AtlrS;;-Mt. ~,~~ ,) ll.I}lh.t f't<-:1 ~""'......... ..
"""7'''"'"'' City Cle,k
CIT::EAN. FLO'''A
Ma,or
(QIitv J&.al)
STATE OF FLORIDA
COl'NTY OF INDIAN RIVER
I HEltEBY CERTIFY, That on thl.
13th
.doy 01
December
9~
19.
b.fore n.e per.onally a"prared .. .~.~I1~~.~.. ~ ~.. .~()w:':!P............ ... .... and Kll ~.J:t.~Y.~ ..~.~.. ~ ~ .~.~g?~ ~~..
re.p,'etlvely Moyor ond City Clrrk 01 the City 01 S.hostlan, a municl'lIll eor"oraUon under the laws of the Stat. 01 Flo,ldo to me kuown
to be Ihe Indh'idulIl. IInd oflleors dest:ri....-d In and who raeeuted the forcgoing eORvryonee to
........................ .............. M~.l?~. .A~I,l.:t!'1. .f1.~.~. .M~.I)n...................
.
. . . . . . . . . . . . . . . . . . . . . .. .. . . .. . . . .. . . .. . .. .. .. .. . .. . . . . .. and sevrrolly aeknowlrdgrd the exeeutlon th.,rol to be their frrr oet And <Ired
os such oWeers thereunto duly authorlsed; and thot the OWcial .eal 0' ..Id eorpnratlon II duly .'flxed thrrrto, And the .aid convryunce
is the net und dred of oald corporation.
WITNESS
lost uforesald.
l~~' lINDA M. GAllEY
i.,>>A MY COMMISSION , CC334817 EXPIRES
~'. . : June '8. l!ll14
~?;iff"iil" ~1lRlTlllll'F"_.lOC.
Linda M. Galley
~--~~--,--~~---_._-~-~~._--'--'-"-
Name
.J~; j~? ~:T-iI7/ (A~ ~~;)
,...'.
1('".
)'1/) /) l^J 1'/
,~:: ;.::
Unit
,l!
Block
..5?~S
Lot
~ -<,/
Date of Mark-out
/</._./ i
I
/-. -) I ~ "~"~, ".":.;;.,
-' .' '-/
/9 ~
,......."'1'
~
Date of Burial
'''/
I," ' , !
I .~, /,'
Time
'.:'::< ,.~ f (~)t)
'f,'''' .
l
/}l")
Name of Funeral Home
.......,.--- '"
"';7 t:.oH.l
Authorizedb,y
-,-...."".
,.-:C~~::il
.,'~,'< ,:",/, ,
/{
,"/
,/ //
\,.,'
-
J.
[[B
State of Florida, Department of Health and Rehabilitative Services, Vital Statistics
APPLlCAe FOR BURIAL - TRANSIT PERMIT .
L '::/ -=l' 71 /f'
'" .-.f'. _",,-,,
13 :)
II ~l
L-f ;
A.
1. Name of
Deceased
(Type or Print)
First
Arthur
Middle
Rodney
Last
Mann, Sr.
DATE
OF
DEATH
Month Day Year
12/07/93
2. Place of Death
Cpunty .
Indlan Rlver
Sebastian
y
U Medical Examiner
h Physician
Address
1623 North
Sebastian,
Name of (If neither. give street address)
Hosp. or
Inst. 350 Croton Avenue
Address
2500 ~, 35th. St.
Fort Pierce, Florida
Phone Number
City, Town or Location
3. Name of Medical
Certifier
Frederick Hobin, M,D" M.E,
34981
(c.fOi)c.fOc.f-7378
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes, P,A.
Fla. Lic. No./Reg. No. Phone Number (Area CQde)
Central Avenue J-J''',~#Q
Fl '3?9~8 1??8 (40"'/) -,.. "J"-
. "'" v __ ~~)_ _, ....t)
a 0
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
5. Check
Appro-
priate
Box
c d
was contacted on 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 will complete
and !'Y@lJ.mT medical certification of cause of death. 12/08/93
Fr,.odE'rid' I:kbir, >J -9 , )t.':;;. was contacted on He/she verified that
, Medical Examiner, will complete and sign the
b 0
medical certification.
S'i'hu,;t.:.:m C't'lIIster:'
6. Place of
Final Disposition:
7. Funeral Director/
.Qt, ",,\,.It ulsposer
Indian River
Removal
from state Donation
F.E. N1~~' 140.
Dlt2~9f7~3
B.
BURIAL - TRANSIT PERMIT
1228-93-0546
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 fili the death certifica~sted.
Registrar or .'
Subregistrar Signature ~'7"--'
Date /~ C 67
Issued: - J _ 7.....J-
Date Certificate
Due:
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 .5/11,4.,;; rf;./ (j ,Z ...v, L?; i!. v.
I /
Date of DispOSition ,!~ / ; I, q)
Signature of Sexton )
or Person-In-Charge )
~1 9.
/ J
,;{c~ ~:p -
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)
J