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Home My WebLink About4-33-38 ------ / <or Paid by CEMETERY Receipt No. . .. . L. P' $ 1 ,000 . 00 1St rice ... T" 0'00: DO" Net Paid $ .................. 11/23/93 Lots &38 . . .. . . Dated. , . . .. . .. . . . . . . . . . . . . . . . . . . . . . . Block ~3 Maxunum No. Burial Spaces. .. . .. .. .. . .. . .. . Uni t 4 Monument permitted. .. ..... .. . . ,... ... ... . NO. 1435 (Data above !hI. line for CJt). Ikc>>'rd only) mUll of &tbustiutt <!Itmtttry I1ttb "1435 NO. THIS INDENTURE MADE TIoJa ....... Z3.rd. day 01 ...... .November......................... A. D., 1.. 9.J., between I he City 01 SobasllaD, a munlclpal corporation eal.tlntr under the low. of the StRte of Florid.. .. Grantor and Susan A. Massie ............................................ 83'7" Plo'raiand' . Avenue ...... ....................................... ................... ...................... ... ?~.~.~~~.~.~~.... .~.~?~.~.~.a..~.~?~8 ......................................... of the County of .....~I1~J.C!-~..~,:!..~~~................... ancl Stole of .........f.lCl~~.dll.................................. aa Grantee, WITNESSETH, That the Grantor for and in consideration of the sum of $ ..~! .q~~... ~.9. . : . . . . . . . . . to it in hand paid, the receipt whereofls herewith ac- ........, knowledged, does by this instrument grant, bargain, sen, release, convey and conium unto the Grantee.. h<<::.:r: .. heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to-wit: All of Lot<s)3. ~ ~ ~ ~ ,Block..... ~ ~. ,UNIT ...~......... ,of Sebastian municipal cemetery as per Plat Number I thereof recorded in Plat 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 Slme forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at aU 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 shall be covenants running with the land. In the event of the failure of the owner of any property situated within Slid cemetery to ob- oerve and comply with meb rules, regulations, 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 first part has cauoed this instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and Its corporate oealto be hereto affIXed, the day and year first above written. CITYn()t. .SE. AS. A.N' FLORIDA 11. / i )) 0..' 1~'7.A~ '. ,"/7, )'/' r /1 ,'et-t-<-..- Allrsll 1".0-<> 1"""'" Clt~' a~rk .../... f/- ..... .. .... (Gritv J&.al) RIVER I HEREBY CERTIFY, That on thl. .. ~J:t;'.cJ........... ... ..day of . .. N9.V.~!I!P.t;!.t;'................... ......., 19.9 .~, Lonnie R. Powell Kathryn M. O'Halloran bl'lore rne personally ftllJ>eflred ............................................ . .. Rnd ....................................... resp,'etively Mayor olld City CI.,k 01 the City 01 Sebo.tIRn, 0 munlclpnl eorpoontion "mlor the In'' of the Stille 01 Florid. to mo known to be lhe Indlvidunls ntld nfflcrrs described In ond who executl~d the for('going eOAvr.YRnce to ................................. ~1,l.~.~I1..f:..... }f?s.l?;i,e.................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .. . . .. . . . . . .. .. .. And severally &l!knowledgrd the execution thereof to be th~lr free Bet IInd cteeo as sneh officers thereunto duly authorized; and thRt the OrflriK' sell I of said corp.nation Is duly afllxffl thereto, ftnd the s8id convrYIUlcr. is th~ llet ltnd deed 01 ,aid corporation. WITNESS my .IJrDAtn,e ond ofllelal leal at SebaaUan, In the County of Indlon RIver nnd State of Florida, the doy ond "ear lASt ulares.id. H JOANN~ SANDBERG NotBry Public.Slate '" F10rfdII ~ Cammis91::J Exptrel APR 3O,lll94 COM~' # CC 006931 ~ . .~~(,~.~~~?:<?.................. No Public, State of Florldo at Lari<:V M omm'Rlllon eXJ1ire.. H. Joanne Sandberg Name IV' .< . ' 0 h~ \"Y\ (), ,) T. 'l \ -\ :;).::::,:. :.;.} .;" <2.. Unit ;..j Block ?: >~ ,.,;;.-:> Lot .......:;1'.. J6 Date of Mark-out j., ---, I u") I ' I ,~, .-'C. ; .-' . ' Date of Burial 1 l' I .;;L .','~: /' <l3 Time :~;" () () ,t) f: :V;i Name of Funeral Home ,.:) i j('t-t ,y< .5 ( " "..:, :::.~::) ;," ,/ Authorized...by..,,<~^1,(.;">/:t/.~:, ' ';'/1 f .,'/ j ::r Last MassIe / ~37 ..::{ X- I L--' _ /6 3_3 tj~ ~Y2 0 /~~ Year [ln~] State at Florida, Depart.ot Health and Rehabilitative Services, Vital.istics APPLlCA FOR BURIAL - TRANSIT PERMIT A. 1. Name of Deceased (Type or Print) N First orman Th Middle eodore DATE OF DEATH 2. Place of Death fRtnt~n River City, Town or Location Roseland 3. Name of Medical Certifier Frederick Hobin, M.D" M.E. 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes, P.A. x U Medical Examiner Address 2500 S. 35th. Street Fort Pierce, Florida Name of (If neither, give street address) HosPSo~ . H . t 1 Inst. ebastIan OSpl a Phone Number n Physician Address 1623 North Sebastian, 34981 (407)464-7378 Fla. Lic. No./Reg. No. Phone Number (Area Code) Central Avenue Fl 32958 1228 (407)562-2325 5. Check Appro- priate Box a 0 The medical certification has been completed and signed. A completed certificate of death accompanies this application. b 0 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 anC\f~eWe medical certification of cause of death. 11/22/93 Frodoricl: HOElin, M.D., ~.E. was contacted on . He/she verified that , Medical Examiner, will complete and sign the c b .... Indian River Removal from state Donation 6. Place of Final Disposition: 7. Funeral Director/ Direct Disposer F.E. ~5~g. No. q<lfj Z~J9~ B. BURIAL - TRANSIT PERMIT 1228-93-0525 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 the death certificate r~d. Registrar or /, '" /J / Date //_') ~ _ cr ~ Date Certificate Subregistrar Signature (t..... &-t#-;^- Issued: _,:r- ~ Due: Permit No. C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT-SEA Signature , Medical Examiner Date or Medical Examiner, , gave authorization by telephone fo 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 ,<)~J3.IJ~T:A4 &,0/ lL~ll il/ ~.) /9) / Signature of Sexton ) or Person-in-Charge ) ;( ~ ~. .~.J..a?-. 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 I Replaces Oct 87 edition which may be used) (Stock Number: 5740-000-0326-2) .- ~