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Paid by CEMETERY Receipt No. . . ?
List Price $.. ~g~ :.~~......
800.00
Net Paid $ ..................
....... Dated...... .~.q (.~~(.~?..........
Lots
Block _L.
Maximum No. Burial Spaces. . . . ..... .. .. ... . Uni t 4
2
NO.
Monument permitted. .. . . . .. .. . . . . .. . . . .. . .
1J83
(Data above thl. line for CJty Record only)
mUll of l'rhustiutt
Ctrtmtttry
mttll
1 :~83
NO.
THIS INDENTURE MADE TIoIa
28th
dAY of
October
92
A. D~ 19......,
between Ihe City of SebllStlan, a municipal corporation exl.ting under the laws of the Stale of Florida, a. Grantor and
Mrs. Ann Molnar
.,'.".........'..'..... '...'............. '311' Manly" Avenue..............,
...'.,'...................................... ,~E!b,~.~ .~~.~.f!-.'.. .~.~.o~~~.~.. ~??5.~
Indian River Florida
of the County of ..'.......................................... anJ State of ......"........,...................".................
u Grantee, 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, bargali., sell, release, convey and confrrm unto the Grantee .J:1~~.... heirs, legal representatives and assigns
the fonowing property situated In Sebastian, Indian River County, Florida, to-wit:
All of Lotes) .~ .. ~. . ~ Block, .~ f. . . .. ,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 offlce 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 said property shan be used solely and exclusively for the Interment of the human dead and shall
be used, kept and maintained at an 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 said cemetery to ob-
serve 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 said property shall terminate and the same shall revert to the City of Sebastian, Florida.
IN WITNESS WHEREOF, The said party of the fltst part has caused this Instrument to be executed In its name and on its behalf by its Mayor and
attelled by Its City Clerk and its corporate seal to be hereto affIxed, the day and year first above written.
Atte~N~ -?m,t):dt.t~~.....
-,- '1' -.. City Clerk
Signed, Scaled und Delivered
In the resence ofr ~
..... .. ....... ...............
a C'
YV~......,~4-fU-.........
((f[il\t ~..al)
STATE OF FLORIDA
COl'NTY OF INDIAN RIVER
I HEIlEDY CERTIFY, That on thl.
28th
,day of
October
92
0' 1... H'
be'ore me personally appeared .~.o~~~.~.. ~.... .~~~~.l.l.......,...,.,..".,..... and K8; tI:ll;Y~. ,~.~. .9.' .~!,!p.<?r~~..
rcsp,'eliveiy Mayor and City Clerk of the City of Sebastion, a municipol corporation under the laws 0' the State of Florida to me known
to be the indivitlultls and officrn described In f.lnd who executf~d the fore'going cORveyance to
........,.....................................,. ,M+.~.... .ADn. .Molnar................",..,
, . ' , , . . . ' . . . .. ' . ' . . . ' . . . . . . . . .. . . . . .. .. .. .. .. .. . .. . . . . ., and severally acknowledged the execution thereof 10 be their 'ree aet and deed
as snch officers thereunto duly ollthorucd; and that the Official sell I of said corporation Is duly affixed thereto, and the said conveyance
is the act lInd deed of said corporaUon.
WITNESS my signAture and offlclal .eal at Sebastian, In the County of Indian River and State of Florida, lhe day and year
lost ",or..ald.
lINOA M. I.OHSl..
Nol8y ~"'FlaIIdII
U, CoIIImlaalon El(llMJUN tt.1IM
COMM. CO CIQI7...
3374
Name
Date
Cash
\f..check# 5 <~o I
Amount Paid
No.
)01001 208001
)01501 322900
)01501341920
)01501 341910
)01501341930
301010343800
)01501 343805
Sales Tax
Garage Sales
CopiesIBid Specs.
LDC/Code of Ordinances
Election Qualifying Fees
Cemetery Lois
;t . Block
3~ .unitL
1!>1 J5<29-.
LoVNiche
Cemetery Fees !
o C.- !
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WCL
Total Paid 1JdSOO
White - Dept. of Origin. Yallow - Finance . Pink. Applicant
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~ Full name of deceased
F""
~ Cause of death
Q Place of Death Alpena Ossineke Twp. Veteran? NO Sex ~Age~
(County) (I'ownship or village or CIty) (Yes or No)
:- Method of disposal Burial Sebastian Cemetery
~ (Whether burial, cremation, storage, etc,) ~ l ,,",Cemetery or Crematory)
~ APPROVED FOR CREMATION I County ^ 1.4..J ". II~ State
\.J
::II: Signature of Medical Examiner
>-
z
:. A certificate of death having been filed as required by the laws or regulations of this state, permission is hereby given
~
o to
U
~ to dispose of
~ Signature
;J
...
.i':.
BURlAL- TRANSIT PERMIT
MICIDGAN DEPARTMENT OF PUBLIC HEALTH
Office of the State registrar and Center for Health Statistics
Ann Molnar Date of death
No.
Oct 17, 2005
FL
Date
Address 222 S. Second Avenue
Alpena, MI 49707
Date
October 18, 2005
MortuaIy Science Licensee)
:: CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUR SPACE BELOW
~ Body was Burial on'tJ:>
.~ Place t(,J~~Tlf')2t)~e0~lc~o7l?). Signature ,
fJ"J .' . jrton n 10 c.h~rvp.'
. i This permit must be endorsed by the sexton (or by the funeral director or Mortuary Science licensee where there is no sexton).
!-
(OVER)
'S-26 9/94 Authority: Act 368 of 1978 and act 299 of 1980
Name
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Date of 1M ark-out I () ~ I ~. - 0,5'
Date of Burial
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Time . r.)O Ii ,1'(
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v" J 17 / l:-~,:)
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Name of Funeral Home '-"" Ie v f VI" \
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Authorized by
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