HomeMy WebLinkAbout4-32-18
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PaIcl b, CEMETEltY Receipt No. . . .f
1000.00
Ust Price S.,.....,..........
1000.00
Net PaIcI S ..................
,...... . Dated .. .~/.rH.~~,.,.............. Lot&"
Bloc
Mulmum No. Burial Spaeel................. Uni t 4
Monument permitted . . . . . . .. . . . .. .. . . .. . .. .
... & 18
2
NO.
01401
(D.ta .boY. thl. line fur at,. ....rd oaJ,.)
CltUu nt &.basUatt
IItfb
01407
Ottutrtrry
NO,
THIS JNDENTURB MAD. TIItI
23rd
dllJ' 0'
June'
93
A. D.. J.......,
betw_ the CJt)' 0' &.butl.n, . lDanlelpaJ corporation alltln. ander the I... of the Stale of PlorIcl.. .. OI'lJltor .nd
Chester Kopin
..'..........,".......".... ........... ............ 465-6" i:9th' 'Street...... ......"..,.,...,........,.........,.. .........'..
Vero Beach, Florida 32960
............................................. ............................................ ............................................
of the C-t)' 01 .~~.,J~~ ..~.t~~~........................ .ni St.le 01 ..... ,J1';I,9.~,~4~"......"........"...."...........
u Onntetr, WITNB88BTH.
'DIIt.the Gnntor Cor ifill In conlIcleratlon oC the sum oC S ..~ R9~ : .q~ . , . . . . . . . .. . . to It t hand paIcl, the l8CIlpt ...hereof II herewith e~
1mo...1edpd, d_ by thtI inltrument putt, buplft, .0. re.... co....,. and confirm unto the Grantee .. .~!" . ., heln,....1 repteBltatIYeI ifill InIp.
the Collowinl JIlOI*l, lIItue. ..!f'. '. to Sebultan. Indfan IUnr County. FIorIcIa, tCMrit:
17.' 32 4
All oC Lol(.) . ...... . Bloet. . ....... . UNIT .......".... . oC Sebutlan municipal c:emetery al per Plat Number 1 theteoClllconIed In Plat
Book 2, at pap 65 oC the pubUc recorda In the .ofllce of the Clerlt of the CIrc:ult Court oC SI. Lucie County of FJorlcla; .... land now tytna 8lld bel..
in IndIenIU1w Count" FlorldL
To Haft and to HoIcl the .me COIII_; JIlOotded tlIat .... property ....D he uaecJ .olel)o and lIlIc:IuaIwly Cor the Interment of the human dead .nd lhall
he ...... kept and malntelned at ID ttn. In a~ wtth the ru'" and fllUlatIo.... ordtnancea and _1utIotl. oC the CIty of Sebastlan, FIorIcIa. hereto-
Core, _ and heNafter adopted or )II09idlld for the ~rernment .... Operation oC IIIcI CIIftllIter)'. The con41tIona, IllItrtdIonI and teq~1 c:ontalnecl
In thla inIItrulMnt IhaR be _nte ..-Ina wtth the lad. In the ewent oC the CeIIure 0' the OWIler oC any JIlOpert)' lltuatad within .... cemetery to ob-
- .... colllJllJ with iuc:h ru.... ..ladatu, -"stIona and .onUnance. ifill the c:ondttlona of the d.d 0' comeyance theteoI'then the title of 1IIc:h owner
In and to aaIcI property nD t_lna. and the .me ahaU NftIt to the Clt)' 0' Sebutlan. Florida.
IN WJTNJ!SS WHEREOP, The IIid pert, 0' the flr. put Ia. Ill"'" thla lnIt_t to be executed In Ita name ..d on It. behalf b, It. Ma,or and
attested b, Ita CIty Clerk and It. corporate _I to ba '-eta aIlIxed. the day and year lint abaft written.
Attntro/~ J.)n,..{)rtI~
-...... '(f"- City aerll .
.... .O\~
MaJ'Gr
I'llgMd. &.aled .nd Dell..red
E..~..........
.(#~rt:..., ,.~......
(Glitv ,.aJ)
STATE OF PU)RJDA
COUNTY OP JNDlAN KJVBR , ..
J HBREBY CERTIJI'Y, nat on thla ..,.,.Z.~x:d............"., 0' """.,.June""".....,............,........,., 1'.93,
....fore me pe....n.II,. .ppeared .~~~~~~..~.'.. .~~~~~,~.............................. and ~~~~~y.~..~.~ ..~~.~.~gC?~!!~..
reaprrUvely Ma,or and City (:Jerk of the Clt)' of Sebut..n, a mantellll' eorpllr.tlon nnder the I..... 0' the. State 0' PIorIcla to me known
to be the individual. and 0"'.,.,.. deaerlbed In and wbo "".eated the '0.......1... _veyanee 10
Chester Kopin
-,
.. .. . .. .. .. .. .. . .. . .. . .. .. .. .. .. .. . .. . .. .. .. .. . .. .. . .... and _er&ll, adrno...led,..d the aeeuUon thereo' to be their free aet and deed
II 111m offtee.. thereanto dul, authorl..." and that the o,ncl&l _I 0' .ald eorporlltlon II dal, affixed thereto, and the ..,,, 1!OftftJ'_
I. the eel .nd deed 01 laIcl eorporatlon.
WITNBSS IDf ......h... and ofllt:lal ... at Sebaatlan, In the da,. end ,M.
laot oforeeaJd.
UNlM II. UlM&.
....,..................
.. ClIIIMllIIIlIn......... -.-
COWl' co_
'J$":;:~:.'.:;:{1ii,:' ~<:::f1W,iW,~,~~~'!:~~:r"",?;:t~;-,~'!~~,;;'~
;;...;o..iio
Name
(!HESIC R.
Kl)n;Il)
I
Unit 9
Block ~ ""J-...
Lot I P,
Date of Mark-out
\ ,.;{\- 00
Date of Burial
\
~y - 00
Time
.I 0, .::;1)
- ,jI';,
.._._----,-,-_..,_._._---_..-----_..._.,...,~..----~_._._..,-----,.;.._-_.._._.;.-----_.~,-_.~----'--,--_.._--_.__._------~-_._-----_...
"
FL..QRlDA DEPARTMENT OF
'.1 '""'"1"\ ..,~f gJ,~rida.'lo.'p~~~~llt o!;H~,a!th,V!ta1 S.iCS
nC .,......... -'LlCATION FOR BURIAL'. TRANSIT PE
:~~~t_j...,; l';VJ_/}~~:t~~ ~f :~~.~ -~>t;\J~'T,.. j.;:\.~ntr~] ,_:",t),;';
J. /7/'
13 3;;'"
IIi
HEALT
A. (TYPE)
1. Nameof----..
Deceased
r ./'$ '.
....--. Middle .....--_.. .. Last.. -'-'- . ..._.____ _.. Date
.~ - ''',', ,'. ...J: "i~ ..;, of
Chester Kopin Death
2. Place of Death City. Town or Location Name of (If neither, give street address)
County Hosp, or'
Indian ;.Riyer '':1. c,..:) ~Je!=,o,~llch: "'l'''-;''~.i1 1nst.,'~c,.~.!anRiver H~ria1~~spit:al
3, Name nr~~icals"S81IIU~1:':OWatkiils;'IID: :..nc,,; Ad~~() '1265'''36th'/Street' _. if) . .; " Ph~n.~ ~umber
Certifier
Medical Examiner Physician Vero Beach, FL 32960 561-567-6340
4. ::::Ii~~~~~~~,~O~i~ D~~ j;.~ddress" 1?~(t",~9.~. ~~~~~_ ;", Fla. ~~~:~~.~~' No: PhOf)e No. (Area Code)
cOx4;iffc;r~ Flmei-ai'BO.le ," ...:Vero Beach"FL329601423 c; 561-562-2365
5. Check ,~: 0 The medical ~~m.cati.~n ~as been completed and signed. A completed certificate of death accpmpanies this
Appropri_a!~ '. ':, . application. .'
Box
--First
Month
Day
.. Year
1-20-2000
b. Ii] Dr. Watkins ~ascontacted,on 1-20-00
Helshe verified that this death wastrom natural causes, that there was no accident nor other extemal cause of death,
. ..and that . he.. " will complete and sign the medical
. ..., "cirtiik:atiOn of cause of death within 72 hours. .
c,D
B.
was contacted on He/she verified that
-, Medical Examiner, will complete and sign the
6, Funeral Directorl
Direct Disposer
. . BURIAL . TRANSIT PERMIT
1423-014-2000
Permissio.n.. is.. hereb,y'granted to d~Jl:DSe.O. fthiS.. body, . .. _. Permit No,.
l!I A five (5) day e~nsion of tkne for filing the death certificate (eXclusive o! weekends) has been requested and granted since the physician has
been contacted by th~ funeral director and will not be able to complete the medical certification of .cause-of-death section of the death e<ertificate within
72 hours.
DNo extension of time for filing the death certificate has been request
Registrar or
Subregistrar Signature
- Date .
Issued:
1-20-2000
Date Certificate
Due:
C.
AUTHORIZA nON for CREMA nON, DISSECnON, or BURIAL.A T-SEA
Approval Number:
Date
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,
Method of Disposition:
~URIAL o STORAGE
CEMETERY OR CREMATORY
Place ofDisposition ...J IJr....a.o-t.n'- I
D.
Date of Disposition '\~" ,..,,_.
\ I
(7~ Hn.~:Gn7
AY 1-"1"\1"'\0
~ON
Signatcre of Sexton
or Person-in-Charge
DOTHER (Specify)
"~-1~ l _ e/A"L
This permit must be endorsed by the Sexton or person-in-charge (or by the FuneralOirector/Direct Disposer when there is no Sexton) and returned
within 10 days to the local County Health Department in the county where disposition occurred.
}
DH 326. 8/97 (Obsoletes all previous editions)
(Stock Number 57~326-2)
Distribution: While: Cemetery or CrematOty
Yellow: Funeral Director or Dired Disposer
Pink: Local Registrar