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Home My WebLink About4-32-20 ~ Paid by CEMETERY Receipt No. . . .?.. Li,t Price $ . ~.q9.: ~9. .. . . . . . Net Paid $ . 8.on. 00..... ... ...... Dated.. fJ.lH/?~................. Lo ts . Block Maximum No. Burial Spaces......, .....,.... Uni t 4 Monument permitted. . . .. . . . . .. . .. .. .. . . .. . &20 NO. 01408 (Dota obove thl. line for Clly Reoord only) CltUll nf &rbusHutt Q!.rtttrtrry m r rb 01406 NO. THIS INDENTURE MADE 1'IU 14th doy of June 93 A. D. 19......, belween Ihe clly of Sebastian, 0 municipal corporallon exlsllng under the laws of Ihe Stole of Florida, as Grontor olld ...... .. .... ........ .................. E\l,g.en~ ..S.... Ro.1.and............. ....:.. . .... . ......... ........ ..................... 607 S, Easy Street .................... ............ ..... ...Sebasti.an.,.. .Flori.da. .32.9.58..... ... Indian River Florida 0' Ihe Connty of ................... ... . .. . . . . . . . . . . . . .. . .. . ... on:! Slote of ....................................................... ao Grontee, WITNESSETH I That the Grantor for and in considerotion of the ,urn of $ ..~ 9.9", 9.Q . . . . . , . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knowledged, doe, by this in!!trument grant, bargain, sell, rei...., convey and conrum unto the Grantee .l:t;i;!3. . .. heirs, 1.1 repre.entatlves and assign. the following property situated In Seba!!tian, Indian River County, Florida, to-wit: All of Lot(s) . ~ ? ~.~ q Block, . . ~ ?.. ,UNIT ..~.......... ,of Sebastian municipal cemetery as per Plat Number I thereof recorded In Plat Book 2, at page 6S of the publlc records in the office of the Clerk of Ihe 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 shall be used solely and exclusively for the interment of the human dead and ,hall be used, kept and maintained at all times In accordance with the rules and regulations, ordinances and resolutions of the City of Seba!!tian, Florida, hereto- fore, now and hereafter adopted or provided for tha government and operation of said cemetery. The conditions, restriction. and requirements contained In this instrument shall be covenant, running with lhe land, In the event of the failure of the owner of any property situated within said cemetery to 010. 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 ,hall terminate and the same shall revert to the City of Sebasllan, Florid.. IN WITNESS WHEREOF, The ,aid party of the first part has caused this in.trument to be executed in it. name and on its behalf by its Mayor and attested by Its Cily Clerk and its corporate ..al to be hereto afflxed, the day and year rust ob7Wrltt ."", / CI7JjT[:1 Altest(.--I'J'ad:~)-rJ..()!ltlt.4J.~... By..-1.- (/ Clly Clerk Signed, Sealed IInd Delivered In the Presence oft '(lJ~....C~............ 6n'D~.............. cOl'N'fY OF INDIAN RIVER (CIIit\! ~eal) 14th I HEnERY CERTIFY, Thot on this ........................day of June 93 19.. .., b,"o.e me persnnnlly appenred .L.<?~~~.~.. ~.... .~.<?~~l.l.............................. ond . ~li ~.I:t.J7~. .~.'.. .9. ~ ff~VP.~li':l. resp,'cllveiy Ma)'nr ond City Clerk 0' Ihe Clly 0' SebostlAn, A munl<:ll'AI cor"ornllon IInder the lows of the Stote 0' Florida 10 me known to be the fndh'idlJllla urn' offlcrrB described In ,md who exeeutl~d the fOf('goinR CORvcyttnCe to Eugene S. Roland . . . . . . . .. . . . . . . . . . . . . . . . . . .. . .. . . . . .. . . .. .. . .. . . .. . .. . ., ond severally oeknowledg..d the execullon Ihereof 10 be Ih.Ir fr.. oel And deed IS .uch oHlce.. Ihereulllu duly aulhorlzcd; and thot Ihe Offlclol senl 0' ssid corporallou Is duly affixed therelo, nOlI Ihe sold cunveyallce i. Ihe lIet and deed of said corporollon. WITNESS my slgnoture ond offlclol oeal at Sebosllan, In Ihe lost "oresold. ~ ".lOHlll. "*r~rA""" ~~""JUN II.IIN COMof. CO ClI2744 Name (;:"" :",';' .f(,,/' j ~A t-\ (~'..\ ; . i:.... ',,~ ^ ;.:: i. " -.~j I: Unit ''/ 'J ...., Block ) ,I..... Lot ;'-./ Date of Mark-out L. i ~~. l1~': 6' /5 c I,~ " .....',. / if .....-' .., ..) Date of Burial Time / ;"J - /:/'.1" -- ,/ Name of Funerl~.rHome'/ /:5 I j:.' {,i "v l " . .~,,-.' /- ~ "'" -~~...~, //" '1' .1 ,-.,,/ ...--' - . , ,7 , .- ,), 'J /,r ''^ " Autho,izedily: / .r/'<t"l/~ -,;, /1.. ~..<~.;... -7'<:" -- - \ \......""-..~/.'" J. Paid by CEMETERY Receipt NO..,) ?~......... Dated,. ?{.~~/ ~ 3 . ..... .... ........... List Price $ . ~.q9. ~ ~9. ., .., . . Lots 19 &20 Block 32 Maximum No. Burial Spaces, . . . . . . . . , . . , . . . . Unit 4 Monument permitted. . . . . . . . . . . . , , . . . . . . . . . NO. 01406 ~s:!3.~~ (Data above this line for City Record only) [lB State of Florida, Departm*f Health and Rehabilitative Services, Vital Statistics APPLlCA~FOR BURIAL - TRANSIT PERMIT . ;:.. / ,0, 0-1 rJ ,;(1 3 d- !Ii A. 1. Name of Deceased (Type or Print) First Genia Middle Marie Last Roland DATE OF DEATH Month Day Year 06/28/1993 2. Place of Death County Brevard 3. Name of Medical Certifier Name of (If neither, give street address) Hosp. or Inst. Holmes Regional Medical Center Address Phone Number 1601 S. Apollo Boulevard James W. Battaglini M.D. -'Physician Melbourne, Florida 32901 (407)~68-2816 4. Name of Funeral Home/ Address Fla. Lie. No.1 Reg, No. Phone Number (Area Code) Direct Disposer 1623 North Central Avenue Strunk Funeral Homes, P.A. Sebastian, Fl 32958 1228 (407)562-2325 5. Check a 0 The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate Box City, Town or Location Melbourne ~ Medical Examiner b a Donna was contacted on 06/28/199..3ithin 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 James W. Battaglini M.D. will complete and sign the medical certification of cause of death. was contacted on . He/she verified that , Medical Examiner, will complete and sign the c 0 medical certification. 6. Place of Sebastian Final Disposition: 7. Funeral Director / BiFOGt QisJa9iilQ'-. Indian River F.E. NO.l~i~. ~IQ 1672 Removal from state Donation Date Signed 06 28 1993 B, BURIAL - TRANSIT PERMIT Permit No. 1228-93-0308 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 fir the death certificate requeste Registrar or ~ Subregistrar Signature . Date Issued: ~~J.~_ q~ 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. Signature of Sexton ) or Person-in-Charge ) o STORAGE o OTHER (Specify) /~ 9. /d~?-, CEMETERY OR CREMATORY P1ace of Dispo~tion s.: 5 ""3:; "//;, -"n'1",'-; ~ Date of Disposition _ _ - D. Methods of Disposition: . BURIAL o CREMATION 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.