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Home My WebLink About4-32-27 ---- Paid by CEMETERY Receipt No.. ?p List Price $... .1., 000 ..00. 1,000.00 NetPaldS .................. 7/29/93 Lots ~ '27 ....... Dated.............................. Block Moxlmum No. BurilISJII_.........,...... Uni t 4 NO. Monument permitted............,.......... 14.16 #" /' (D.t. .be.... thla line for Clt,. Reeord oaly) atUll nf l'fbusttatt (ltrtttttrry Irtb "14i8 NO. THIS INDENTURE MADB 'I1da 29th day of July 93 A. 0.. 1........ beh,'een Ihe Clly of Sebot..", . lDanlelpal corporation nlotlnl' under the 1.10. of the Stote of Florid.. .. arentor .nd Mary E. Mather-Smith ...................... ...... ..........492..'roled.o.. Street ..... ..................................... .................. ...... .................. .....................~:.~~ . .~?~ ..?~~~.?~.'.. .~.~~~~.~.~~~. .~.~ . ~~.9?~............ ...................... of the Count,. of ... Jp4;i,~.t:1.. R;l..y.~~.................... .n'.1 St.te 01 ... n,~+J4~....................................... u are"" WITNBS8ETHr T1at the Grllttor for.nd in conlliclentlon of the sum of S ..~ }.l?~g... 9.9............ to it in bond paid, the receipt whereof i. herewith.e:- knowledged. doe. by thilinltrument pant, lmplft, leU, relelle, convey and confirm unto the annt~~.r. . . . .. heln.1ep1 repre_tatlYllIand ... the following property sitllltecl in Seblltlan, Indian Rmr County, F1oricla, to-wlt: ( '6&27. to 32 4 ..~ AD of Lot .r. . . . . " ,B ct........., UNIT ............. ,of ....b.lllan munidJIII cemetery II per Pllt Number 1 thereof recorded in Pllt Book 2, at JMI1l 65 of the pubUc recordlln the office of the Clerk of the CIrcuit Court of SL LucID County of Florida; Slid land now Iylnsand being in Indlon River County, Florida. To H.ve .nd to Hold the same fo_; proYided that said property ohaO be uled solely .nd exclusively for the interment of the humllt dead and shill be uled. kept and maintained at .0 tirneoin accordance with the rulll and resulltlolll, ordinance. and resolution. of the CIty of lleblltlon. Florid., hereto- fore, now .nd hereafter orIopted or proYided for the sovernment IrId operation of said cemetery. The concl1t1on.. restriction. and requirements contained in thl. instrument IhaD be covenant. runnlnl with the land. In the _t of the fallure of the owner of any property situated within said cemetery to ob- """" Iltd comply wit" inch rul.... ....Iotion.. l'IIOtution. and ordlnon.....nd the conditlonl of the deed of conveyance thereof then the title of such owner in and to said property .10.0 terrnin.te .nd the Slme ohall revert to the Clt, of Sebeltlan, FloridL IN WITNESS WHEREOF, The said JIIrty of the flrll port ha. canoed thlo instrument to be executed in it. name and on it. beh.1f by It. Mayor .nd altelted by ito City Clerk and Ita corporate .u to be hereto ofIIxed, the doy .nd year fInt .bove written. .~~ JYJ C11;/~ Attesh ... ;-:-:-'-::~'7'''''''-''''' CI~~""'''''''''''''''''''' CITY OF SEBASTIAN, FLORID)'!. f /l c-:-- ~...j dJ~/tLJ'- By ...ili7 ~~;~~......................... Rlgn.d, Se.led .nd o..lIYO",d :~.t"\A? .~Cl.!J!..~.. ..., ......,.. .... .... .~ .J 0~.c.~~......... (CIIitv ~f.l) STATE OF FJ.onlDA COl'NTY OF INDJAN RIVER 29th July 93 1 HEREBY CERTIFY, That on th.. ....................... .d., of ..................................................., 19...., brfure me penon.lly appe.red ...~~~~.c;:.~~.,'!.~..~~.~.~~~~.t.c....................... and K~~.I:t.~y.~..!:f.~..9~~~gl?~~~.. _p"ctlvely M.yor .nd City Clnk of the Clt)' nl Se.....tl.n, . munlcllNlI etIrpor.tlon undrr the I.... of the State of Florid. tn me known 10 .... the Indlvidu.l. Alld officer. dlllCrlbed In and ....0 executed the 'on'lfOlng eunl')'onee to . ......... .............................. ..~El-.:t;'Y. ..E.,.. Ma.tbaJ:::-.Sroi t.b.............. ............................................ . . . . . .. . . .. . .. .. .. .. . .. .. .. .. . .. .. . .. .. .. . .. .. .. .. .. .... .nd oeyor.lly ocltnowledpcl Ihe ",,_lion thereof to be thelP frre .et .nd deed II such ,,'fleers U....,unto duly .ulhorloed I .nd lbot the Orflelal _I of sold corpoeatlOl1 I. duly ."._ed thereto, ami the sold convey.nc:r I. Ihe lIet and deed of sold c:orporetion. WITNESS my .......tare and otfldol _I at Sebaatla", in the Co 1.11 otor..a1d. UlllMII. Ult& ...., ,............ __ ClIltIIIIIIIIII......... .... ClllIIII.._ .nd 1M. Name 'I1Jf~y Unit .1 18'--. . /Y}~.rt1GR- SA .J! Iii \. Block .3 ;- Date of Burial ~r 1/'/1S- 1/ h/C;:r Time II .' t:Jo A ",Nt . Lot Date of Mark-out Name of Funeral,Ho~/'i / ..-.... ....>~/ .>" Authoriz~~-'~T-A~/i" i ~~. '-~,.';-::/'>." ,.""'''''' ,,' /'l;r..... . J ' /7/":/ :"".//.. />{l (.~\4 fI..>(. .x.i~-1 , . , J:" 11Il~] State of Florida, Departme. Health and Rehabilitative Services, Vital .ICS APPLICATI~FOR BURIAL - TRANSIT PERMIT ~-~ A-dlt) d 7 /3 Z;J. !;L.j A. 1. Name of Deceased (Type or Print) First Mary Middle Eve I yn Last Mather-Smith DATE OF DEATH Month Day Year 03/31/1995 Medical Examiner Name of (If neither, give street address) Hosp,or Inst. H I R' 1 d . I o mes e lona Me lea Address Center Phone Number 2. Place of Death County Brevard 3. Name of Medical Certifier Andrew Atkinson, M.D, 4. Name of Funeral Home/ Direct Disposer Strunk Funeral Homes 5. Check a 0 Appro- priate Box City, Town or Location Melbourne X Physician Address 930 S. Harvest City Blvd. Melbourne Florida 32901 407 725-5050 Fla. Uc. No.1 Reg. No. Phone Number (Area Code) 1623 North Central Avenue P.A. Sebastian FI 32958 1228 407 562-2325 The medical certification has been completed and signed, A completed certificate of death accompanies this application. b ~ was contacted on 04/0J/199jtithin 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 Andrew Atkimmn. M.D. will complete and sign the medical certification of cause of death. c 0 was contacted on . He/she verified that , Medical Examiner, will complete and sign the medical certification. 6, Place of Sebast ian Cemetery Final Disposition: 7. Funeral Director / Direct Disposer Indian River F.E. No.lReg. No. Removal from state Donation Date Signed . B. BURIAL - TRANSIT PERMIT Permit No 1228-95-0185 . IJirmission is hereby granted to dispose of this body. . llr""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 filing the death certificate requested. Registrar or Subregistrar Signature ~:~~d:L/~- fs- Date Certifi~e " Ot::- Due: _-;_/v 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: 00 BURIAL o CREMATION o STORAGE o OTHER (SpeCify) Place of Disposition Date of Disposition ~~t3;'!s7lc..,., ~.h?~ 1~1€'f A"ot€,'f- &, /995 , Signature of Sexton ) or Person-In-Charge ) LJ./~~ I. /.I~ / 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: 5740-000-0:.'126-2) :r