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Paid by CEMETERY Receipt No... U...... D.ted. .~!.~~(~~...,...,.......". h~~ci8 .
L\at Price $..... ?~~. ~ ~<?... Maximum No. BurlaISJI8_............... JIni t 4
500.00
, 14~1
NO.
Net Pold S
Monument permitted .. . .. . .. . .. . .. .. .. . .. . .
(Dot. .bon tt.1o line for atJo Reeord 011")
(ftUg nf &rbasttan
Cltrmrtrry
'114~1
IIrrb
NO.
THIS INDENTURE MADZ 'I1lt.
........ ??t.h..... d., of ......... ."'~.8~~~....... .................. A. D.. I'.~.~...
heh....n the City of &buti.... . municoJpel C!OI'J>OI'8t..... ulotln. .nder the I.w. of the St.te of Florid.. .. arantor alld
Maryland S. and/or Henry C. Elliott
.. .. ... ................. .................. .65-1" Barber' .S.treet.............. . .... .. .....................................
Sebastian, Florida 32958
............................................ ............................................ . ... ......................................
of the Coont, of .....;J;mlJ~p...~.~~~:r................... .n'l St.te of ..F~~.~.~~~.........................................
u arontee, WlTNE88BTH I
500.00
Thot the Grentor for end in eonllideratlon ~f the IUm of S .......................... to It @h~rid, the receipt whereof Is herewith.c-
knowledaecl, does by this instrument 8fI'It. borp\il, seU, releese, mn",y .nd mnflrm unto the Grantee ......... hetn.1ep1 representatiYa end .ulpts
the foUowl.. property situated In Sebastlall. IIIdIan Rmr County, FIorlda. to-wlt:
AD of Lot(s) ..~. ~.. . BIodt, .~~.. ... ,UNIT ..~.......... ,of Sebastian mullidpal cemetery II per Plat Number 1 thereof remrded In Plot
Book 2, It JI8I!O 6S of the pubHc records ill the omce of the Clerk of the CIrcuit Court of St. Lude County of Florida; said IoncI now lying.nd bei..
in IlIdlon River County, Florid..
To Have and to Hold the same fore_; proY\ded th.t said property shaD be ullOd solely alld exc1uJlvely for the Intermellt of the humen dead .nd shall
be uaed. kept end maintained at aD times In ar:eordallCe with the rules.IId replatlons, orcIlnallCesand resolutions of the City of Sebolltlon. Florid., hereto-
fore, now .IId hereafter edopted or provkled for the ...-nment end operation of said cemetery. The conditions. restrictions end requirements mntolned
In this Instrument shoD be co._nts rarmtna with the land, III the event of the faI1nre of the owner of eny property situated within said cemetery to 0b-
serve end comply with iucll rules, .....lotlons. retoJutlons alld .ordinences end the colld\tlom of the deed of eon",yonce thereof then the title of lIIeh owner
In end to soid property shoD terminate end the same shoD rerert to the City of Sebostlan, FtorIcIa.
IN WiTNESS WHEREOF, The said puty of the first put hos cauted this Instrument to be executed In its name end on its beholC by its Mayor and
.ttested by its CIty Clerk end its corporate _I to be hereto offlxed, the d.y .IId year fIrtt .00'"
....... Si?ban1~qqqqqq
- i~r CIt,(d.,rk
(CIIitv $tal)
STATE OF PI,ORIDA
COl'NTY OP INDIAN RIVER 20th 93
August
I HEREBY CERTIFY. That on this ....................... .d.y 01 ..................................................., I.....,
Lonnie R. Powell Kathryn M. O'Halloran
before me penon.lly .pp"a",d ........................................................... .nd ....................... .. .. . .. .. .. . .. ..
r"!""Clive'y M.yor .nd City Clerk of the CIl)' 01 &bostlon. . munlell..1 corporation under the I..... of t~ State of Florid. to me known
to be I"e indl.idOl,I. and office.. delerlbed in .nd wi", ueeuled the foel'goln, """.ey.n... to
Maryland S. and/or Henry C. Elliott
. .. .. .. . .. .. .. .. .. . .. .. .. . .. . .. .. .. .. . .. . .. .. .. .. . .. .... .nd ...eral!y oeknowled,ed the e...~utlon thereol to be their fre. .ct ond deed
II slle" off~.. tllereanto duly .athoriaed I and th.t the Ornel.1 ..01 of uld enrpoeotlon \to daly .fflxed thereto, and the uld convey.nee
I. the oel .nd dftd 0' ..Id l:OI'JIOratlon.
WITNESS my sl....hI'" .nd offldal _I at &butlo... In the Coullty of Indl.n River alld State of Florid., the day .nd yea.
I.st ofor....d.
M JOANN! SANDI!RG
....,......... at f'bIda
_ClIlMiIII\IIn __ NIl' ..... N
OOMM'CC-
...:.~.;;~~HH.....HH.........
espt-,
Joanne Sandberg
Name ~\-\ F-: ",R ~ c. f J.J-..10Lr'
Unit~
Block ?J~
Lot ~ 5 .
Date of Mark.out~ '3
'\.
Date of Burial
qJ~~/c,:~
I
Time It I, <:113 A. /d '
Name of .Funera.I.H.,.om..e. .....<.M...(::"'......(.~ "..".".'. ,y".,'. '
~di
AUlhori'. ..~ ~
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JeJz;:W{i/)) FI... <:3~q6~
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In,} d8, :B/ld ~ /bJ;'-J l'
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yeep.:It #d/"
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..... -
PaidbYCEMETERYReceiptNo...?~?,..,......Dated 8/20/93 Lot 28
.. 500 00 ,..,',..,..,',...,',.,""'...Block 32
List Pnce $ .' ,
, . . , . , . , . . . , , , , . . Maxunum No. Burial S ce TT 't 4
500 00 pa s..,.,..,........"In1
Vnl':/':dt.......~.'ji;~A . MO~/J.~Ttted
( iT _-3 ~ ffV,va (!. &~ .......................
(Data above tbla One lor City Record oo1y)
NO.
, 1421
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City of Sebastian
POST OFFICE BOX 780127 0 SEBASTIAN, FLORIDA 32978
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
september 3, 1993
Maryland s. and Henry C. Elliott
657 Barber street
Sebastian, Florida 32958
Dear Mr. & Mrs. Elliott:
Enclosed is Cemetery Deed No. 1421 for Lot 28, Block 32, Unit 4.
Also enclosed is a form - Return for Transfers of Interest in
Florida Real Property - which must be filled out by you and
completed by the office of the Clerk of the Circuit Court when
and if you have the deed recorded. If you wish to have this
deed recorded, you may do so at the office of the Clerk of the
Circuit court, 2145 14th Avenue, Vero Beach, Florida.
VeujlY_ yours,
nr.U:VIf'..;m. tJ~A-
Kathryn M. O'Halloran
city Clerk
KMO: j s
enclosures
~
.
.
rJ73
THE SEBASTIAN CEMETERY
CITY OF SEBASTIAN
SEBASTIAN, FLORIDA
RECEIPT IS HEREBY ACKNOWLEDGED OF THE SUM OF:
F~ ~ Dollars (SSch1.tM
FROM: fJ7/1R YL/Jjl/,D $', 1lP',)));-e IIE///--€ '/ (!, .E ~L/OTT
/
tS7 /6/l"e/3ER ST.
,<::;'E/3 /J,ST//JAJ I ;: A- .3 d- 9$8-
,
)
on this day of , 19 for the purchase of the
following described Cemetery Lot(s) upon the terms and conditions as
stated herein:
Description of Property:
Cemetery Lot (s) ~e Block ..3' c2 unit.y
Purchase Price: ~~ Dollars (S Stfz1. tflJ )
Terms and Condition of sale: c). IF 33{
This contract shall be binding upon both parties, the seller and the
purchaser, when approved by the owner of the property above
described.
I, or we, agree to purchase the above described property on the terms
and conditions stated in the foregoing instrument:
The City of Sebastian agrees to
the above named purchaser(s) on
above instrument.
?72~~' t~
~;;?-~/~
sell the above mentioned property to
the terms and conditions stated in the
~ a !;!t~
City of bastian
'liJ ()~ L(! /JJ,. .. 10<-\
Witness r
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State of Florida, Departmea Health and Rehabilitative Services, VItal .tics
APPLICATlClrFOR BURIAL - TRANSIT PERMIT
~~Fr
;(j 3 d-
O ~I
A.
1. Name of
Deceased
(Type or Print)
First
Henry
Middle
Clyde
Last
Elliott
DATE
OF
DEATH
Month Day
09/12/93
Year
2, Place of Death
County
Indian River
3. Name of Medical
Certifier
Michael P. Tonner, M.D.
4. Name of Funeral Home/
Direct Disposer
Strunk Funeral Homes,
5. Check a 0
Appro-
priate
Box
City, Town or Location
Medical Examiner
Name of (If neither, give street address)
Hosp. or
Inst. Indian River Memorial Hospital
Address Phone Number
2300-5th.Avenue
Vera Beach, Florida 32960 (407)567-7111
Fla Uc. No.lReg. No. Phone Number (Area Code)
Vera Beach
X Physician
Address
1623 North Central Avenue
P.A. Sebastian, Fl 32958 1228 (407)562-2325
The medical certification has been completed and signed. A completed certificate of death accompanies
this application.
b iii
n.,..
'I'nnn...r
was contacted on n~ /1 ~ /~~ 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 Michael P. Tonner. 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 Sebastian
Final Disposition:
7. Funeral Director/
Direct Disposer
Indian River
F.E. No.l~. r4u. -
Removal
from state Donation
Date Signed
B.
BURIAL - TRANSIT PERMIT
Permit No. 1228-93-0410
Permission is hereby granted to dispose of this body.
o A five day extension of time for filing the death certificate (excl~ive 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 e death certificate request
Registrar or e.
Subregistrar Signature '
~~d: 9-/3_'73
Date Certificate
Due:
C.
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA
Signature I 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 ~eriod 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)
J(~ 9- j(~~7
Place of Disposition ':;.e.d A or /.A AT (7 F- -. IZ.. ~~ r!. II
Date of Disposition . <1 II~ / ~ :3 I
Signature of Sexton )
or Person-in-Charge )
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: