HomeMy WebLinkAbout4-32-35
Paid by CEMETERY Receipt NO....~....... Dated..... f,(.~~/?~.............. Lots 3.t 3j ~
2000.00 Block
un Price S .. . .. .. . .. . .. .. . . . Maximum No. Burial Spaces .. .. .. .. . .. .. . "On i t 4
Net Pafd S .................. Monument permitted .. . .. . .. .. .. .. .. . .. . .. .
NO.
,', ]2
/39;)
(Data above tit.. line lor Clt, Jteeord only)
atuu nt &,ballttatt
(ttrutttrty
I"b
"1392
NO.
THIS INDENTURE MADE 'I1da
26th
....................., da, of
February
93
A. 0.. 18,.....,
bet..'..n III. City of S.itutlan, a muntelpal eorporatlon nlltln, und.r the laws 01 the State of Florida, al Grantor and
John L. Hector and/or Frances M. Hector
,..,..',.""".............. ....56.S..Autumn. .Terra-ce..... .....................,............................. ..............
".................... ...........~~.~.~~~.~~~,',. .~.~?~~.~.~.. ~.~.~.~~.............. ,.,..,.".......,...........................
of the Coanl)- 01 .. ..lr:t.4;l,~.I,l.. !M.Y.E:!~.................... an,1 Stale 01 .. ..Jf),q~J4~..................... ..................
u Grantee, WITNB8SBTH, , , " ,
2000.00
That tbe Grantor for and In consideration of the sum of S .......................... to It In han! paIcl, the receipt whereof Is herewith a.,.
knowledpd, dues by this Instrument pant, barplft, sen, releale, convey and confirm unto the Grantee . ~~~.. ~ heln, lepl reprelllntatlva and assl8nl
the fobo~..P!!'pertl s1tuateclln Sebastian, Indian RIver County, florida, to-wlt: .
31,,32}33,34,3S 32 4
AU of Lotts) . . . . . .. ,Block,........ ,UNIT ............. ,of Sebastian munldpal cemetery as per Plat Number I thereof recorded In Plat
Book 2, at JIIIe 65 of the pubHc recordlln theomce of the Clerk of the Clreult Court of !It. Lude County of Flortcia; ..Iclland now lyInJ and belDll
In Indian RI_ County, FlorldL
To Have and to Hold the lime fore_; provlcled that aaIcl property shaD be utecllOlely and exc:Ju1lve1y for the Interment of the human dead and shall
be used, kept and maintained at aU lImel In accordance with the rules and replatlonl, ordinances and resolutions of the CIty of Sebastian, Florida, hereto-
fore, now and hereafter adopted or provIclecl for the IlOvemment and operation oiaalcl cemetery. The condition.. restrictions and Iequlrements contained
In thillnltrument .haU be covenantl runnlnt wtth the land. In the event of the failure of the owner of any property IItuatecl within aaIcl ..metery to ob-
sene and comply with iuth rule.. replallons, relOJutlonl and ,ordinances and the conditlonl of the dllecl of conveyance thereof then the title of lOch owner
In and to aaIcI property IhaII terminate and the .me lhall revert to the City of Sebaltlan, FloridL
IN WITNESS WHEREOF, The aaIcl party of the f1rst part h.. caDled this Instrument to be executed In Its name and on Its behllf by It. Mlyor snd
attested by Its CIty Clerk and Its corporate leal to be hereto affixed, the day and year lint above/ ten.
//
CIT '0
Alt'Slt~ !.: ~-....0..0(/Ml..11~
,/., '~r City C1.rk
.... .. ..~
RI,nod, S.aled and D.llv.red
In ~ ~~~: 0"
~~..d~................
~~.~.......
(flitv '.al)
STATE OF FU)RIDA
COl'NTY OF INDIAN RIVER 6 93
2 th February
I HEREBY CERTIFY, That on thla ...................... ..day 01 ...... ."........................................., I.....,
Lonnie R. Powell Kathryn M. O'Halloran
b.f".. me perlonall, appeared .........................,.,...,.....'..".,.".,.,........ and ..................................... . .
r.......tiv.ly Mayor and City C1.rk of the City of S.ba.t1an, a montel,..1 eorJlOratlon under the lawI 0' the State of Florlda to me known
10 b. IlIe Indlvidunl. nnd om.... deserlbed In and wllo ."..uled the 'o"lOln, ....veyanee to
.. '..,., . ......................... ...]Qhn. .t.... .lle.c;.t;9.~.. And/.Q1: ..f.J;'~mc.e.f). .M... .a~~ t.Q~..............................
. , , , . .. . . , , . .. . . . . . . , .. . . . .. . . . . .. . .. .. . . .. .. .. .. . . .. ... and ..v.rally a.knowled,.... the ."eeutlon th.reof to he their fre. a.t and d.ed
as such offte.rs tll.reunlo duly authorlaed I and that tit. Omelat ..al of laid eorporatlon II duly aftl"rc1 the..to, and tbe said eonv.yane.
I. the Ret and deed of said eorporaUon.
WITNESS Ill)' .I...atu.. and ofnelal _I at Seballlan, In the Cou
lilt ato....ald.
J.Jta N. U)Hk
NDIIIy PIMo8IIt _......
.., CeInmIMIlllI e..-. MI tt,'"
COMM' CO..,..
~---
Name~ oliN
A.
JI ,,-r--'" /
r;..l':: / J,c',j.C '
Unit 1-
Block .3 ~
Lot "3 j-
Date of Mark-out
I '
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Date of Burial /'> / / ,,) If;; ")- Time
.1""-"7 "'\
Name of Funeral Home '~'~n;" Al }-~5
,/ /' r"/fI' ,-'
I' /'/, ,/
Authorized by \:~.' ;":/~";'~';:::;""""';"':"~'/AI'"
-,-- \
/ 1
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....-.4. $ C':." <.) j
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QQ)-~ l.., $).
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OL9190n-&9 ..
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3.LVa '
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
3232
~~L~_
Dalt ' ~:I?3~
No. Amount Paid
001001 208001'" Sales Tax
001501 322900 Garage Sales
001501341920 CopIesl8Id Specs.
001501 341910 LDCICode of Onllnances
001501341930 EIecllon QualIfyIng Fees
601010343800 Cemetery lois
LotINlche Block
UnII_
001501 343805 Cemelely Fees ,?,.5';' ~ 0
a tj,(1. J~~~
~ t" -.4 _,.2 -,l' .7..$
O.
~t
#~
Total Paid ' d IJ
Whit. - Dlpt. af Origin. Vall.. - Fln.nea . Pink. Applicant
:.,i!;s[Ja~'q l.':IO:I,' all'31: b,OO.II. I
.I",e.L'1< 'eg,,'elfc~~'~.:.J.,")'11I:lQ:I' i
-:~'- I
-,,])>ll~ .....'Ttt.~~.r~ I
~l1?OCf&S.. ' ,,~. ~o ~~!~l f
~~UL'Hd ' !J
~':I,!H3V3BO\:l3^. ,
. . 'lSH.LL~9~6, , '
NVI.LSVSaS".LNnO:)tn,/aONVAQV.HSV:).
~V.d','SaWOJl"VHaNn:l}lNmu.S
It' v qa.a-s. .,11.0' III.n,3.Op pa," I/' l/'" a '1.~II-'lIa's
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL - TRANSIT PERMIT
f-J2~.l J
FLORIDA DEPARTMENT OF
A.
1, Name of
Deceased
(TYPE)
First
Middle
Last Date Month Day Year
of
Hector Death Feb. 11 2005
Name of (If neither, give street address)
Hosp. or
Inst. Tiffany Hall Nursing & Rehab
8'83 S. U.S. '1, '19 Phone Number
Port St. Lucie, FL 32952 772-873-1770
John
L.
2. Place of Death
County
St. Lucie
3. Name of Medical
Certifier
City, Town or Location
Port St. Lucie
M Address
Ravi Mehan, . D.
Medical Examiner
Physician
Address
1623 N. Central Ave.
Sebastian, FL 32958
Fla. Lie. No.lReg. No. Phone No. (Area Code)
4, Name of Funeral Home/DiI.::..::.1 B;"l-'v,,"..1
Establishment
Strunk Funeral Home
5, Check a. 0
:~~ropriate I
b. rn
1228
772-589-1000
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
(Co~~
Trish was contacted on 2/1'/05
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr., Mehan will complete and sign the medical
certification of cause of death within 72 hours,
Ii'ltr ~~l 6;~f-'u.4er
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
3. Funeral Director/
e of death within 72 hours.
F.E. No.lReg. No,
1862
Date Signed
2/11/05
3,
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 1228-05-0068
o A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within
72 hours.
ONO extension of time for filing the death certificate has been requested.
Rw~;'!'l,~1 61
Date
Issued: 2/11/05
Date Certificate
Due: 2/16/05
Subregistrar Signature
,
J,
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -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:
It!SURIAL
DCREMATION
Signature of Sexton
or Person-in-Charge
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
).
DSTORAGE
Date of Disposition
;s ~~/05---:-
.
DOTHER (Specify)
l i0f-l:~
'his 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
lithin 10 days to the local County Health Department in the county where disposition occurred.
H 326, 8197 (Obsoletes all previous editions)
;tack Number' 5740-000,0326-2)
Distribution: White: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar