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Home My WebLink About4-32-38 ---' 71 Paid by CEMETERY Receipt No...... Ust Price S. .~9.9:.~.q....... 800.00 Net PaIcI S .................. ..... . Dated .....~ !.~~t.~~............... Lots ~' Block _ Maximum No. BurlaISpaces.. ........... ... .Uni t 4 38 NO. Monument permitted .. . .. . .. .. . .. . .. .. . .. . . 1400 (Data .bove tltll line for City Jteeord onl,) Cltitu of &tbusthttt <ttrmrtrry IIrrb NO. 1400 THIS INDENTURE MADE '11IIa 16th da, of April 93 A. D.. I......., bet,,'..n th. CIl, of SebOltlan, . munielpal eorpor.tlon nlltln, und.r th. lawI 0' the State 0' Florida, II Grantor and ...".................................. ..W.:l..l..liam.. R... ..OX.. Catbed.na. .ne.plar......................................... 461 Easy Street ,'.,...... ............ ...................Se.bastian,. ..Fl0 r-ida..32.9.S8 ...... ,..,.'..,.............. ....................' Indian River Florida 0' th. Count)o 0' .,........................................... an" Stlte 01 ....................................................... al Grantee, WITNESSETH. That the Grantor for and In conslderatlon of the 10m of S .~~9.'. 9.Q. .. .... .. . .. ... . to It In hand paid, Ihe receipt whereof Is herewllh ae- knowledaed, dool by thillnotrument grant, barpln, lilli, relealll, convey and confirm unlo tbe GranteD ~.i!~.; ~. heir.. lepl repre_tallves and alll8ns the followllll property situatplln Sebastian, InclIan Rmr County, Florida, to-wit: AU of Lot(s) ~.~ ~.~'~ , Block, . ~? . .. ,UNIT .... ~. . . . . . .. . of Seblstl.n munldpel cemetery as per Plat Number 1 Ihereof recorded in Plat Book 2, at pip 65 of the pubUc records In the ,office of the Clerk of the Circuit Court of St. Lude County of Florida; .ldland now lying and bellll in Indian River County, FlorldL To Haw and to Hold the ame, foftlver; provicled that said property shall be usecl solely and exelullvely for the Interment of tho human dead and shall be usecl, kept and maintained at aIIt1melln aecordance with the rules and replatlon., ordlnlncel and resolutlonl of the City of Seballtlan, Florida, hereto- fore, now and hereafter Idopted or provicled for the government and operation of aaIcl cemetery. The eondltlonl, reltrlctlons and requlremenll contained In this Instrument shaU be COvenantl runnlnl with the land. In the event of the falluro of the owner of any property IItuated within laid cemetery 10 ob- serve and comply with iuth rules, replation.. resolutlonl and ,ordinancel and the condlllons of the dllecl of conYllyance thereof tben the title of such owner In and to aaIcl property lhall terminate and the .me mall reVllrt to the City of Sebastlan, FlorldL IN WITNESS WHEREOF, The aaIcl party of the lint put has ..used this Instrument to be exeeuted In itlname and on its behalf by itsMlyor and attested by lis City C1ert and Itl eorporate seal to be hereto affixed, the day and year firllt 100.. written. CITY Alt"hqd~.J~; ..m....f)!/I..~~.. ~1' "-' Clt)o Clerk slgne,!, S.al :"~;~~' nr1,fi.:=nnnn ~...~............... STATE OF FI.ORIDA COl'NTY OF INDIAN RIVER 16th April 93 I HEREBY CERTIFY. That on thll ....................... ,day 01 .,....,............................................, 1.,.... Lonnie R. Powell Kathryn M. O'Halloran br'ore me p.....n.n, ap~a..d ......................................'".'....,.....,...,. and ....................................... r..pt",Uvrly Mayor and City CI.rk of the Clt)o 0' S.buU.n, . municipal corporation und.r the l.wI of tho, St.'e 0' Florida to nl. known to b. lhe Indlvldunll nnd oW<<.. deaerlbed In nnd wllO n.eulrd the ron'lJolng euav.y.nce to (QIitv "ral) ........, ................................. .t.'lJ.U;l..~Al..R... .Q;t: ..C.~.t;h~.~.:tn~. .~~ple,J;',.............................. ........ . . . . , .... .. ... ...... .... . ........ .. ...... ......... ...... and ..verltny leknowledged the ""ecutlon the...,' to be thr.lr 'rre ad .nd deed .. such ofFIc.r. thereunto duly authorbedl and that the Ornelal ...1 0' ..Id ...rJlOrallon II duly aWxed th.r.to, and tbe IBid conv.yan.. I. tb. Rd Rntl deed of nld eorporatlon. WITNESS 111)' IllfIIature and o'""lal leal at S.baltlln, In the lalt "or..ald. UllOA It LOMII. .... .................. ..,CelrIIlIIIIoll....... 1.,... COMII'CC.,.. Linda M. Lohsl Name o 'Li.~ ;" F) /'}) f: lie. /;1 E I'D i L" ,12:. Unit '-I Block ..:5 2.. Lot ~3 2; " ..::;;'>1:61 Date of Mark-out 10/5/ If I I F'-' ' Date of Burial j""jQ7 I 0 I I I I Time 1/ ~ ") , ,DC /,f' I'll, Name of Funer!lIHOm~ \ ! / ,-_.,~ -"". /';"- Authorized bY,::~::~\'X 6T;.:j'u to A ,:J :,".:' '-'r" _..,//~",;,/., )r / }' ;,;;; / .,lJ /1// t' .' ,~.. .,;>... '"r~ I,.' :. I: _~ y /_;_.~. ,/ J I~ A. 1. Name of Deceased (Type or Print) First 2. Place of Death County I ndian River 3. Name of Medical Certifier State of Florida, Deparbnent of Health, Vital Statistics APPLlC. FOR BURIAL - TRANSIT PERMIT t. 3~ 13 3d- tI~ . Middle Last William H. City, Town or Location DATE OF Bepler DEATH. Oct;. 3, 1997 Name of (If neither, give street address) Hosp. or Inst. Indian River Memorial Hospital Address Phone Number Month Day Year Vera Beach Medical Examiner Noor Merchant M.D. Physician 7744 Bay Street, Sebastian, FI 561-589-0879 4. Name of Funeral Home/ Address Fla. Uc. No.lReg. No. Phone Number (Area Code) Direct Disposer 1623 N. Central Ave. Strunk Funeral Home Sebastian, FI 1228 561-589-1000 5, Check a 0 The medical certification has been completed and signed. A completed certificate of death ~ccompanies Appro- this application. priate Box 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 filing th eath certificate requested. 6. Place of Sebastian Final Disposition: 7. Funeral Director / Cir;g~ niopnC!or B. ne~ieJtre.f af Subregistrar Signature C. Signature or Medical Examiner, b QS Wendy was contacted on 10/3/97 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 Dr. Merchant 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. I ndian River F.E. No.1 Reg. No. 1862 Removal from state Donation Date Signed 10/3/97 .. BURIAL - TRANSIT PERMIT Permit No.1228-97-407 ' ~~~~d: ' ~ (3 (~1 ~~~~a'\q, AUTHORIZATION for CREMATION, DISSECTION or BURIAL -AT-SEA , Medical Examiner Date , 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. Methods of Disposition: ~ BURIAL o CREMATION Signature of Sexton) or Person-in-Charge ) CEMETERY OR CREMATORY o STORAGE o OTHER (Specify) Place of Disposition Date of Disposition ~t-.. a4YlJT~ ~('i:n ~ 1) Ii 'l'1 ~~ 3L. ~ This permit must be endorsed by the Secton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the County whefe disposition occurred. DH 326. 10/96 (Replace. HRS Form 326 which may be u.ed) (Slock Number: 5740-000-0326-2) :J: