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Paid by CEMETERY Receipt No.. ..
List Price S.~ I ~<?9:.<?9.. .....
.---r-' 1,300.00
NetPaid$ ..................
- 'C;........ Dated.. fl/.?U9.fl....... ..... .. ..... Nichef
Block ,
Maximum No. Burial Spaces. . . . . . . . . . . . . . . . Uni t 4
& 45 West NO.
Monument permitted.......................
-1;';41
(D.t. above thl. line for City RecMd only)
atity of t;t ltnstintt
OJrmrtrry
Ilrrb
'-1541
NO.
THIS INDENTURE MADE TIdI
21st
of . June 96
day.........,...........................,....... A. D., 1.......,
bet",..n Ihe City of Seba.tlan, a municipal corporation exl.tlng undc. the I.w. of the State of Florid.. .. Grantor and
Mary D. Lacey
. . . . . . . . . . .. . .. . . ... ... .. . .. . . . .. . . . . ,. "64l!/' 'SW' Fll:!ll1ing . Stree-t. . . . . .. . . . . . .
.....,..,....,..... ........ ... .....,.',.. S~b!ist.~!i~.',.~.~?,ri~. .~.~?~~,....., '.
of the County of ..+~Q;i,~, MY~L............ ............ .nl State of :........ Elp.:r;;i.da ..... ............ ..................
.. Grantee, WITNESSETH,
T";'t the Grantor for and in consideration of the sum of S .. ~.,)9~: ~. . . : . . . . . .'. . . to it In h.nd paid, the receipt whereof is herewith ac-
knowiedged, does by this instrument grant, barg.m, sell, release, convey and confirm unto the Granlee .. J;1!?:I; . .. heirs, legal representatives and assigns
the followinJ! I1ropert); !ituatecjln Sebastian, Indian River County, Florida, to-wit:
N1Ches 44 & 45 WesJ1 4 .. .
All of~. ...... ,Bloclc,........ , UNIT.. ............ ,of SebastIan mumapal cemetery as per Plat Number I thereof recorded in PI.t
Book 2, at page 6S of the public records In the office of the Clerk of the 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 shan be used ..,lely and exclusively for the Interment of the human dead and shall
be u.ed, kept and maintained at aU times In accord.nce with the,rules .nd regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto-
fore, now and here.ner adopted or provIded for the government and operatioo of said cemetery. The conditions, restrictions and requirements contained
in Ihls In.trument ,hsll be covenant. running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob-
serve and comply with such rules, regulations, resolutions and ordinance. and the conditIons of the deed of conveyance thereof then the title of such owner
in and 10 said property shall terminate and the ..me .h.1I revert to the City of Seba.tian, Florida.
IN WITNESS WHEREOF, The said party of the first part ha, caused this in.trument to be executed in its name and on its behalf by it, Mayor and
attesled by Its City Clerk and Its corporate seal to be hereto affixed, the day and year fiut above written.
CITY OF SEBASTIAN, FLORIDA
,- './Yl 0 .j
AltffiT:rdl.. ,,1-'./....,. .1'hL~.!-:<:":':-:-:.....,...,..
City Clerk
Si;"7' ''{t-:
By r"1~c,.~,c,..4-A . . f-<', ,I(~, ( ,~ !-:.,A-:~ tr.. :, ,: . . ., .
Mayor
Higm'll, Sellled nntl Dellvtred
In lhe Pr.y"hce 0" /// . .
.. :/*'-/Z /.U"7'\'-'~ ~~dh< '1' . ., . ... ... .,
/ / -7 'I) -y
(};.'!-;.~~. </ /' . ./ (?~-:'ht....{,.-
I /
S~'ATT': 01' I'LOltlllA
CIJl'NTY OF (NDlAN RIVER
(<lIit\! !ileal)
21st J1.ll1e 96
I IIEIlEIlY CERTIFY, That on thl. ............... .... .d.)' of ............................................., I.....,
h..cure lIle pmunnlly nppmcd }~l1:!-.~e..~....~~r:t~~gl~t... and Kl=lth~..~.,..q'.~n9,J;'~........
rr!'tpl.,..t iwdy Marnr find ell)' (,Ir.rk of the City of SebRstlnn, II IOnniei"nl (~OTf1orutinn undrr the 18"'8 of tht' StRh~ of Jflorhla to. mr. known
10 bf~ II", Indh'iduuh; nnd offlct'rs lIes(~rnK.'d in flncl who ('xecuh~d tllt~ (unguillR CUAVt")'lInce to
. .&nr. .0,. .Lacey.... .... .,.... ...... .,....
\
. . . . . . . . . . . . . .. . . . . . . . . .. l\ud srverrLl1l' ncknowleclg("tl t.hc execution thereof to be thefr fnr Rct And clcefl
Ol; !;lIdt offlcl"S: tlH'rt'unto duly uuthorlzrd; and thRt the OfflciRI sC'ul of said corpurallun fa <.Iuly a{(lxed thereto, Rml the sHid run...yuncc
is tht' lief. IIml dt'ell of said corporaUon.
WITNESS lilY .Ignnture and official .eal at Seba.tlan, In the Counly of Indlnn (liver nnd Stale nf FloridA, the. day and ,e..
IRst lI(or~8.hl.
...........,..................................................
Notary Public, StAt. of Plorllln at Largo.
M)' ""nuai..lon expire..
Linda M. Galley
:l <: )
,; ,,)
Name
Unit
~I
"
f 5'- (v....;)
~.,.....,.,..--.-----:--..........,. ...
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3/fF. 0-5--
~~7
Name of Funeral HO,r:ri': . / ~ HI
/' ~.. )(,""
/ -' /
Authorized by (,. ~. /~' ,
Block
::/
11=
/1,
Lot
Date of Mark~out
Date of Burial
P;"7J
) j ,
...-"'~' )
/;....-,j~H.
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./
Crematory Representative
I hereby certify that herellJ are contained the Cremated Remains
of: .~~"~~._^."___"._<_~ Q,. LA!;;EY~_<_<_<".<,_. <_.<_~
Cremated on the -~_'____ _ r4.,daY.Q.[&lJru~_2.QQ~______.___~_
Pennit No. ----1L-__ rUnty of Death "__<.._Pro~_,_
Date of Death ~tm!n:..._~OO.~,_.",_.__
Funeral Firm -'--, ~ SaWKL~Y.mt~l1!l.HQ.m~_
AD
By:
ADeo
820 Northwest 57th Street
Fort Lauderdale, Florida 33309
.~~-"
-~^'_v:...:>
3276
Dca~
~eck#_~~
Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 CopiesIBld Specs.
001501 341910 LDClCode of Ordinances
001501341930 Election Qualifying Fees
601010343800 Cemetery Lots
LOtINiche~' . BIock_~/ . Unitf--
001501 343805 Cemetery Fees .-
/) /1 ..,./ ~ ~ I"~^~
C;J 0'-- \...:.. - ,V/JI ~~ ~ - ~ ~ ~!?
tit?
Total~ ~()O
Initials
White - Dapt. of Origin. Yellow - Finlnce . Pink. Applicant
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.
.
PLEASE PRINT
DECEASED /YI A fG I
NAME: ~. , I
tFll8Tl
IMIllOUI
LAce j/
.,-"
(----
Il.AS Tl
DATE OF Bmm:
s-
.
0~
/ 9 / '"'~
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lOAYI
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DATE OF DEAm:
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!YUIll
SIGNATURE: ~JZayf ;dJ ~{..
~~TURE:", (0 A R .; ]:.:J LAC C' ./
,
DATE: / I.{ r-{.'1<-e. ( if '1 tr
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FOR OFFICE USE ONLY
COLUMBERItJM:
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