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Paid by CEMETERY Receipt NO........... Dated... ~.~(?/??................. NiCheA& 23
1 300 00 Block 1Ptest
List Price $ . . . ... . . . .: . . . . . . . . Maximum No. Burial Spaces. . . . . . . . . . . . . . . . Uni t4
NO.
Net Paid $ . .1.,.300.00.....
Monument permitted. . . . . . . . . . . . . . . . . . . . . . .
1521
(Data above thIs line for City Record only)
OJUy of l'rhustiutl
<trrmrtrry
II rr~
15"21
NO.
TillS INDRNTIJRE MADE TIaIa .'"
6th
December
95
day of ..
A. D., 19,
hel",ee.. the City of Sebastian, a munlclpal corporaUon e:oloUng under the laws of the State of Florid.. ao Grantor and
David L. Lundberg
. .."." ,. ,..... ,.... "890 'Haverhill,Avenue.'."".'"
Sebastian, Florida 32958
of the County of
la Grantee, WITNESSETH,
That the Grantor for and In consideration of tlte ,urn of $ ~ !.~99...99................ to it in Itpnd paid, tlte reoeipt whereof Is herewitlt ac.
knowledged, does by tltis inlrtrument grant, bargain, sell, release, oonvey and oonfirm unto tlte Grantee.. !:~~... heirs, legal representatives and assign'
the followin~ property situated in Sebastian, Indian River County, Florida, to-wit:
Nlches 22 & 23 31W t 4
All of ~. . . . . .. ,Block,... ~!'l. .. ,UNIT ............. ,of Sebastian municipal cemetery as per Plat Number I tltereof reoorded in Plat
Book 2, at page 6S of tlte public records in tlte office of tlte Clerk of tlte Circuit Court of St. Lucie County of Florida; said land now lying and being
in Indian River County, Florida.
.,. J~.#!,!n. ,Riv~r.
, " Inl State of
Florida
..........,........
To nave and to Hold the sare forever; provided tltat said property ,hall be used solely and exclusively for tlte Interment of the Ituman dead and shall
be used, kept and maintained at all time, in accordance witlt the rule, and regulation" ordinances and resolutions of the City of Sebastian, Florida, Itereto-
fore, now and hereafter adopted or provided for the government and operation of said cemetery. Tlte conditions, restrictions and requirement' contained
in tlti, instrument ,ltall be covenants running with tlte land. In the event of tlte failure of the owner of any property situated within said cemetery to ob-
serve and comply witlt suclt rule" regulations, resolution, and ordinanoe, and tlte conditions of tlte deed of oonveyance tltereof tlten tlte title of suclt owner
in and to said property shall terminate and lite same sltall revert to tlte City of Seba,tlan, Florida.
IN WITNESS WHEREOF, Tlte said party or tlte first part ha, caused this in,trument to be executed in its name and on its beltalf by Its Mayor and
atte'ted by Its City Clerk and Its corporate seal to be Iterelo affixed, tlte day and year fir,t above written.
Atl~:~ ))1 Odm.14~~",.
~ City Clerk
Sigm'd, Selll ~ IInd Dellvere0
In the Pres ee Of'V -1..
. ;; ~ (.),.~
.~ChJ~
STATE OF FLORIDA
C01'NTY OF INDIAN RIVER
I lIEHEllY ClmTIFY, That on this
"T:,~?~
M aTor
(Cllitll ~ell()
6th
December
95
19, , , .,
.dllY of
b..fo'e me personally appeared ..1\r?t,ur..L:.. F.i~t~Oll and K~t~:ry,n..l:I.'.. ~: ~~.~?~~.~... ....
respl'{'li\'t'ly Ms)'or And City Clerk of th~ City of SebAstinn, " munkipal corpofRtion under the laws of the State or Florida to me known
to bt, tlu' indivitluuls and nfficrrs des(:rfb'.'d in IlOd who exeeult~d the fon.goin<< CUAveYlll1ce to
, , . . , . , , , , . . , , , . , ' , . R~yiq , J., ,L1ll;1QQe,.r;g , , . . , . . . . . , , , , . , . , .
. . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . and sevulllly acknowledgt.t.J the execution thereof to be their free act nnd (leetl
as snch officers thereunto duly 8uthorized; and that the Orficial sClll of said corporatioll is duly affixed thereto, nnd the said conveyance
is tht~ net llnll deed of said corporation.
WITNI~SS my signature and oW.lal leal at Sebaatllll, In tlte
IlIst IIfon'sahl.
LINDA M. GALLEY
MY COMMISSION , CC 37~1l!4 /'
EXPIAES: JunelB, 1.
......l1IIU ~ Nile UIIdiIrMtIIn
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Date of Mark-out
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Date of Burial ,:/1.,,< "; / ! t..r
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Time '
;: ~. (f'() i ',",), /i} ..
Name of. Fune~al Home /L.'{C. 'h: I, f .
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Paid by CEMETERY Receipt No... ?7.~........ .. Dated... ~.~{?/~?................. Niches 22 & 23
. . 1 300 00 Block 31 West
list Pnce $ . . . .'. . . . . ~ . .. .. . . . Maximum No. Burial Spaces. . . . . . .. . .. .. .. . Uni t4
NO.
1521
Net Paid $ . .1.,.300.00. .. ..
Monument permitted. . . . . . . . . . . . . . . . . . . . . . .
(Data above this line for CUy Reeord only)
.
.
PLEASE PRINT
dJECEA.s},;D J
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(FlllSll
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DATE OF BIRTH:
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IMONTHI
(OAYI
CYEARI
DATE OF DEATH:
IMONTHI (OAYI IYEARI
SIGNATURE: ~ C;, ~~
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SIGNATURE:". IT IN-
DATE: \ d). \ 1...1 ) 1 ~ <=t Qr
------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
COLU1\1BERIUM:
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NUlVIBER: . f IA-{ ~f01
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PLEASE PRINT
~J!JCEASE~ I
NAME: A~.l 0
IFIRST!
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LtJNlOl3eRG
{LAST!
DATE OF BIRm:
II
1er
1'1 (I
/MONTHI
IDAY!
lYEARI
DATE OF DEAm:
(MONTH,
IDAY)
IYEARI
SIGNA~~~~\) ~~~
PRINT \ ~
SIGNATURE:'" ))A-J \ 1) h. ~ h U to I[) f:1 ~ R C
DATE: I 'J/ 'l ) 1 S-
------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
COLUMBERITJM:
IEASTI
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(WElT)
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City of Sebastian
1225 MAIN STREET 0 SEBASTIAN, FLORIDA 32958
TELEPHONE (407) 589-5330 0 FAX (407) 589-5570
December 7,1995
DaWl L. Lundberg
890 Haverhill Avenue
Sebastian, Florida 32958
Dear Mr. Lundberg:
Enclosed is Cemetery Deed No. 1521 for Niches 22 & 23, Block 31 West, Unit 4.
Also enclosed is a form - Return for Transfers of Interest in 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, P. O. Box
1028, Vero Beach, Florida 32960.
S~m. Oi/~A-
Kathryn M. O'Halloran, CMC/AAE
City Clerk
KOH:lmg
Enclosures
(\wr-from\cerndeed. wpd)
tIE SEBASTIAN CEMARY
CITY OF SEBASTIAN, FLORIDA
075
,~..I CEIP.7 IS
(~~
FROM:
.",
L~.-;? '\ () U -
Dollars ($ C).XJ. y...;:::-)
the purchase of the
the terms a71d
Description of Property: .
Cemetery L~ 1Z(~fche (s &cJ t ~ -=s 310c1<. '1 / I;)~/- ani t . <:.f.
Purchase pr''Ce~~----;;tJl ~" 7'~Md ~Dollars ($)301). .~)
\~ '/J' /
Term~ and Condi tion of sale: !.-U~-.vk~. //.f-O I
ci~i:j $' lSU. tJJ'a/.J LI d~-i:vv~(cJfe.o.$ /~5.~ ..2 (.u~'--
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 t:hC:S;:S Q\;:~~
. ~
The City of Sebastian agrees
the above named purchaser(s)
above instrument.
property to
stated in the
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Witness.-J-
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iq State or Florida, Department of Beallh and Rehabilitative Services, Vital Stallsllcs
1 ';'''"~''i.- 'IYoo_" fm~^i=: FOR :~::":~:"'NSlT PE::'T -.DA1E -Mo"h D.'
Dcc0aspd OF '(e~jf
Rita Cath~;dn'? Llll1db€rg DEATII F,.,b. J6, 1996
2 PI~c{) or D9ath- ------- ,- Cily. Town or Cocatio;;----- , ----...~lame of (If neither, give -street addresS)----n
County I1osp, or
IndivlI River 5e1:astian Ins! 890 Haverhill "we.
3- Narnc-;;r Medical- ---- ----. ---- MfJdICatEXiiminer---- ---~ress---- --- - f't)one Nur;;bm-
Gel fifip, 3840 U "
Hal"h GGiglJr, 11,1). 1 . .s. n",y d
___L.__....._______...___ ___ Physici~__ 1k:bast,ialiLD. 32958 407 388-0770
4 N,lme of Funeral I tome/ Address Fla, Lie, NO.iRegJNo. PhoneNUriiber(Area CodeT
Direct Disposer 953 Old Dixie B-6
Indian HiVl'l.' Crt[ililtions, Inc. Vero Beach, Fl. 32960 KB0000235 407 234-5961
S.C:h;~ck-------- a ~ . Thc-;ilodical certification has 1;0-;-;'; completed and signed A'completed certifiCate of de~ihx'"Cc);;;-D,lni,;S
Appro- Ihis application
pI bin
l30x
b 0
-'-'. ---.... __u, ---.-__.___ '_.._____ was contactedon_.____ wilhin 72
hours after dC81h, He/she verified that this dealh was from natural causes. that lhere was no Bcddenl
nor other external cause of dealh, and Ilk,! .-___'._______,__._ will co'nplete
and sign the medical certification of calise of dealh,
. ------,-----,-------- --- was conlacted on __.___ . He/shE' vrrifi'lrj thaI
-- . - -..--, ------------- ---, Medical Examinrr, will Comflle!(~ and sign th<:
medical certification,
,: [J
. ...----. .--- -______0,. .____ __~__
13 Place of In stale cemetery/ Gulf Cremation Removal
. !mal Dispo~t!.?'~_ _.~. _~___~emat y_:_~~!:"e!~~)\Jnlyp(lll!L~?~b_ County. -D.from state_.----.D~~~ation.
7 Funr'ral Dtreclor / Sign Ie, FE No /Reg, No, Date Slg,,(,d
_ u~~ecl.~~~~:___._ ::....:":::'_ <. J...-<....l' - -)-__ ___ K~QQQQnL- 2-l6-:9L-_____
.. -- - '-" - ---~- ---------- -.._-~--------_._-
B
BURIAL - TRANSIT PERMIT
Permil No.195-92::92!___
r0.rmission is he,eby granted to dispose or this body.
II A five rlay cxl0.llsion of time for filing the death certificate (exclusive or weekends) has been mquested and gmnted as undue hardship
vlould result fro!)) filinq within Ihe normal time limit. If the certificate cannol be tiled wilhin this extendod lime limit. a .Funeral Diredor I Dired
Disp,,!'''' n"I"',1 will be Irler! wilh the Locat nellistra! 0' fhe County il1 which death occurred.
~ No extcnsion of time for filing)M del1lh enctific!>le requested,
Registrar 01 ,. ./' h. / .~J'~ Date / .".;1'/Oate Cerlificflle
Sutlfegistrar Si(lnatoJrf' J-l-"Z-.,-/7,{d_K:'.Ih:/!,.-:ff"<"5rr - .__Issued:~.../.'l /:LhDUe: ___ ".___"
c
AUTtiORIZATION for CREMATION, DISSECTION or BUR'AL-A~-SE~E~<ltion ^U~hOri~()t!('n
" No. f..:..:..ff..d. -/~f ;l -./..-3..5
Medical Examiner Dale ___.___,__,~_,__._
Sign,1ture ____... ______. .._... ._..._
or _ Frcdprick Hobin, M.D. . . "''l".".. Pa.ul Goodridge
Medical Exam;""". __." ,_0. _.___ gave autl1onzahon by telephone to __'h .. .____..__
..--- Funeral Director/Direct Disposer Date __ ,~. J fl.. c; ~_m _n
---Th',;r....,ed;C~ilF.xa;l1in"rs approval must he ohtained belore disposal by any of tho <1bove methods, A warfing period or ,18 hours aHu
(!i?alh is r0qllirrxf for all '~rernations,
D
FOR FUNERAL DIRECTOR/DIRECT DISPOSER USE ONLY
1 Date BuriHI-TIllllsit Perlnif (pink copy) was filed with Local RegistrAr'
? Date Tempomry Cedificate was filed with Local negist".,.
.3 O"tC' c0l11plel" r:"rMic"te '110'3 filed with Local RegiSlmr:
,\ follow.Up Uforts~, Acl;v;!I<;s 'Note parfif'~ 1\ dates contacted): -.
-------- --------..------. ---------
~---_. . - _._-~------_.-
5 NmHc ~1111 place ')f ~'i:)nosition _______... _ ___.- ____,_
(; F,!',c:r',' Di":'clor![)ir0ct Oispc.~pr n("port fited: Yes ____ No_ _ ,_ Date Filed:_,___.....
FUNERAL DIRECTOR/DIRECT DISPOSER COpy
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