HomeMy WebLinkAbout4-31-28w
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Paid by CEMETERY R.celpt No. . . .
List Price S..~.! .~9'<? :.9~...
1,300.00
Net Paid S ..................
q.?Z.... Dated... .nt1J~;...........:....
1.7 &
vest
Ma"lmum No. Burial Spaces. . . .. .. . .. .. . .... B 1 0 c k j 1
. Unit 4
Monum.nt permitted. .. .. . .. .. . . . . . . .. . .. . .
Niche
28
NO,
14',5
(Data abo... thl. line for Clt, Reeord only>
muv Df &rhasthtu
O!tmtltry
I ttb
'114'15
NO.
THIS INDENTURE MADE 'l1tJa .....l s t. .. . .. .. .
d.y of .......... No.v.embe.r..................... A. D~ It. 9.4..,
""t.....n Ih. Clly 0' S.butlan, a munlelpal corporation ."I.tlnr under the law. of the Stat. of Florlcl.. u Grantor and
Mrs. Alma Jean Proth
. . . . . . .. .. . ... . ..... .. . . .... .. ... .. . ... .... '''557 . 'Fu tch' . Way.......... ..... . . . ... . . . . . . . . . . . . .... . . .. .... ....... ........... ...
............... ............ ....... ........... Sl!~~.::'.~~~.~.~. .~~.?r:~~~.}~~.~.~.. ................. ....... ........ ............
0' the Count, of . Jm~;I,~.t:I.. R;l..y.~,r;...................... an,1 Stat. of ..... ..f.lQ:r.:;I..d.~....................................
u Grantee, WITNE88Em,
That the Grantor for and in consld.ratlon of the sum of S ~ .,}.q~ : ~9.. ... .. . ... .. . to It In hand paid. the receipt wh.reof Is he....lth ac-
knowl.dged, does by thll instrument grant. bargalft. sell, r.I..... convey and confirm unto the Grantee .~~r.... h.Irs.legal repr.sentatlves and assigns
the foUowll)g p!operty sltUllt.d in ~.stIan,lndlan RIver County. Florida, to-wit:
NiCheS 27 & 28 West 4
AD ofil'ff> .. . . . .. ,Block... 301, '. ,UNIT ............. ,of S.bastlan municipal cem.tery al per Plat Numb.r 1 th.reof recorded In Plat
Book 2, at page 65 of the pubUc records In th. office of the Clerk of th. Circuit Court of St. Lucie County of Florida; said land now lying and belnll
In Indian River County, Florida.
To Hav. and to Hold the sam. forever; provided that said property shaD be ueed 101ely and e"cluslv.ly for the interment of the human dead and shall
be ueed. kept and maintaln.d at aD tlmelln accordance with the rul.. and regulation., ordinance. and r.solutionl of the City of Sebastian, Florida. hereto-
for., now and h....fter adopt.d or provided for the Ilovernm.nt and operation of said cemetery. The condition I. restrictions and requlr.ments contained
In thll instrum.nt sbaD b. covenantl runnlnll with the land. In the event of the faDm. of the own.r of any property s1tUllted within said cemetery to ob-
serve and comply with iuch rules. regulations, relOlution. and ordinance. and the conditions of the deed of conveyance thereof th.n the title of lOch owner
in and to said property shaD terminate and the same .hall r.vert to the City of Sebastian. Florida.
IN WITNESS WHEREOF. The said party of the fust part has caused this Instrument to b. ."ecuted In Its name and on its b.half by Its Mayor and
att.sted by Its City Clerk and It. corporat. oeaI to be her.to afftx.d. the day and year fult above written,
Alte'ho/~.t.YJ.: Od.e.~......
City C1.rlr
C<T:,O$;;J;i'Z~
Ma,or
und Delivered
-~"c/~.~.:u;uu
......Y.... .. ............. ..............
(GIifv ~al)
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
I HEREBY CERTIPY, That on thl. ....,....l.S.t..........d.y of .........No.v.embe.r............................, 1I.91i,
b.fur. m. p.rsonally appeared ........~~.~~~~..!:-.....~.~~~.~.?!?-.................... and K~~.I:t.~y.~..~.~..q:.~~g?J;~~..
r..",,,,Uvely Mayor and City (1.rk of the City of Sebastian. a munlelllal corporation und.r the I..." of the Stat. of Florida 10 me Irnown
to be Ih. Individual. Ilnd office.. d..erlhed In Ilnd who .,..eut.", the to..golnr eo..cyane. to
..... .... ..... ................,............. J:f:r.:!!I. ,. . All)l.~..,J ~~.t).. P.l'.Q.t;h.......... ... . ..... ..... ........................... ...
. . . . . .. .. .. . . .... .... .... . . . . . . ... . .. . ... . ..... ... . ..... and ..v.rlllly aeknowledrttl th. e"..utlon th.reof to be th.lr free aet and d.ed
.. .nch orn..r. ther.unto duly Bnlhorlstd; and that the Offl.lal ...1 of ..Id corporation la duly aWx.d thereto, and the oald conv.y.nc.
I, the Ret and d.ed of ..Id corporation.
WITNESS my Ilrnature and otnelal _I at S.bullan, In the ,
lut aforesaid.
UNOA M. GAU..EY
MY COMMIllSlllII' CC m724
EllPIREll: ....1.. 1_
......nn....,.1WD 0IiIINIlIIII
Name
Unit
Block
~ ~J,(h
A I b(!c~-I
'3 i
Date of Mark-out
. .~. :,/;:~~<,~':'::~"'~;',,:-; .~" ^,', -'.'
. . '.... .', , :;~ .;~-r: '.'. ~.- )~<_;~::..: >::;':;',f:~~.\';"~':;;(.";-"~";~.~...'..
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rcREffiAI;'v S
5~~
If
~ R I/{:; Sf
, I
/ /l (, '
if '6/'11.1
l "
, I 3;00 f',f'n
Date of Burial //8,9C/ Time
__. "', j", ..--------:J...., i; ,/i {: e: ('rj t{ ,/, 0 h S ,.r::r' ( .
.J;....LiGt.. r"; .....1:Jtu \. ~ ... _' ,
Name of Funeral Home ~.
\ ) ,~1/2/1
\'~_~ t! Jjf ~
Authorized by .J' r
<.0
C\J
'(1)
m
<:)
.~~.""""-.~_""--7~"''''''~~~~~~~~'';;C~~;; 'T'~"".'
" n.~.~ "":J.'~'-':... ~,.t'l''''t. ~ ._, "~""";'......
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..f~dd~rM<e~de~~e:/
4IRF~T RA~CIAY P~OTH s~
2nd ~ ~ NOVEMBER , /,9 M-
OCTOBER 30. 1994 -e~~tkdINOIAN RIVER
NO V R CRE na.s ~ A 95-94-179
12490
-e~ &'n de
~ak~tkd
g-~~~
Y3',.
-~ --- _.' ~ _._- _._,- -- --- -- -- --,._---.-- -- -
._r~J/:~~~__ ____~_
5.
A.
1. Name of
Deceased
Type or Print)
First
Albert
Middle
Barclay
Last
Proth Sr.
;;/ (}7rA (J g
;Q 3/iJ
IJ
M nth Day Year
OCt. 30, 1994
~]
State ot Florida, Dep.ent of Health and Rehabilitative Services, VI,Statistics
APPl_ION FOR BURIAL - TRANSIT PERMIT
DATE
OF
DEATH
2. Place of Death
County
Indian River
3. Name of Medical
Certifier
City, Town or Location
Medical Examiner
Name of (If neither, give street address)
Hasp. or
Inst. 557 Futch Way
Address
Phone Number
Sebastian
M.D.
7955 Bay Street
Sebastian Fl. 3295 407 388-17 0
Fla. Lie. No.1 Reg. No. Phone Number (Area Code;
Phili J. Corrao,
4. Name of Funeral Home/
Direct Disposer
,Indian River
5. Check
Appro-
priate
Box
X Physician
Address
6604 20th Street
Crena~ions, Inc. Vero Beach, Fl. 32966 KBOOO0166 407 234-5961
a liCI The medical certification has been completed and signed. A completed certificate of death accompanie~
this application.
b 0
was contacted on within 7 ':..
hours after death. He/she vefified that this death was from natural causes, that there was no accidep
nor other external cause of death, and that will completf
and sign the medical certification of cause of death.
c 0
was contacted on . He/she verified the
,Medical Examiner, will complete and sign th.
medical certification.
6. Place of
Final Disposition:
7. Funeral Director/
Direct Disposer
Cremations
1m Beach Count
F.E. No./Reg. No.
KAOOOO235
Removal
from state Donation
Date Signed
10-30-94
B.
BURIAL - TRANSIT PERMIT
Permit No. 195-94-179
Permission is hereby granted to dispose of this body.
o A five day extension of lime for filing the death certificate (exclusive of weekends) has been requested and granted as undue hafdshir
would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director/Direc'
Disposer Report" will be filed wi the Local Registrar of the County in which death oCCllrred.
[J: No extension of time for filing death certifica queste
Registrar or
Subregistrar Signature
~~: ;/, " ~p ~~~ Certificate
Signature
or Frederick Hobin, M.D.
Medical Examiner,
AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEAz!mation Authorizat:
No. ",Q.l/../9..//J.. /2.$
, Medical Examiner Date
c.
. . Paul Goodridge
, gave authorization by telephone to
Funeral Director/Direct Disposer. Date 11-1-94
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.
Signature of Sexton)
Of Person-in-Charge)
o STORAGE
o OTHER (Specify)
K-ja ~'~~7
CEMETERY OR CREMATORY
Place of Disposition j e~ If. S 0,;1;1 (J~~~ ,.Ti...JI!..,
Date of Disposition I' / / 11 /9 #oj. I
D.
Methods of Disposition:
o BURIAL
. CREMATION
This permit mtlst 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 (Roplaces Oct 87 edition ~Jhich may be lJseoi
rSlock N'Jn',t.c-r: 5740000,032<',-2,
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