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Home My WebLink About4-30-16 ~~ aBty nf 8tbuattnn ~ \llrmrtrry m rr~ nl~;32 NO. THIS INDENTURE MADE TIlII ........... ~qtl:1, day of .........,.... May........................... A. D., mooo between the City of SebllStlan, a municipal corporation existing IUIdcr the laws of the State of Florida, liS Grantor and ,..,....... ..............................,...' ~17f\~j~JY Ct.....................'............................................ . . . . ' . . . . . . . . . . . . . . . . , . , , , . . . . , . . , . . . .. . . . . " ... .J:tQQ~!gnd,. .FL .329.58 . . . . . . . . . . . .. .,.......................................... Indian River . Florida of the County of ,....................................,....... ani State of ....... .'........'...................................... as Grantee, WITNESSETH, 1 That the Grantor for and in consideration of the sum of $ " ~ ?~ : ~~ . . . . . . . . . . . . . . . to it in hand paid, the receipt whereof is herewith ac- knoWledged, does by this instrument grant, bargaID, sell, reiease, convey and conium unto the Grantee ,h~~.... heirs, legal representatives and assigns the following property situated In Sebastian, Indian River County, Florida, to-wit: All of Lot(S)~~~~~. . Block, ... ,~?... ,UNIT... ~........ ,of Sebastian mUniclp~1 cemetery as per Plat Number 1 thereof recorded In Plat 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 iyingand being in indian River County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exciusively for the interment of the human dead and shall be used, kept and maintained at ail times In accordance with the ruies and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the govermnent and operation of said cemetery. The conditions, restrictions and requirements contained in this instrument shall be covenants 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 .ordinances and the conditions of the de'ed of conveyance thereof then the title of such owner in and to said property shall terminate and the same shall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has caused this instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto aff'1xed, the day and year fust above written. CITY OF SEBASTIAN, FLORIDA AU'~(i;.9~;/~':-cc By .~.~..W.'!?~....,...,..... Mayor ((fiitlJ ~"nl) STATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this......... .~9.~~....... .dRY of ............. ..~~................................, Hx~~~o before me personally appeared.... .Wal:te;c. W.. .Bame!3..........,' .."..,..., ..... .,. and K9t:1Jm .M~..Q :~.J,+m::fW......... respectively Mayor and City Clerk of the City of Sebastian, a municiplIl eorporation under the laws of the State of Florida to me known to be the Indlviduuls DlId officers described in und who executed the foregoing CORveYllnce to Susan Kelly ....................................................................................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. alld severally acknowledged the execution thereof to be their free act and deed ss such officers thereunto duly authorized; and that the Official seul of said corp()ration Is duly aff' thereto, and the said conveYllnce is the act IInd deed of said corporation. UNDA M. GALLEY ;.. MY COMMISSION t CO 7 " : I EXPIRES: June 18. 2002 '. ;ii~".," Bonded 11uu NoIary Public Un_.. and year WITNESS my signature and offlclal seal at Sebastian, In the last aforesaid. --.... ._-_._--_._---.--_...,--~.._.__.--_._---"--- ,--- ._-_._-----_.._----~-~-----_. ---......-- ...._..-.._._~._._--- ..-.-.-" Name ~I{-t h /pe"J if J{eJ {y (CRf7YI~/NS) /j'y A Unit Block 30 Lot ,~ I? Dele of Me,'-Oul ,~k (p! fYJ Date of Burial .5 /~ 100 I I Name of Funeral Home . ~It ILl iLl . L4,' I Time /!)/3 fY if Authorized by 1Y-~;-- Ar- ~ ~~IZ-~ -a. Neme -M (let V7r IP: Unit 1 ~J1 Block .3 D ." ,'i~':\-:: /& " ftii<'i" .'- :::: :: :::::OUI ,'if( !:t :; I / Time :u~::,:::U:ffil HO:;,~~{'I'. .../-1'/ LL Lot /1 / CJQ) /./-,/ '- ex FLORlDA DEPARTMENT OF S~f Florida, Department of Health, VitalAistics ~PLlCA TION FOR BURIAL - TRANSIT P~IT A /0 flJ 3 {J \..... !/1' HEALT A, 1 , Name of Deceased First Middle Last Date of Death (If neither, give street address) Month Day Year Frederick Thomas Kelly, Sr August 17, 2000 Physician Address Address19V -E-.;JEtV MtJBJ '&L(/]). f.) FE.. F=1-~oI Name of Hosp. or Inst. Inter rated Health Services of Palm Phone Number Ba 2, Place of Death County Brevard 3. Name of Medical Certifier City, Town or Location Palm Ba Medical Examiner 4, Name of Funeral HomelDirect Disposal Establishment YOUTlO' & Prill 5, Check Appropriate Box Fla. Lic. No./Reg. No. Phone No. (Area Code) 735 Flemming Street Funeral Home Sebastian, Fl 32958 a. D The medical certification has been completed and signed, application. 2415 561-589-1933 A completed certificate of death accompanies this b, m "DR .:ro/-1;0 7~t::MsK~ was contacted on ~- ~/ -oi) He/she verified that this death w~slrom natural causes, that there was no accident nor other external cause of death, and that ftE- will complete and sign the medical certification of cause of death within 72 hours. c, D He/she verified that , Medical Examiner, will complete and sign the was contacted on B. ation of cause of death within 72 hours. FE No./Reg, No. 2294 L Date Signed 8/20/2000 6, Funeral Director/ Direct Disposer BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit N02415-00-009 ~ 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, o No extension of time for filing the death certifica has b)0en requ d. Registrar or ,- -- ~ ,/ Subreglstrar Signature -;:;> .../ Issued: 8/20/2000 Date Certificate Due: 8/30/2000 Date C, 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. IBURIAL DCREMATION SignatL:re of Sexton or Person-in-Charge o STORAGE CEMETERY OR CREMATORY Place of Disposition S EJ!3 .4 "S r: p. /1 C. e N1 E; ~ R!., V . / I Date of Disposition e,AI/ cO D, Method of Disposition: DOTHER (Specify) } ,,fj? ? ,~dk:J' This 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 within 10 days to the local County Health Department in the county where disposition occurred. DH 326. 8/97 (Obsoletes all previous editions) (Stock Number 5740-000-0326-2) Distribution White: Cemetery or Crematory Yellow: Funeral Director or Direct Disposer Pink: Local Registrar 5