HomeMy WebLinkAbout4-29-02
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\!!'emetery
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NO.
THIS INDENTURE MADE ThIa ..........20t.h..... day of .......May................................. A. D., 19..99.,
between the City of Sebllst!an, a municipal corporation existing under the laws of the State of Florida, as Grantor and
. . , . . . . . , , . . .. . . . .. .. . . . .. . . .. . . :r q <l4, . .:a r ;L.I.1.1<1.1'!. y. . . , . . .. . .. . . . . . . , . . . . .. , . . . . , . . . , . . . . . . . . . . .. . . . . . . .. . . . . . .. . .. . . . .
825 Vocelle Avenue
. . . . . . . . . . . . .. . . . ...... ....... .... . . . . Se ba.t sian., ..F.l, , 329.58. . . .. . . . . , .. ....,..........,..,.,.......................
of the County of .IIl~~.~p... ~~.Y.~:r:....................... an] Stute of ........... ..fl.Qri.d.~..............................
as Grantee, WITNESSETH,
That the Grantor for and in consideration of the sum of $ ~. !,Q9.Q... 9.q . . .. . . . .. . . . . to it in hand paid, the receipt whereof is herewith ac-
knowledged, does by this instrument grant, bargaiit, sell, release, convey and confirm unto the Grantee . !1.~ ~ . .. 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 municipal 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 lying and being
in Indian River County, Florida.
To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall
be used, kept and maintained at aU times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto-
fore, now and hereafter udopted or provided for the government 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'od 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 fust 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 affIxed, the day and year fust above written. IDA I
^'"", ~1l::P1~~ CITY O>;~AB~AN' p~~~~.
City Clerk MaJor . . .....\ . . .
(ClIit\! ~l.'lll)
STATE OF ,OnIOA
COL'N'fY OF INDIAN RIVER
I HEI1EDY CERTIFY, That on this ......... f. 9.t 4.. .. .. .. day of ................ M~.Y.. . .. . .. .. .. .. .. .. . .. .. .. . ...., 19 9. 9.,
Martha S, Wininger Kathryn M, Q'Halloran
b,'f'Jre me personally appeared ,.............,.....,.......,........,..,...,..".....,',., and .,.,................................,..
resp,'ctively Mayor and City Clerk of the City of Sebastiun, a municipal corporution under the laws of the Stute of Florida to me known
to bc the Indh.iduuls und offic... described In and who exeeutcd the for,'golng cORveyunce to
..,....,..................................... :.J;~.9-.~.. ~~.~!).~~.~.y........................"..........,....,..........................
WITNESS
last aforesaid.
, . , . . , . . . . . . . . . . . . , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. and severally acknowledged the e utlon ther~f to be their free act Ilnd deed
as slIch officcrs thereullto duly authorized; and that the Official seal of said corporation I ilul affixed thereto, Rnd the said conveYllnce
is thc Ilct Ilnd deed of said corporation.
~
-"-----"-'-'------'-~----'~.,-,----"..,,~---,---_.
"-"-'-~---~----~,,---~- --------,,'-----, -------
Name C,ff K+ST~ Ai p:-' ~Rl/J1)LEi/
1
Unit 'I
Block ~ 9
Lot J...
Date of Mark-out
Date of Burial
Name of Funeral Hom~
Authorized I:>Y":'>:''/
,~ I/<j he;
I I
5"ho/99
- ,
Time
_....-
S fi!..l:J~;t::- J;
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FLORIDA DEPARTMENT OF
Sta. Florida, Department of Health, Vital .tics
APPLICATION FOR BURIAL - TRANSIT PERMIT
I 0<-
I!J de;
trlf
HEALT
A.
1. Name of
Deceased
First Middle
Jacksonville
Last Date
of
B ri n kley Death
Name of (If neither, give street address)
Hosp. or
Inst. St. Luke's Hospital
Month
Day
Year
Christine
May
15
1999
2. Place of Death
County
Duval
City, Town or Location
3. Name of Medical
Certifier Tom Roddenburg, M, D,
Physician
Address
4500 San Pablo Road
Jacksonville, FI
Phone Number
Medical Examiner
904-953-2000
4. Name of Funeral Home/D~u~t 8is1ll8881
Establishment
Strunk Funeral Home
a. D
A~cgi~ N. Central Avenue
Sebastian, FI
Fla. Lie. No.lReg, No, Phone No. (Area Code)
1228
561-589-1000
5. Check
Appropriate
Box
The medical certification has been completed and signed. A completed certificate of death accompanies this
application.
b, lSil
Edgar was contacted on 5/17/99
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Roddenburg will complete and sign the medical
certification of cause of death within 72 hours.
c. D
was contacted on
He/she verified that
, Medical Examiner, will complete and sign the
Iiru I r'l' I ....,of
of cause of death within 72 hours.
F.E. No.lReg. No.
1862
Date Signed
5/17/99
6. Funeral Director/
B,
BURIAL - TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No.1228-99-02 58
D 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.
D No extension of time for filing the death certificate has been requested.
file!,:.!.\.! ~
Subregistrar Signature
Date . Date Certifica~
Issued:~Due: S ~O qq
C.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT -SEA
Approval Number:
Date
Medical Examiner, . gave authorization by telephone to
Funeral DirectorlDirect 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.
Method of Disposition:
CEMETERY OR CREMATORY
Place of Disposition Sebastian Cemetery
D.
~BURIAL
DSTORAGE
Date of Disposition
May 20, 1999
DCREMATION DOTHER (Specify)
SignatL:re of Sexton } /J
or Person-in-Charge I ~1 9 ' /~ ~ '/ .
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-OO0"()326-2)
Distribution: lNhite: Cemetery or Crematory
Yellow: Funeral Director or Direct Disposer
Pink: Local Registrar