HomeMy WebLinkAbout1-12-35QUIT CLAIM DEED
DREW'S FORM R. E. 8 ?Tinted and for sale by The H. & W. B. Drew COMPeTlY
............ /,�TN
Cbi�3 Inortiture, 11-ade this- -- ------- day of __j D. 19_2g,
- - ---- --
between --------- S_F_.._9_A_Zk_T_1_A_r4 ------ P - - - --
------------------- ------------------------------------- I of the, County of
--------------------------- . part --
--------- .- and State of - -- - (77-;n0AZJ 0 A - ____ of thefiMtpart,
and------- ('A_ty_ T-IF_0 ------ ------------------------------------------------------------------------------
of the County of --- j__N_Qt.6_t1 -_
9 ---- and State of ------- --------------------- -------
of the second part.
1r1l'.VESSE1'H, That the said 1)a;,t--y It -he sum
of the first pail, for and in consideration of t
4N No ---------------- - Dollars,
-rvv E: o _r ___j
of_ -- -- -------------- _____Y -------- P - ---------------- ---- ------------------------------------------
in hand paid by the said part.....__ of the second part, the receipt whereof is hereby ack-now7ed1jed,
ha- 5---- remised, released and quit-claimed, and by these presents do-e-S-- remise, release and quit-
claim unto' the, said pavt__7____ of the second part, and----[t -L-e _r ------- heirs and assigns f0r6V6P, all the
right, title, interest, claim and dewand which the said pa7't__Y ---- of the first part ha-,-'t---- in and to
the following described lot----, piece -___ or pa.j,cel___. of la7ld. Sitlt-ate, lying and being in the County Of
to -wit:
� C-7
J-H -D-1 -4- - -------------- -- State of -----
------------- ----- ------------------ ------------------------------------- I ------------------------------
--------------------------------- - -------------------- -
C_V ------ fr,- ---------
-17 ----------
------------------------ ------------
--- tj� Pt ----------------------------
_LQ_ CA
---------- ---- --------- ---
V4- 4_Aze- " ........
- -----
---------- ---- -- ----------- ------------------ - - ---------- ='` ------- --- -- c--_--_` - -------- - -----------------
-- - - ---------
-------------- - - - - -- - - - --
--- - --------------------
-------------------- -
---------------- -
TO H�4 V'E JXD TO HOLD the some, together with all and singular the appurtenances there-
unto belonging or In anywise appertaining, and all the estate, ri.sht, title, interest and claim what-
to the only proper use, benefit soever of the said part-_ - -__ of the first part, either in, law or equity,
- AMNGP - - - -- -- Dollars,
hand paid by the sal, ,art_-Y---- of the second part, the receipt jvhcreof is hereby acknowledged,
ha-5---- remised, released and quit-clahned, and by these presents do -e %S-- remise, release and quit-
claim Unto the said part-7 --- of the second part, --heirs and assigns forever, all the
right, title, interest, clain?, and demand which the said part-Y. Of the first part in and to
the following described lot----, piece -__- or parcel---- of Iand, situate. lying and being in the County of
CJR ------------ -- State of-- M f
------- - -- ------------------ I --------- to-wit:
------------------------------- - - -------------------------------- ------------------------------------------------ - -- -------------
--------------- -------------
------------ ------- ----------- f ---------------- ---------------- -- - - - - --
- -- C( CI P
------------------------------ C-*� -4 /'_ C_ 0%,
r.
-------- --------- -------- --------------------------------------------------
----------------------------
_V ------------- ------------- - ---------- ---- ----- ----
C,-- --
- -- --------- --------------------- ---------------------------------------------
--------- ----- 7 --------------
- - --------------- ----------------- - ---- - - - - -- -------------- -- -----------------------------------------------------
TO H.4 k*E .4.N'D TO HOLD the same, together with all and singular the appurtenances there-
unto belonging or in anywise appertaining, and all the estate, right, title, interest and claim what-
soever of the said part_y---- of the first part, either in law or equity, to the only proper use, ben6flt
and behoof of the said park-7---- of the second part, _4_t ----- ------------ heirs and assigns 10776Ver.
IN WITNESS WHEREOF, the said part-_7---- of the first part ha-A---- hereunto set---
hand---- and seal---- the day and yeaPfirst above written.
Signed, sealed and delivered in presence of C I,:- M r=� Tg
S 070A �T_IAN
-- - -------- --- - --
- - ------ 131, 'ell
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-------- ----- - Seal)
---------- ------------------ (Seal)
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County of-IN / -( fV - - -- - - -(- � r --R ------ - - - - --
{
I IIEItEBI" CEILTIFr, that on this day personally a ed• befoA",. e an officer au-
- iN
tllorixed to adrn.in �r catlls and take q , no led67ne its, - -- -- -- - c''." ----- - -_ - -- '
to me well known to b the person-.S- described in and who executed the f e oins instrument and
1-11 AV � ------ a.cknowZedged before ne that __- _T =__._____.executed the same freely
and voluntar-
ily for the purposes therein expressed.
�l
p ,Y'D 7 FURTHER CERTIFY", that the said___ . -_ p
known to nze to be the wife of the said ___�2- n-- - -2nrl znade by and be ore rn , separately and apart I !!
on a sepal ate and private eXamination J f
from her said husband, did ack nowled 6 that she executed tTze f oregoi , Deed for the purpose of �
relinquishing, alicrlating and coma ' 1g all her right, title and intezest, whether of dower, home-
stead or of separate property, s utory or equitable, in and to t ands described therein, and that
she executed said Deed fre y and volzz.ntaPily and without ny compulsion, constraint, apprehen-
sion or fear of or fr zer said husband.
_ li
1�'IT,N•E r1z hand a o cial seal ,�1nd fate o ____ -- !_� = -__- '- --------------- - - - - -- - - -- -- this
Counin Of - - - -- - - -Cz - - - - -r..
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----------- - - - - -- -day of - - - - -- - - -- - -- { -------- - - - - -� d . D. 1
-- (Seal) =
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3809
RECEIPT
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Name
11 Cash
0
XCheck 0 54
oo—s2i
No.
CCD.:
Amount Paid
001001 208001
Salsa Tax
001501322900
Garage Sales
R..
001501341920
CopieslBkl Specs.
001501341910
LDCICode of Ordinances
001501341930
Election Qualifying Fees
601010 343800
Cemetery Lots
O
LoUNiche Block
Unit
1450L
001501343805
Cemetery Fees
Total Paid 1015-
white- Dept of Origin • Yellow - Finanes • Pink - Applicant
Name " \N� �f 1 r�'�✓ C�4 I't i
Unit DUL �q2
Block F V
Lot
Date of Mark -out
G �J (� Date of Burial � l a i e • ' IiA U I�'••'
Name of Funeral Home
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Authorized by Ct y L(_ L. {-.( ,U �C.
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Name " \N� �f 1 r�'�✓ C�4 I't i
Unit DUL �q2
Block F V
Lot
Date of Mark -out
G �J (� Date of Burial � l a i e • ' IiA U I�'••'
Name of Funeral Home
i
Authorized by Ct y L(_ L. {-.( ,U �C.
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1'fGJ X31 ^70
B BURIAL — TRANSIT PERMIT
Permit No.
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardshil
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 with the L al Registrar of the County in which death occurred.
yo No extension of time for fi' �g the- ertificatarequested. 02/02/9$
Registrar or Date Date Certificate
Subregistrar Signature Issued: Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical Examiner Date
or
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 afte
death is required for all cremations.
CEMETERY OR CREMATORY Sebastian City Cemetery
Methods of Disposition: Place of Disposition
YO BURIAL ❑ STORAGE Date of Disposition 99 0
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge) s
This permit must be endorsed by the Secton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sextoi
and returned within 10 days to the local County Health Department in the County where disposition occurred.
DH 326. 10/96 (Rep(aces HRS Form 326 which may be used)
S
FLORIDA DEPARTMENT OF
State of Firs-Ida, Department of Health, Vital Statistics
�1A.L.1
APPLIG JN FOR BURIAL — TRANSIT PERMIT _ �/'
_
o 98- uo0yt
A. (Type or Print)
1. Name of First
Middle Last DATE Month Day Year
Deceased
Nettie
O
R. Carpenter DEATH January 31, 199$
2. Place of Death
City, Town or Location Name of (If neither, give street address)
County
Indian River
Hosp. or
Vero Beach Inst. Integrated Health Services
3. Name of Medical
Medical Examine 1265 36th StreetdMt) 567 -6340 Phone Number
Certifier
Guy R. Ulrich
Vera Beach, Florida 32960
Physician
4. Name of Funeral Home/
199�e2bth Street
Fla. Lic. No. /Reg. No.
Phone Number (Area Code)
Direct Disposer
Cox- Gifford Funeral Home
Vero Beach FL 32960
1423
(407) 562 -2365
5. Check a ❑
The medical certification has been completed and signed. A completed certificate of death accompanies
Appro-
this application.
priate
Box b X❑
Guy Ulrich MD was contacted o 71 -31 -9$ within 7,'
hours after death. He /she verified that this death was from natural causes, that there was no acciden
nor other external cause of death, and that will complete
and sign the medical certification of cause of death.
c ❑
was contacted on . He /she verified tha
, Medical Examiner, will complete and sign the
medical certification.
6. Place of
In state cemetery/ Removal
Final Disposition:
Xh crematory - name /county: n from state Donation
7. Funeral Director/
F.E. No. /Re . No. Date Signed
r A %j
�ZL k
Direct Disposer
� 1l p�`�y —.2
1'fGJ X31 ^70
B BURIAL — TRANSIT PERMIT
Permit No.
Permission is hereby granted to dispose of this body.
❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardshil
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 with the L al Registrar of the County in which death occurred.
yo No extension of time for fi' �g the- ertificatarequested. 02/02/9$
Registrar or Date Date Certificate
Subregistrar Signature Issued: Due:
C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL —AT —SEA
Signature Medical Examiner Date
or
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 afte
death is required for all cremations.
CEMETERY OR CREMATORY Sebastian City Cemetery
Methods of Disposition: Place of Disposition
YO BURIAL ❑ STORAGE Date of Disposition 99 0
❑ CREMATION ❑ OTHER (Specify)
Signature of Sexton )
or Person -in- Charge) s
This permit must be endorsed by the Secton or person -in- charge (or by the Funeral Director /Direct Disposer when there is no Sextoi
and returned within 10 days to the local County Health Department in the County where disposition occurred.
DH 326. 10/96 (Rep(aces HRS Form 326 which may be used)