HomeMy WebLinkAbout4-27-15~i#g of ~rbr~t~#ittn
V' L ~ 1G l i ~ ~ ~ ~ ~L ~ NO. ! t~~YU
14th October 97
THIS INDENTURE MADE TIa4 ...................... day of ............................................. A. D., 19......,
between il:e Clty of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and
................................... Howard..J.. ,and./or. Virginia.Mt,Kayser.........................
3975 10th St ~~~~~~~~'~~~~"'~"""
................................... Sebastian,..FL .32958......................... , ........................................... .
Indian River Florida
of the County of ............................................. an•l State ot .......................................................
ae Grantee, WITNESSETH:
1 800.00
That the Grantor for and in consideration of the sum of S , , , ,? , , ,, , , , , , , , , , , , , , , , , , to it in ~ranQ paid, the receipt whereof is herewith so-
knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , , tllelr heirs, legal representatives and assigns
the following property situated In Sebastian, Indian River County, Florida, to-wit:
All of Lot(s)14. &. 15Block, , 27.... ,UNIT ,4, , , , , , , , , , , , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded in Plat
Book 2, at page 65 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
bb used, kept and maintained at all times in accordance with the roles and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto-
IHtb, ribw and hereafter adapted or provided for the government end operation of said cemetery. Tha conditions, rastrictiona and requirements contained
!n this instrument shall be covenants running with the land. [n the avant of rho Failure of the owner of any property actuated within said cemetery to ob-
sern and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed 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 affixed, the day and yeaz First above written.
,~ / ~ /~~_ ~ CITY OF SEIIASTIAN, FLORIDA
Atteat : ......................................................si V~-~ ..tt ~~~~.. ...... .................
R~U~•
City Clerk Mayor
Signrd, Scaled and Delivered
In the Presence of:
... (Qlitg ~eu1)
STATE OF FLORIDA
CUUNTY OF INDIAN RIVER
I HE1tEIIY CERTIFY, Thst on this ......14th . day of October ,,,,,.~ 1a.98~
before me personnlly appeared ~ialter. W...Barnes ................................... andKathryn. M...O.~.HallO>=an ........ .
respectively Mayer nn<l Clty Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known
to be the iudividwds and officers described In and who executed the foregoing eoaveyunce to
Howard J. & Virginia M. Kayser
.................................................... and severally acknowledged the execution thereof to be their free act and deed
es such officers thereunto duly authorised; and that the Official seal of said corporation Is duly nff ed-fllii reto, and the said conveyance
is the net and deed of sold corporation.
WITNESS my signature and official seal at Sebastian, in the Coun of ien R and ate f F orida, the day and dear
lest aforesaid. ,
. - ----•
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,1 v..,.: ; IJNDAM.OALLEY ... ..... .. ... ... ....................
`t'•a ~ b, MY COMMISSION A CC 740478 ary bile, State Florida at Larg9
"~'~•'a': EXPIRES: Jung 18, 2002 MY co esl r ar (/
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STRUNK FUNERAL HOMES, P.A. 6091
CASH ADVANCE ACCOUNT-SEBAS~'IAN =
916 17TH ST.
VERO BEACH, FL 32960 63-1205/670 "`
PH. 772-562-2325 DATE ~ ~ Z U ~ V ~ 01 ;
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Main Office
j~~~ 959 20th Place
. - - - ~ - _ Vero Beach, FI 32960
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Indian River National Bank Piz) ss9-9zoo
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FLORIDA DEPARTMENT OF
HEALT
A• (TYPE)
1. Name of First
Deceased
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT
Middle
Howard James
Last Date
of
Kayser Deatn
Month Day Year
April 19 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
Indian River Sebastian Inst. Sebastian River Medical Center
3. Name of Medical Address Phone Number
Certifier Farhat Khawaja, .D. 7754 Bay Street
Medical Examiner Physician Sebastian, FL 772-589-3000
4. Name of Funeral Home/rDicaoi~Bispesal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
Establishment 1623 N. Central Ave.
Strunk Funeral Home Sebastian, FL 1228 772-589-1000
5. Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~ Darlene was contacted on 4/20/07
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Khawaja will complete and sign the medical
certification of cause of death within 72 hours.
c.
was contacted on
He/she verified that
Medical Examiner, will complete and sign the
medical rtifica ' n use of death within 72 hours.
6. Funeral Director/ ign F.E. No./Reg. No. Date Signed
oiwa-oispeseF+ 1862 4 /20 /07
B. BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 122$-07-0170
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~ieath section of the death certificate within
72 hours.
~No extension of time for filing the death certificate has been requested.
Date Date Certificate
SubregistrarSignature Issued: 4/19/07 Due: 4/24/07
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. Awaiting period of 48 hours after death is
required for all cremations.
D~ CEMETERY OR CREMATORY
Method of Disposition: Place of Disposition Sebastian Cemetery
BURIAL STORAGE Date of Disposition ~~~ 3 . `U
CREMATION OTHER (Specify)
Signature of Sexton
or Person-in-Charge } ~~ ~ ~~~ ~`
_. i ~
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.
Distritwtion: white: Cemetery or Crematory
DH326, &97 (Obsoletes elf previous editions) Yellow: Funerel Director or Diced Disposer
(Stock Number. 5740-000.0326-2) Pink: Local Registrar ~~ ~ ~