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7'H[S INDENTURE MADE TWa ...... 19th February ~9
............ day ot ............................................. A. D., 1 ......,
betn-een fire City of Sebastian, a municipal corporation exist[ng under the laws of the State of Florida, ae Grantor arrd
Helen George
......................................1211' S:' Waterway'Drive ........................................................
............................................
.......................................... Barefoot Bay, _ FL..32976............
of fire County of Zi?dk~n..~,V4'L' ........................... an l State Dr ..Florida...........................................
ae Grantee, WITNESSETHr
That the Grantor for and in consideration of the sum of S 1 r $QQr ~~ ................ to it in hand paid, the receipt whereof is herewith so-
knowicdged, does by this instrument grant, bargain, sell, roleasc, ~ronvcy and confirm unto the Crantco t}@X: , ... heirs, legal ropresentntlvea and assigns
the following props:ty situated in Sebastian, Indian Rlvar County, !^lorida, to-wit:
All of Lot(s) 35&36. , Blodc, ?g...... ,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 end shall
be used, kept and malntelned at all times in accordance with the rules and regulatlona, ordinances and resolutions of the City of Sebastian, Florida, hereto•
fora, now and hereafeor adopted or provided for the govornment and oparatlon of Bold emetery. Tha condltlona,raserletlone and roqutremente 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 dried 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 year fast above written.
CITY OF SEIlABTIA~/"//N~, FoLO~RIDA
Attestr .. ..... .... ..
.... .. '
..City Clerk .. • . Mayor
Signed, Sealed and Delivered
in the Presence oP:
... ..5....~ ........................... (lGlt~ ~Ytti)
7~..,.. ~~~.~. .?<4Wd ..................
v" ..
STATE OF FLORIDA
COUNTY OF INDIAN RIVER 19th February 99
I T•[E1tEBY CERTIFY, That on this day nf ..................................................., Ig....,
........................
Ruth Sullivan Kathryn M. 0 Halloran
before me personally appeared .. ......................... and .................,.....................
reapcctively Mayor and City Clerk of the City of Sebastian, u municipal corporation under the laws of the State of Florida to me known
to be the IndN•idwds and officers described !n and who executed tho foregoing coaveyunce to
Helen ,George ................................................................ .
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, arrd severally acknowledged fire execution thereof to be their free act and deed
as such officers thereunto duly authorized; and that the Officixl seal of said corporation Is duly affixed thereto, and the said conveyance
is the net and deed of said corporation. ^ ~~
WITNESS my signature and official seal st Sebastlen, in the
last aforesaid. ~=
LINDA M. GALLEY ~
MY COMMISSION A CC 7 78 '
EXPIRES: June i8, 2002 °tary
Bonded Thru Nntery Publk Underwdlen My CD[
of Florida, the day end yea-
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Date of Burial ` 'tee ~ °~ ~ ~`" ~'` Time .,,~
Name of Funeral Home
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FLORIDA DEPARTMENT OF
HEALT
~.
I . Name of
Deceased
State of Florida, Department of Health, Vital Statistics
APPLICATION FOR BURIAL -TRANSIT PERMIT i~
,~
First Middle Last Date Month
Helen Elizabeth George
STORAGE
?. Place of Death City, Town or Location Name of (If neither, give street address)
county grevard Barefoot Bay Hosp. or 978 Waterway Drive
Inst.
I. Name of Medical Address Phone Number
Certifier James W. Neel, M.D. 200 East Sheridan Road
Medica- Examiner Physician Melbourne, Florida 32901 321-725-4500
Name of Funeral Home/Direet-Bispvsal Address Fla. Lic. No./8ecd-Pio. Phone No. (Area Code)
Establishment 1623 N . Central Avenue
Strunk Funeral Home Sebastian, Florida 32958 1228 772-589-1000
Check a. ~ The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b. ~ Sandy was contacted on 12/29/03
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that Dr. Neel 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
media certification of ca of death within 72 hours.
Funeral Director/ ~ ature ~ 1 F.E. No./Reg. No. Date Signed
BURIAL -TRANSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 122$-03-533
~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.
No extension of time for filing the death certificate has been requested.
Registrn-vt~ .... Date Date Certificate
Subregistrar Signature ~„ ~~-tC Issued: 12-27-03 Due:
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.
ethod of Disposition:
BURIAL
CREMATION
Signature of Sexton 1
or er on-in-Charge !r
CEMETERY OR CREMATORY Sebastian Cemeter
Place of Disposition y
of
Death
Year
December 26, 2003
Date of Disposition December 31, 2003
OTHER (Specify)
pis 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
Ihin 70 days to the local County Health Department in the county where disposition occurred.
Distribution: White: Cemetery or Crematory
326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer
Eck Number: 5740-000-0326-2) Pink: Local Registrar