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Home My WebLink About1-41-29w ,Y•u -pl-p yy s sl �s 17 $ �a 1 hV 4� ^\ u I Al R r Iv Z N. t 0 Lu rn 3t 3=-i io yy s sl �s 17 $ �a hV 4� ^\ u I Al R r Iv Z N. Li Y Lu rn 3t 3=-i JPaid by CEMETERY Receipt No .... 4............. Dated .....F'.1 24.18 . 5 ................. NO. 300.0 {� List Price $ ...........0 ....... Maximum No. Puriul Spaces... -2 .... ........... Net Paid S ...300; 00 ....... Monument permitted . , ,F1 at ............. . Robert L. Brown Lots 28 & 29, Block 41, Unit 1 Addition 14395 80th Ave. (Data above this line for City Record only) Sebastian, Fl. 32958 Ti#u of #rbtttsxiatt � r11trterg Derb NO. 1658 THIS INDENTURE MADE Tide ....... ,24 ttt ........ day of .......August ............................. A. D., 19A5... between the City of Sebastian. a municipal corporation existing under the laws of the State of Florida, a Grantor and Robert L. Brown ........................................................................................................ ...................I........... 14395 80th Ave. .............. Sebastian. %.? ?.....32y 8 .................. I......................... ............. ............................... of the County of ...... Indian Rivez t''1c >rida ........ ............................... aa1 State of ...... .. ........ ............................... as Grantee, WITNESSETHt That the Grantor for and in consideration of the sum of $ ... , 30Q . OQ,., , , , , , , , , , , , , to it in hand paid, the receipt whereof is herewith ac- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee , H is.... heirs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: All of Lot(s) 9 , Block, , . 41 .. , , UNIT A. Ad d i t ion, 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. Lurie 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 all times in accordance with the rules and regulations, ordinances and resolution& of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted 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 doed of conveyance thereof then the title of such owner in and to said property shall terminate and the same &hail 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 first above written. Atteti...i..�rr`e: • ��lr✓. t'. V... 1�_.......��t" sC . ...... . City Clerk Signed, Sepled and Delivered n the Pre _6 oft .. ... off...... STATE OF FLORIDA Y,�.YVr1T'V fin T1iTY � 1 CITY OF SEBASTIAN, FLORIDA By..... ...... f ..: ��... .... r i►oFay�r�, .. IT - -3, 0 I -A `i 1 mol Daft -of Ma*-, Date of &afW Name at Fum Aiffimfteed tW A - REPORT OF DEATH (To be core NAMEOF DECEASED 4 14 0— - First t Middle COUNTY OFDEATH 11�1�-- COUNTY HEALTH RTMENT TION OF DEATH - BURIAL TR f PERMIT Piet ed b� facility where death occurred) DATE OF �y � :35-Am- DEATH _ / — / TIME '7 PM r "' Last CITY (local) (Please check) ' / OF DEATH l i L- t LZ Y AGE tGr SEX F-7 RACE r PLACE OF DEATH r "� �' t + Ina /el �t (Give street address if not facilit s ch as hospital, nursing home, etc.) Se- yl j , y'' i#G l A Name of � Medical Certifier ��e --`� ��4/h � Address i Phone TioC -- (Official certifier of cause of death) B - RELEASE (To be completed by person having authority to release remains) IS HEREBY representative of TO RELEASE THE REMAINS OF THE ABOVE NAMED TO: (State) remains) (Name of next of kin or legal representative authorizing release) C - BURIAL - TRANSIT PERMIT (To be completed by funeral director or representative) I, REPRESENTING .y�ir °(AJ 1 (' _ f yt ' Y � ; 2 -' (Dame of funeral home) (City) (Phone) HEREBY ACCEPT THE REMAINS OF THE THE TIME LIMIT`ESrABLISHED B1r1,Akir director or NAMED AND AGREE TO SECURE AND FILE A COMPLETE CERTIFICATE OF DEATH WITHIN (Printed Name of Indiana Licensed Funeral Director) (Indiana Funeral Director License No.) A CERTIFICATE OF DEATH HAVING BEEN FILED OR A PROVISIONAL NOTIFICATION OF DEATH RECEIVED AS REQUIRED BY LAW, PERMISSION IS HEREBY GIVEN FOR TRANSPORTATION AND DISPOSITION OF THE REMAINS — EXCEPT FOR CREMATION WHICH REQUIRES A COMPLETED CERTIFICATE OF DEATH., LOCAL NUMBER FILE DATE (HEALTH OFFICE I E) D - RESIDENCE (To be completed by funeral director) . LAST KNOWN LAST KNOWN ADDRESS OF { ' " COUNTY OF RESIDENCE I�J f f , r DECEASED /; ;''S4 v Ic ," "° / j (Street) (City) (State) (Zip) ADDRESS 2 YRS. PRIOR TO DEATH (If different) (Street) (City) (State) (Zip) (Street) (City) (State) (zip) E - DISPOSITION (To be signed by sexton of cemetery or r esentative of crematory) NAMEOF ,J C M TERY /C"MATORY PLACE OF DISPOSITION (CYO, .r f,unh) {Stater (Zip) METHOD O DISPOSITION (Cl�ck, l 1' A,0y} - - -- Burial Cremation _ Entombment Inumment _ Donation _ Removed from State _ Scattering _ Location of Scattering DATE OF DISPOSITION } t� ` f 3. � t`i'i -7 DATE OF CREMATION �T CREMAINS RETURNED TO FUNERAL DIRECTOR FAMILY_ CEMETERY SIGNATURE OF SEXTON OR CREMATORY REPRESENTATIVE„�� I . White Copy -- Health department's copy. To accompany the body to its disposition. Must be signed by it, sexton of the cemetery or the representative of the crematory, and returned to health dcplhnent in the' county where the death occurred within 2 days after burial or cremation. me be mad Copies p y e for faxing. Confect local health department for out -of- -state shipment. 2. Yellow Copy- Cemetery/Crematory copy for they records. 3. Pink Copy - -To be mail ed by the facility where the death occurred to the local health department within 24 hours following death. Copies of the white form maybe made by the facility for its' records and for faking in lieu of mailing. I SDH 06- 093 -32 NSF 38220 (R/1 -96) A% � I a N � C U = F s c Z W aLL C [OwS g A I. NzV 9 s m m O K m U- C7 O C _0 U N O J LL p '6 E d E E E 0 U) 0 U W V m t m 3 pp O m O t�Ll tfI uO'l Z O Z O O O O O (OO O STRUNK FUNERAL HOMES, P.A. 6241 CASH ADVANCE ACCOUNT - SEBASTIAN 916 17TH ST. VERO BEACH, FL 32960 ^j 63- 120516 la-710-7 PH. 772 -562 -2325 DATE +. 1 aJ Do me, �jl!_�l_ �� L/y\CVIfWI t114t^ E %Qd DOLLARS s I j� 95820th Tam _ -- - —_ — = Vero B-&I, R 32M _j NB. IBd18R RRK �1 'i- cC k cn2) 5899200 w � n •A+� ®i FOR '006 24 LuB 1:0670 L 20 5?l: 0 206 S20111@ O_ c$ o o sj 7 r aw co C?� cv �.i a U/, ,8,e,� y�,a''x"a9