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Home My WebLink About2-37-14Paid by CEMETERY Receipt No... ~ .........Dated .. Mai 1 3 : 19 8 5 .. • NO. List Price i 4 5 0: 00.......... Maximum No. P-uiai Spaces ...? ............ . 450.00 - FLAT - Net Paid S .................. Monument permitted ...................... . CAROL JUNE ADKINS (Data wtwre thL line !or Gty Reebrd ody) 1' • 0 . BOX 4 5 FELLSMERE, FL 32948 f~i#~ of ~rbtt,~#~~n (~rut~e#~r~ ~rp~ NO. lo~~ TH18 INDENTURE ld[ADE TW ...13th ............. day of .......Mai.................................. A. D., 1Y8.5...s tatN~een the City of Sebaatlaa, a municipal corporation a:lstins under the lawn of the State of Florida, as Ciraator and CAROL JUNE ADKINS ....................................................................................................................................... P.0. BOX 45 ....... . ........... .... ....... .k'E.~Z.SM~'R~'... FL.....329.4~ ......................... ........................................... . of the County of ... ~NP.I~, R.j,V~'1~ . ....................... and State of .... FLORIDA........................................ u Orantal. WITN8S8>tTNt That tho Grantor for and in consideration of the sum of S 4 5 0:00 .. , , , , to it in hand paid, the rooeipt whereof le horowith ao- knowledged, does by this inatrutnont grant, bargain, sell, release, convey and oonfum unto the Grantee ..her ... hairs, legal represontativw and aaaigns the fpibwing proporty fituated !n Sobattian, Indian RNer County, Florida, to-wit: All of Lot(s) ,13614 ~ g~~~ , , ,37, . , ~ UNiT ... ~ . , ...... , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded !n Plat Book 2, at page 65 of the public rocords in the office of the Cbrk 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 forover; provided that said property shall be uaod solely and oxcluaivoly for rho Interment of tho human dad and ahaU be used, kopt and maintainod at all timos in accordance with the rules and regulations, ordinances and reaolutiona of tho City of Sebastian, Florida, heroto- fore, now and hnraafter adoptod qr provided for the government and operation of said cerr-eiery. The conditions, reattictiona and roquiromonta contained in this inatrurnont shall bo covenants tunnir-g with the land. In the event of the failure of the owner of any property situated within raid cemetery to ob- serve and comply with such rubs, regulations, roaolutions and ordinances and the conditions of the do'ed of conveyance thereof then the title of such owner in and to said property shall terminate and the same shall rover[ 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 Beal to be hereto afFixed, the day and year first above written. CITY OF SEBASTIAN, FI..ORIDA CIt~.Clerk ~%~~ ice Irlyor l3lgnrd, Sealed and Detlveied !n the~resence ofl }, !Q-n~~,-... . its. .... ~~c,?'.~`:°c.'r~......... (~~t~ ~s:<J) STATE OF FI.oRIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That oa thL ..... 1 3 ch .............d.y o! .. • • .. • • • ...rl a y..................................., io. 8 5 .. before uu; personally appeared .... L : .GENE. HARRI .S ... . . . .......................... and DeboraPi C ; Krages ... , . , ..... , . respectively Atsyor end City Clerk of the Clty of Sebastian, a municipal corporation under the laws of the State of Florida to me know~a to br the individuals and otflcers described 1a and who executed the loregoing coaveyance to CAROL JUNE ADKINS ....................................................................................................................................... .~` .- ...........::`..,.......,................................ and sererally acknowledged the ezecutlon thereof to be their tree act and deed as such otficaLs tlsereunto duly yuthorlaedt and that the Official seal of acid corporation la duly •ftlxed thereto, rod the wld conreyance !s the act' Wad. dercd ot: aold,oorDgration. WtTNE3S my aigaature and oftklal seal at Sebutlan, In the County of Indian Rlrer sad State of Florida, the day and year last afoea~ald. Notary Public, fate q~ ~'lor~4,at Ny cvoarsrlaalert esplra'Potary u c, a of Florida My Commission Fxpues Auq. 22, 19$8 b+d+d rhw rror ~+~a - I++unga, Iw STATE OF FLORIDA .PARTMENT OF HEALTH & REHABILIT~E SERVICES VITAL STATISTICS APPLICATION FOR BURIAL-TRANSIT PERMIT A. (Type or Print) ~.~y /337 ~~ 1. Name of First Middle Last DATE Month Day Year Deceased O F Carol June Adkins DEATH May 7, 1985 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Brevard Melbourne Inst. Holmes Regional Medical Center 3. Narne of Medical ~~hysician Address Certifier TYromas Hoffman, M.D. ^Medical Examiner 1317 Oak St. Melbourne, Fla. 32901 4. Funeral Home/ Name Address 63ic~x~~c+xPotting er & Son Funeral Horne 1200 S. Indian River Dr. Sebastian Florida 32958 5, Check a ~ The medical certification has been completed and signed. A completed certificate of death accompanies Appro- this application. priate b ~ was contacted on . He/she verified that Box this death was from natural causes, that there was no accident nor other external cause of death, and that will corrrplete and sign the medical certification of cause of death. c ~ was contacted on . He/she verified that Medical Examiner, will complete and sign the mecEi c of tigst,,... ~~ 2368 May 8, 1985 Z~/ ~ - 6. Funeral Director/ Fla. Lic. No./Reg. No. Date Siyned gnature /~ x6~nr~e~i~dR~~ f~ B. (~,p~ BURIAL-TRANSIT PERMIT •7~~ _ 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. If it cannot be filed within this time limit, a "Fwieral Director/Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. r or Reyistr ~-- Date Q _r- ~ ~ ~~ ~0~ ~ `~~ ~D ~ ~ ~ " ' ~ g g SutrRe Istrar Si nature ~ -f~y~~i~~=~ ~ -r'"` - i L 1 o. ' ' 7 L!t~ 2 ~i,~ , Issued , C. AUTHORIZATION for CREMATION, DISSECTION or BURIAL-AT-SEA Signature ,Medical Examiner Date ar 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 after death is required for all cremations. D. CEMETERY OR CREMATORY Method pf Disposition: BURIAL ~ STORAGE CREMATION ~ OTHER (Specif Signature of Sexton 1 / > ~~1,/~ or Person-in-Charge )_ ~~~~~--~~ / ~' i^'~-w Deborah C. Kraqes, City C Place of Disposition Sebastian Cemetery Date of Disposition May 10, 1985 k 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. HRS Form 326, APR. 81 (replaces previous editions which may be used.)