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Home My WebLink About4-27-05Tiiu of #Phastiau *Trutrt t ' Uerb NO. 1st December 97 THIS INDENTURE MADE Tilde ...................... day of ............... ............................... A. D., 19......, between the City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and Susan Clancy ....... I ............................ . .... .342 - Faith* Terrace.............................. ............................... Sebastian, FL 32958 ................................. . ........... .. ...................... . ................... .... . ........... I........................... of the County of ...... Indian. River ..................... an 1 State or Florida ........................ ............................... is Grantee, WITNESSETHs That the Grantor for and in consideration of the sum of $ ............ 500 ......... , 5OO :OO .. , , , 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 GranteJ!?e . , .. , , heirs, legal representatives and assigns the following property situated In Sebastian, Indian River County, Florida, to -wit: All of Lolls) . 5, .... , Block, .. 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 be used, kept and maintained at all times In accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of add 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 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 year first above written. CITY OF SEBASTIAN, FLORIDA Attes s . ....... !.:!. ... By .......... City Clerk Mayor Signed, Scaled and Delivered In rise Bence ofs �... ................ S ATE OF FLORIDA COUNTY OF INDIAN RIVER I HEREBY CERTIFY, That on this7l5t .................... day of December...... .............................., before me personally appeared Walter W. Barnes and Kathryn M. O Halloran ................. ............................... ....................... respectively Mayor and City Clerk of the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the Individuals and officers described in and who executed the foregoing conveyance to .............: 3n�y.................................................................. Susan C and severally acknowledged the execution thereof to be their free act and deed as such officers thereunto duly authorised; and that the Official seal of said corporation Is duly of thereto, and the said conveyance is the net and deed of said corporation. WITNESS my signature and official seal at Sebastian, in the my of nd i RI r d State of Flo a, the day and year last aforesaid. : LINDA M. 4 k Zl 7 a � a• �",`= tT' (;!,44!f':SSIilh i . � 375T21 drra:::e'!ia.aw & yPuWtJkaI#r Notary Public, Sts f Florida at Larg . IMS -- My co at pare s Lind M. Galley Name /4� Unit_ by Block c Lot ::;1'� Date of Mark -out �� Date of Burial Time w Name of Funeral ,Home -' \ -�� I� Authorized by +*'! ^ n 0 IJ D Paid by CEMETERY Receipt No. , 965 ............... Dated ............ . 500 . 00 ................. NO. List Price $ .. Maximum No. Burial Spaces .. Net Paid $ 500.00 .. • . .. . . Monument permitted ....................... (Data above this line for City Record only) FWRWA D1PART&fl r 1HEAL4 State of Flo ' a, Department of Health, Vital Statistics 13 � 7 APP LICV FOR BURIAL — TRANSIT PERMIT A. (Type or Print) 1. Name of First Middle Last DATE Month Day Year Deceased OF Thomas Clancy DEATH Oct. 13 1997 2. Place of Death County Hillsborouqh 3. Name of Medical Certifier Rohit Patel, M. D. 4. Name of Funeral Home/ Direct Disposer 5. Check Appro- priate Box ral Home a ❑ City, Town or Location Tam Medical Examiner Name of (If neither, give street address) Hosp. or Inst. Universi Community Hospital Aaoress Phone Number Physician 114081 N. 56th Street, Tampa, FI 813 - 989 -3400 Address Fla. Lic. No. /Reg. No. Phone Number (Area Code) 1623 N. Central Avenue Sebastian, FI 1228 The medical certification has been completed and signed. A completed this application. 561 - 589 -1000 of death accompanies b ® Barbara was contacted on 10/14/97 within 72 hours after death. He /she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Patel will complete and sign the medical certification of cause of death. C ❑ medical certification. was contacted on . He /she verified that , Medical Examiner, will complete and sign the 6. Place of Sebastian Cemetery In stat emetery/ Removal Final Disposition: cre toy - name /cou ndian River from state Donation 7. Funeral Director/ �S' nat F.E. No. /Reg. No. Date Signed Di�iepeeer c 62 10/14/97 B. BURIAL — TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228 -97 -0425 ❑ A five day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted as undue hardship would result from filing within the normal time limit. If the certificate cannot be filed within this extended time limit, a "Funeral Director /Direct Disposer Report" will be filed with the Local Registrar of the County in which death occurred. ❑ No extension of time for filin_ the death certificate requested. 'or Date Date Certificate Subregistrar Signature A.. 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 after death is required for all cremations. D. CEMETERY OR CREMATORY Methods of Disposition: Place of Disposition _;& "L. , ( "per-+ .a � _ 5Q BURIAL ❑ STORAGE Date of Disposition CL G,_� I P.. I ❑ CREMATION ❑ OTHER (Specify) Signature of Sexton ) or Person -in- Charge) This permit must be endorsed by the Section 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. DH 326. 10196 (Replaces HRS Form 326 which may be used) (Stock Number: 5740- 000 - 0326 -2) • • 91'5 THE SEBASTIAN CEMETERY CITY OF SEBASTIAN, FLORIDA OF THE SUM OF: u FROM: on thi ', day following described conditions as stated Description of Property: Cemetery Purchase Price Terms and Condition of sale: Dollars � for the purchase of the upon the terms and Bloc1 _ Unit Dollars This contract shall be� binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described. I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: The City of Sebastian agrees to sell the above m ed property to r the above named purchaser(s) on e terms end gr�diti s stated in the above instrument. t r /� /� / / i City f !!Yar Witness . . . • - 9St City of Sebastian 1225 MAIN STREET 13 SEBASTIAN, FLORIDA 32958 TELEPHONE (561) 589 -5330 o FAX (561) 589 -5570 December 1, 1997 Susan Clancy 342 Faith Terr Sebastian, FL 32958 Dear Ms. Clancy: Enclosed is Cemetery Deed No. 1609 for Lot 5, Block 27, Unit 4. Also enclosed is a form - Return for Transfers of Interest in Real Property - which must be filled out by you and completed by the office of the Clerk of the Circuit Court when and if you have the deed recorded. If you wish to have this deed recorded, you may do so at the office of the Clerk of the Circuit Court, P. 0. Box 1028, Vero Beach, Florida 32960. We are enclosing two copies of Receipt No. 965 and ask that you sign and return to us the copy marked with an "X" and retain the other copy for your records. A stamped, self - addressed envelope is provided for your convenience. Sincere Kathryn M. O'Halloran, CMC /AAE City Clerk KOH:lmg Enclosures